Tell me about your career path and why you chose to go into medicine
Unlike some of my peers, I didn’t always want to be a doctor. My mum was a midwife, which showed me how rewarding the caring profession could be, but most of my family were teachers, so medicine wasn’t an obvious choice for me.
I was always academic, so I was encouraged at school to go into medicine. It turned out to be the perfect profession for me because I like working with people, I like variety, and I like seeing an almost immediate impact of my work, which you get with surgery.
I trained in Cardiff, then moved to London where I joined a research group at Imperial College looking at bowel function, rectal cancer and pouch surgery. I was the first woman in this research group and quickly spotted the areas that were neglected, including pelvic floor research.
The combination of bowel and pelvic floor health is my area of expertise now.
What is LARS and how does it affect the patients you see?
LARS stands for low anterior resection syndrome, which is the collection of bowel problems some people get after rectal cancer surgery. It can also occur after treatment for other cancer types, so it’s not just related to rectal cancer. Symptoms can be debilitating and include faecal incontinence or leakage, needing to poo frequency or urgently, or tenesmus – a constant feeling that you have to poo, but you can’t.
This research area is more important than ever as we know bowel cancer is rising in younger people, so patients expect a good quality of life after surgery because they’re living with the effects of surgery for longer.
In my experience, cancer patients are usually well-prepared for the effects of surgery and for having a stoma, but the closure of stomas doesn’t always happen on time.
Where expectations are sometimes mismatched with reality is after the initial treatment period. Patients recover from having chemotherapy, during which time their bowels are badly affected. Then their treatment finishes but their life doesn’t go back to normal. As you would expect, when people hear they’ve got cancer, their focus is on that and the immediate treatment, not how it will affect the rest of their lives.
It’s important we raise awareness of the effects of treatment, including LARS, and make it easier to talk about. It’s common but not normal, so it’s important to seek the help that’s out there. And as clinicians, we need to continue to educate ourselves and be better joined up to more readily offer this support – as cancer services become more separate from non-cancer services, it becomes harder to spot and treat these issues.
How much do we know about LARS? What still needs to be discovered?
We know there are different reasons why LARS happens, but we don’t know why some patients get it and others don’t, or why it affects people in different ways.
We also don’t know exactly how many people have LARS. Current estimates show 75% develop symptoms within a year, and around 40% of those will still have major LARS after 12 months. But people adapt to life after chemotherapy and accept LARS symptoms as their new normal, so it goes underreported as patients don’t always flag it as a problem.
Frustratingly, patients are not asked about LARS symptoms as part of the standard questions that form follow up for cancer treatment. The POLARiS trial aims to change this and to make it standard practice for the centres involved, but it’s still a challenge to define what normal bowel function is, which makes these questions tricky to interpret even when they are mandatory.
Tell me about the POLARIS trial and how funding from Bowel Research UK has helped
Our aim is to find out how useful the treatments for LARS are and whether there is a better way to treat patients with bowel cancer to protect bowel function. The POLARiS study recruited patients from 4 centres in the UK.
The study, funded by Bowel Research UK, was a pilot trial. Pilot trials allow us to prove that studies like this are possible. We were able to recruit 156 patients onto our trial, and the results enabled us to secure funding for a bigger trial that we hope will change the way LARS patients are treated.
Not only did this funding allow us to secure further funding for a larger trial, it also allowed us to work with an international group to develop a new LARS score. We are still working with the international research community involved to validate the new score which we hope will allow us to tell whether treatments have led to a meaningful improvement in their LARS symptoms over time.
We set up LARS workshops, educating whole teams at our trial centres. We also identified gaps in support, for example in some hospitals it is difficult for men to access to pelvic floor physiotherapy as typically the service would sit in women’s health departments.
What message do you have for supporters who donate to Bowel Research UK?
Thank you! Without your support, topics that are harder to understand or more taboo can be overlooked by funders. Our Bowel Research UK grant has been crucial in securing funding for a larger trial that’s going to have a huge impact, not just in cancer but bowel disease more generally.