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  • Glioblastoma (GBM) is an aggressive, challenging to treat, and not fully understood form of brain cancer that currently has no cure
  • Each year ~10,000 Americans and ~2,200 UK older citizens are diagnosed with the disease
  • The standard of care is surgery followed by radiation and chemotherapy
  • Prognosis is poor with median survival of ~15 months with treatment and ~3-4 months without treatment
  • Researchers and medical institutions throughout the world as well as multinational pharmaceutical companies, giant MedTechs and biotech start-ups are exploring novel therapies for the disease
  • The US leads the world in investment in biomedical research carried out in universities and research institutions, but China is catching up
  • Promising research avenues include immunotherapy, targeted therapies, gene therapy, nanotechnology, and tumour-treating fields but the current success of multiple clinical trials is not good
  • Diversified MedTechs might be reluctant to fund research and development (R&D) in GBM due to its complexities, rarity and smaller patient population
  • As GBM is a public health concern governments might consider increasing their investments and coordination of medical research to find efficacious therapies for the disorder
  • Agile smaller MedTechs and biotech start-ups with streamlined processes have a presence in GBM R&D, which might be due to the condition’s unique challenges and market dynamics
 
Beyond the Battle: Illuminating Glioblastoma
Unmasking its challenges and promising horizons

 
"In the battle against glioblastoma, a relentless and unforgiving adversary, we confront the fragility of our own existence, and the limits of our medical prowess. It is a disease that embodies the epitome of human suffering, where hope and despair dance an eternal waltz, and where the line between life and death blurs into an unsettling haze of uncertainty." Henry Marsh, Do No Harm
 
This Commentary explores the ever-evolving realm of glioblastoma (GBM) research and suggests that something promising is underway, which needs more support. As the landscape of research and development (R&D) takes shape, a compelling phenomenon emerges: the rising tide of university-based researchers and agile biotech start-ups daring to tackle the unique challenges of this brain cancer. With determination, they delve into niche areas, embarking on ground-breaking endeavours, fueled by scientific curiosity, patient advocacy, and the pursuit of disruptive innovation. Small companies’ streamlined decision-making processes and unwavering focus on GBM research give them a competitive edge, which they share with global pharmaceutical companies, while diversified MedTechs hesitate in the face of the relative rarity and complexities of the disease. GBM’s challenges, which extend from its elusive location to its resistance to conventional treatments pose substantial obstacles that require unconventional approaches. As the stakes rise, smaller MedTechs and start-ups, often fueled by innovative scientific breakthroughs from universities and supported by government research grants, prove their mettle, undeterred by failure or setbacks. Glioblastoma therapies appear to be a world where the underdogs rise, and cutting-edge treatments hold the key to rewriting the fate of the disease.

 
In this Commentary

This Commentary is in two parts. Part 1 entitled Glioblastoma: Advances and Challenges in Treatment provides an overview of glioblastoma, covering its characteristics, incidence, and standard treatment approaches. It delves into the global efforts of researchers who are exploring novel therapies for GBM, instilling a renewed sense of hope in the battle against this disease. The Commentary describes key innovative treatments such as immunotherapy, targeted therapies, gene therapy, nanotechnology, and tumor-treating fields, and briefly discusses the companies actively pursuing these therapies, highlighting that the current success of multiple clinical trials is lacking. Part 2, entitled Glioblastoma Research: Government Support and the Rise of Innovative Players, acknowledges the research conducted in universities and medical institutions worldwide. American universities and research institutes are particularly well-positioned due to the US’s leadership in biomedical research investment, although China is rapidly catching up. The Commentary suggests that governments should increase their support for novel therapies to treat glioblastoma, as relying solely on private entities to fund research for such a rare and complex disease seems unreasonable. We highlight the Chinese government's commitment to supporting biomedical research and addressing rare diseases like glioblastoma and draw attention to Parag Khanna’s thesis in Technocracy in America, suggesting Chinese state capitalism may have advantages over Western liberal democracies in developing high tech medical technologies. The Commentary ends by noting the significant presence of smaller companies in this field. Many that take risks in pursuing innovative solutions have streamlined decision-making processes and are driven by scientific curiosity, patient advocacy, and potentially disruptive innovation, which gives them a competitive edge.
 

Part 1
 
Glioblastoma: Advances and Challenges in Treatment

Glioblastoma (GMB) is an aggressive, common, and malignant form of brain cancer in adults, which is challenging to treat because the tumour is interconnected with healthy tissue, making it almost impossible to excise completely. Also, radiation has the potential to damage peripheral healthy tissue, and the brain’s natural barrier to chemotherapeutics makes GBM one of the most difficult and deadly diseases to deal with.
 

What are gliomas? - Mr Ranjeev Bhangoo
 
Your brain is made up of various types of cells, and GBM specifically affects glial cells, which have supportive roles, such as providing nourishment and protection to the neurons, which are the main cells responsible for transmitting signals in your brain. Glioblastoma develops when there is an abnormal growth of glial cells. However, its exact cause is not fully understood, but researchers believe that it may be influenced by a combination of genetic factors and environmental exposures. When someone is diagnosed with GBM, it means they have a tumour that typically starts in the brain but can spread to other parts of the central nervous system (CNS). The tumour grows rapidly, often infiltrating nearby healthy brain tissue, which makes it difficult to remove entirely through surgery. Because of its invasive nature, GBM can cause various symptoms depending on its location, including headaches, seizures, cognitive changes, weakness, and difficulties with speech or vision.
 
Incidence

Glioblastoma is relatively rare compared to other cancers and its global incidence rates vary by region. The disease is more common in older adults. While there have been no significant changes in its incidence over time, ongoing research aims to better understand the factors that influence its occurrence. The condition accounts for ~15% of all primary brain tumours and its annual incidence ranges from 0.59 to 3.69 cases per 100,000 people, and these numbers may vary based on factors such as age, genetics, and environmental factors. Each year, ~10,000 individuals in the US will present with the disease, and ~2,200 cases will be diagnosed in England. Advances in diagnostic techniques and increased awareness of the disease may have contributed to improved identification and reporting of cases. Age is a significant factor, with the highest incidence rates occurring in older adults; with the peak observed between 65 and 75, while being relatively uncommon in children and young adults. Researchers continue to study potential risk factors and factors that may influence its occurrence, but because the condition is complex and challenging to study, its causes and risks are still not fully understood. Notwithstanding, some factors that have been associated with GBM include, exposure to ionizing radiation, certain genetic syndromes, and a family history of glioblastoma, but most cases occur without any identifiable risk factors.
 
Standard of care

Treating glioblastoma is challenging because currently there are no curative therapies for the condition and treatment has remained almost unchanged for >20 years. The standard of care involves surgery, which aims to remove as much of the tumour as possible without causing damage to healthy brain tissue. However, due to the tumour's invasive nature, complete removal is rare. Thus, following surgery, the patient undergoes a combination of temozolomide, a type of chemotherapy medication that can enter the brain through the blood-brain barrier, and radiation therapy, followed by additional temozolomide treatment for six months. The effectiveness of these therapies is limited by high rates of tumour recurrence, treatment-related toxicity, emerging resistance to therapy and ongoing neurological deterioration. GBM has some of the worse outcomes of any cancer: a survival rate of ~15 months after diagnosis makes it a crucial public health issue. Only ~25% of patients survive more than one year, and only ~5% survive >5 years. Despite the first recorded reports of gliomas in British scientific reportswere in the early 19th century and the first histomorphology was made in 1865, there only have been four drugs and one device approved by the FDA for the condition. Given the disease's poor survival rate with currently approved treatments, new therapeutic strategies for GBM are urgently needed. 
 
Novel therapies

Various researchers, medical institutions, multinational pharmaceutical companies, giant MedTechs and biotech start-ups are exploring novel therapies for GBM, offering renewed hope in the battle against this devastating disease. Promising avenues have emerged and are chronicled here. Part 1 of this Commentary describes the current landscape of these therapies while acknowledging encountered challenges and failures. Despite setbacks in clinical trials, the unwavering commitment to combatting the disease and improving patient outcomes remains evident. Researchers throughout the world strive to unlock the full potential of these therapies, building upon successes and providing new hope for GBM patients, but this could benefit from more centralized support and coordination, which is addressed in Part 2.

Immunotherapy
Immunotherapy utilizes the body’s immune system to treat diseases, including cancer. By stimulating or enhancing the immune response, it strengthens the immune system’s ability to recognise and destroy harmful substances like viruses, bacteria, and cancer cells. For GBM, immunotherapy offers a promising alternative to traditional treatments.
 
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Immune checkpoint inhibitors (ICI) block checkpoints exploited by cancer cells, enabling the immune system to target cancer cells more effectively. Adoptive cell therapy modifies a patient’s own immune cells to specifically attack cancer cells. Immunotherapy for GBM is significant as it potentially improves patient outcomes, increases survival rates, minimizes damage to healthy tissues, and has shown promise in cases where other treatments have failed.
Companies conducting immunotherapy R&D
Ongoing clinical studies are actively assessing the effectiveness of immunotherapy in combating GBM. Global pharmaceutical companies such as Merck & Co. and Bristol Myers Squibb, are at the forefront of R&D efforts pioneering immunotherapies for the disease. Additionally, Roche has made investments in novel therapies for GBM and is actively involved in clinical trials evaluating the efficacy of their treatments. Bristol Myers Squibb’s clinical studies investigate the potential of immune checkpoint inhibitors (ICI), which as we explained, is a type of therapy that unleashes the immune system’s full potential by removing the brakes that hinder its ability to identify and eliminate cancer cells effectively. While ICI therapies have achieved substantial success in the broader field of oncology, their impact on GBM has been modest thus far.

Celldex Therapeutics, a clinical stage biotech based in New Jersey, US, is also committed to the development of immunotherapies for glioblastoma. Their research is focussed on innovative therapeutic vaccines and antibody-based treatments that stimulate the immune system’s response against glioblastoma cells. Despite the considerable R&D efforts dedicated to immunotherapy, its efficacy so far in GBM remains limited due to the complex challenges posed by the blood-brain barrier, incomplete understanding of the neuroimmune system, and the multifaceted immunosuppression that accompanies the disease. However, recent advances in treatment strategies offer renewed promise by combining immunotherapy with other complementary approaches.
 

Targeted therapies
Targeted therapies are a specialized form of treatment that focuses on specific molecules or pathways crucial for the growth and survival of cancer cells. Unlike conventional treatments like chemotherapy and radiation, which can harm healthy cells along with cancerous ones, targeted therapies aim to attack cancer cells while minimizing damage to healthy tissues. In the case of GBM, targeted therapies hold promise as they identify specific abnormalities or mutations driving the growth and survival of cancer cells. These abnormalities can be unique to cancer cells or occur more frequently in them compared to normal cells. Targeted therapies are designed to interfere with these specific abnormalities or mutations in various ways. Some treatments block or inhibit proteins or pathways that are overactive or abnormal in cancer cells, aiming to halt their growth, induce cell death, or hinder their ability to spread.
 

What are targeted therapies? - Dr. Whitfield Growdon
 
For instance, tyrosine kinase inhibitors, a group of drugs used in GBM, work by blocking the activity of tyrosine kinases - proteins involved in signaling pathways that promote cancer cell growth. By inhibiting these, the drugs slow down cancer cell growth and potentially shrink tumours. Another targeted therapy approach under investigation for GBM is angiogenesis inhibitors. Glioblastoma tumours, like all tumours, rely on a blood supply to grow and can stimulate the formation of new blood vessels (angio genesis) to sustain their growth. Angiogenesis inhibitors disrupt this process by targeting the molecules involved in blood vessel formation, depriving the tumour of essential nutrients and oxygen.
 
Targeted therapies are not universally effective, as their success depends on the specific abnormalities present in cancer cells and individual patient characteristics. Ongoing research and clinical trials focus on identifying the most effective targeted therapies and optimal ways to employ them in GBM and other cancer treatments. To enhance the effectiveness of targeted therapy for the condition, several strategies are being explored. These include utilizing nanoparticlesand monoclonal antibodies to transport anticancer drugs directly to the tumour, overcoming the brain's protective barriers. Additionally, introducing genetically modified bacteria into the tumour after surgical removal aims to selectively destroy cancer cells while sparing normal brain tissue. Also, tailoring treatments to individual patients and testing them through clinical trials are crucial steps in maximizing the potential of targeted therapies for GBM and other cancers.


Companies conducting targeted therapy R&D
Several prominent companies, such as Roche and Novartis, are engaged in R&D efforts for targeted therapies in GBM. Bristol Myers Squibb and  AbbVie also have ongoing projects focused on targeted therapies for the disease. In January 2023, Cantex Therapeuticsazeliragon, a targeted therapy developed for glioblastoma, received orphan drug designation from the FDA and commenced a phase II clinical trial. Cantex licensed the drug from vTv Therapeutics, a clinical-stage biotech, which intended the therapy to be for Alzheimer patients. Azeliragon, administered as a once-daily pill has excellent tolerability, and works by blocking the RAGE receptor involved in a specific biological process. By preventing certain substances from interacting with this receptor, the drug has the potential to enhance the effectiveness of GBM treatment. Despite progress in targeted therapy research, multiple phase III clinical studies have failed. This starkly highlights the gap between the urgent need for effective therapies, the expanding scientific understanding of the disease, and the lack of translation into novel treatments. This discrepancy can be attributed to various factors, including the inherent biological and clinical challenges posed by GBM, as previously mentioned.
 
A different type of targeted therapy for difficult to treat brain cancers is being developed by Cognos Therapeutics, a MedTech based in Inglewood, California, US. Its lead offering Sinnais, is a novel implantable drug delivery pump designed to overcome the blood-brain barrier (BBB), which is a significant challenge in modern medicine. Although we have mentioned the BBB several times in this Commentary, let us describe it more fully as it is central to Cognos’s Sinnais offering. The BBB protects the brain from potentially harmful substances in the bloodstream. While it serves a protective function, it also restricts the entry of many drugs, including those developed for brain and other central nervous system (CNS) diseases. Numerous medications have been developed by pharmaceutical companies for brain and CNS diseases but cannot be used or have limited efficacy due to their inability to cross the BBB. Sinnais is Cognos’s proposed solution. When implanted the device delivers therapeutics locally and metronomically (at precise intervals) to the desired area in the brain. By potentially providing patient- and tumour-specific targeted chemotherapeutics directly to the tumour site in microlitre resolutions, the device offers a more targeted and effective treatment option for brain cancers, including GBM. A commercial opportunity for the company is to partner with pharmaceutical companies that have developed drugs for brain cancers and other neurological disorders but cannot deliver them across the BBB. In January 2023, Cognos entered into a business combination agreement with Noctune Acquistion Corp, a special purpose acquisition company (SPAC), in a move to become publicly traded on Nasdaq. The deal is expected to help Cognos expedite its R&D of Sinnais, which has the potential to become the world’s first implantable device for local targeted and metronomic delivery of therapeutics for the treatment of neurological diseases. 

Gene therapy
Gene therapy is a cutting-edge medical approach that aims to treat genetic disorders and certain diseases by targeting and modifying the genes within your cells. Genes are like the instruction manuals that tell your cells how to function properly. When there is a problem with a gene, it can lead to the development of various diseases.
In gene therapy, scientists use specialized techniques to introduce healthy genes into the cells of a person with a genetic disorder or disease. These healthy genes can replace the faulty ones or provide the cells with the necessary instructions to function correctly. The therapy’s goal is to fix the underlying genetic cause of the disease rather than just treating the symptoms.
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Because GBM is known to be aggressive and difficult to treat, gene therapy holds potential for its treatment. One reason is that GBM is believed to be often caused by specific genetic mutations that lead to the uncontrolled growth of brain cells. Gene therapy can target these mutations directly and correct them by introducing healthy genes or inhibiting the effects of the faulty ones. Another advantage is that it can deliver therapeutic genes directly to the tumour site in the brain. This may be achieved by using viral vectors or other delivery systems, with the capability to cross the blood-brain barrier. By doing so, gene therapy can precisely target cancer cells while minimizing damage to healthy brain tissue. The therapy has the potential to enhance the immune system's ability to recognize and attack cancer cells by modifying immune cells or by introducing genes that boost the immune response against the tumour. Gene therapy for GBM is still in its infancy but holds potential for treating the disorder by directly targeting the genetic abnormalities responsible for the tumour's growth. Its ability to deliver therapeutic genes precisely and enhance the immune response against cancer cells makes it a significant avenue to pursue for future treatment options.

Companies conducting gene therapy R&D
Several pharmaceutical and MedTech companies are actively engaged in gene therapy R&D programmes to treat glioblastoma. Novartis is currently conducting ongoing clinical trials, which involve the utilization of modified viruses to deliver therapeutic genes. Genprex, a small clinical-stage biotech traded on Nasdaq and based in Austin, Texas, is developing gene therapies for cancer, including GBM. One of their notable products is GPX1, that employs a non-viral nanoparticle delivery system to introduce a therapeutic gene into tumour cells, inhibiting their growth. Genprex has achieved some early success with advanced non-small cell lung cancer (NSCLC).  Mustang Bio, another clinical-stage biotech specializing in gene therapy R&D is focused on developing CAR-T cell therapies. This involves modifying a patient's own immune cells to recognize and selectively attack cancer cells. In May 2019, the company obtained Orphan Drug status from the FDA for an oncolytic virus, licensed from the Nationwide Children’s Hospital, which effectively kills cancer cells and is used in the treatment of GBM.

In April 2019, the FDA granted Ziopharm Oncology Fast Track Designation for its treatment, Ad-RTS-hIL-12 plus veledimex, which targets GBM. The therapy involves delivering a gene that produces a protein to stimulate the immune system's response against the tumour. Initial studies produced promising results in a small number of GBM patients. However, following an activist attack by WaterMill Asset Management Corp, Ziopharm underwent a reorganization, appointed a new CEO, abandoned the clinical study, and rebranded itself as Alaunos Therapeutics, relinquishing its GBM asset.

Tocagen, a clinical-stage, gene therapy company based in San Diego, US, is dedicated to developing treatments for cancer, including GBM. The company developed two drugs, Toca 511 and Toca FC, that can cross the blood-brain barrier and target tumour cells. The drugs work together and involve delivering a therapeutic gene into tumour cells and then activating it with an oral medication to selectively kill the cancer cells. In April 2017 the company listed on Nasdaq and later that year, its lead product received FDA Breakthrough Therapy Designation and Priority Medicines (PRIME) designation from the European Medicines Agency for the treatment of high grade gliomas (HGG). However, in September 2019, Tocagen announced that its phase III randomized, multi-centre clinical trial consisting of 380 patients with recurrent HGG failed the primary endpoint of overall survival compared to standard of care treatment. To get so far in the process and not yield significant results for survival is a significant setback. Shares in the company fell ~80%, half of its employees were made redundant, and the company set about restructuring.


Nanotechnology
Nanotechnology involves working with tiny particles (nanoparticles), which are thousands of times smaller than the width of a human hair and can be engineered and manipulated to have special properties and functions. One area the technology is making significant contributions is in the field of medicine, particularly in the development of new therapies for challenging diseases like glioblastoma. Nanotechnology-based therapies for GBM work by utilizing nanoparticles that are designed to specifically target cancer cells in the brain. These can be loaded with drugs or other therapeutic agents to kill or slow down the growth of cancer cells. Scientists design nanoparticles in such a way that they can cross the blood-brain barrier and reach tumour cells more efficiently. Once the particles reach the tumour cells, they release therapeutic agents in a controlled and targeted manner. This precision helps to minimize the damage to healthy brain cells and reduces side effects compared to traditional therapies. Nanoparticles can be engineered to respond to specific signals or conditions within the tumour environment, allowing for even greater precision in drug release. The technology also allows for non-invasive imaging and diagnosis of GBM. Scientists have developed nanoparticles that can be used as contrast agents in imaging techniques such as magnetic resonance imaging (MRI), which can help visualize the tumour and monitor its response to treatment over time. While more R&D is needed, the use of nanotechnology holds promise for improving outcomes and quality of life for patients with GBM and other challenging cancers.
 

Companies conducting nanotechnology R&D
MagForce, a publicly traded German medical device company is among the early developers of novel nanotechnology-based cancer treatments. Its lead offering, the NanoTherm therapy system, is the first and only nanotechnology-based therapy to receive European regulatory approval (CE marking) for the treatment of brain tumours. The system utilizes magnetic nanoparticles to heat and destroy tumour cells. The process involves injecting magnetic iron oxide nanoparticles into the tumour. Then, MagForce’s therapeutic device, the NanoActivator, is used to treat the affected area with an alternating magnetic field, which generates heat, leading to localized tumour cell destruction. The company is now working on a strategy to market its NanoTherm therapy outside Germany aided by a €35m loan from the European Investment Bank under the European Fund for Strategic Investments.

Imunon previously, Celsion Corporation is a New Jersey, US-based clinical-stage oncology-focused company that has been working on a nanoparticle-based multi-modal drug delivery system called ThermoDox®. The system utilizes heat-activated liposomal nanoparticles to deliver chemotherapy drugs directly to tumour sites, including GBM. The nanoparticles release the drug when exposed to focused ultrasound or radiofrequency ablation, which selectively activates the drug within the tumour. In September 2022, Celsion changed its name to Imunon. “With this name change, we are underscoring our commitment to create a new category of medicines. With a strong balance sheet supporting current operations into 2025, we are well positioned to build a differentiated company to deliver the promise of our mission”, said Corinne Le Goff, president, and CEO. In February 2023, the company announced the commencement of patient enrolment of a clinical trial to evaluate a therapy for ovarian cancer, another “difficult to treat cancer”.

BIND Therapeutics was a biotech co-founded in 2007 by Robert Langer, a pioneer of many new technologies and widely regarded for his contributions to biotechnology. BIND engineered a nanomedicine platform developing Accurins®, a novel targeted and programmable class of therapeutics designed to target specific cells or tissues and concentrate a therapeutic payload at the site of disease. In 2013, the company raised a US$70m in an IPO, and had early success with a Phase I clinical trial comprised of 28 patients. The study established the safety and tolerability of BIND-014 in patients with advanced or metastatic solid tumour cancers, and in 2015, its findings were presented at the American Association for Cancer Research (AACR) Annual Meeting. Despite this success, in May 2016 BIND filed for voluntary Chapter 11 of the US bankruptcy code and its assets were acquired by Pfizer for US$40m. The novel therapy continued to be developed but not for GBM; findings of a phase II clinical study comprised of 42 patients with metastatic prostate cancer, was published in the July 2018 edition of JAMA Oncology, and reported the median radiographic progression-free survival to be 9.9 months.


Tumour-Treating Fields
Tumour-Treating Fields (TTFields) is an innovative treatment approach used for certain types of cancer, including GBM. It is a therapy that utilizes electromagnetic fields to disrupt the growth and division of cancer cells and involves the use of a device that generates low intensity alternating electric fields, which are designed to interfere with the process of cell division; a crucial step in the growth and spread of cancer cells. By applying electric fields to the tumour site, TTFields aim to disrupt cancer cells' ability to multiply and form new tumour masses. The significance of the technology for GBM lies in its potential to provide an additional treatment option that can complement existing therapies and can be used in combination with traditional treatments: surgery, radiation therapy and chemotherapy. One of its advantages is that it specifically targets cancer cells while sparing healthy tissues. The electric fields disrupt the division of actively dividing cells, which is a characteristic of cancer. Healthy cells, which typically have a slower rate of division, are less affected. This approach may lead to fewer side effects compared to other treatment modalities. Clinical studies have shown that TTFields can improve overall survival and progression-free survival in patients with glioblastoma when used in combination with standard treatments. The therapy has been approved by regulatory agencies, including the FDA, for the treatment of GBM and is being increasingly integrated into clinical practice.

Companies conducting TTFields R&D
Novocure is a pioneering MedTech oncology company that developed and commercialized the Optune®, a non-invasive portable device, which delivers TTFields therapy and has been approved by the FDA for the treatment of GBM. The company was founded in Haifa, Israel in 2000 by Yoran Palti, (Professor of Physiology and Biophysics at the Technion Israel Institute of Technology in Haifa). NovaCure grew to become a Nasdaq traded corporation with a market value of >US$7bn, >1,300 employees, annual revenues of ~US$0.54bn, and operations in the US, Europe, and Asia.

Palti hypothesized that alternating electric fields in the intermediate frequency range could disrupt cancer cell division and cause cancer cell death. He set up a home laboratory, where he demonstrated that, when applied at tumour cell-specific frequencies (200 kHz for GBM), alternating electric fields disrupt cell division, leading to cancer cell death but sparing healthy cells. The results motivated him to set up Novocure. The company’s second-generation Optune device has design improvements intended to enhance patients’ experience with TTFields treatment. The device consists of a set of adhesive patches or arrays that are placed directly on the patient's scalp over the area where the tumour is located. These are connected to a portable device that generates the electric fields. It weighs ~1.2 kg (~2.7 lbs) and is worn continuously while the patient carries on with their daily activities while receiving treatment.

On 6 June 2023, NovoCure’s shares crashed ~43% after the failure of a clinical trial of Optune on non-small cell lung cancer (NSCLC) patients. The company plans  to file for US Premarket Approval (PMA) for TTFields in treating NSCLC later this year, and expects to announce results from three other late-stage studies of its device targeting other indications by the end of 2024.

QV Bioelectronics is a UK-based start-up founded in 2018 by a biomedical engineer and a neurosurgeon. The company’s lead offering, referred to as GRACE, (Glioma Resection Advanced Cavity Electric field therapy), employs electric field therapy like that of NovoCure, to slow the growth of GBM. Different to NovoCure’s Optune, GRACE is positioned to be implanted into patients already undergoing surgery. After surgery, it delivers therapy to the tumour resection margins where most of the glioblastoma recurrence takes place. The device is expected to operate without causing harm to healthy brain cells. To-date, QV has raised ~£3.5m, (~US$4.5m) and has received ~£2M (~US$2.5) in non-dilutive grants, including £860k (~US$1M) in March 2023 from Innovate UK, the UK’s national innovation agency.  The company plans to use recent proceeds to expand its preclinical studies, finalise the initial design of GRACE, and develop a commercial strategy and regulatory pipeline as it prepares for clinical grade testing.


Part 2
 
Glioblastoma research: Government Support and the Rise of Innovative Players
 
Universities and research institutions engaged in GBM R&D
 
In addition to companies, which we described in Part 1 of this Commentary, universities and research institutions around the world are actively engaged in R&D efforts aimed at exploring novel therapies for glioblastoma. American universities and research institutes are particularly well placed as the US leads the world in investment in biomedical research. For instance, its National Institutes of Health (NIH) annually invests  >US$40bn in medical research throughout the US. However, China is catching up (see below). One leading American institution that benefits from this US policy is the Massachusetts Institute of Technology (MIT), where researchers have been investigating innovative approaches such as nanotechnology-based drug delivery systems and targeted therapies to combat glioblastoma. In the UK, the University of Oxford has made significant strides in developing immunotherapies and personalized treatments for GBM. In Canada, the University of Toronto’s researchers are focussed on novel gene therapies and the development of targeted nanoparticles for improved drug delivery to GBM tumours. In Australia, the University of Sydney’s Brain and Mind Centre is actively involved in the exploration of stem cell-based therapies and advanced imaging techniques to better understand the tumour’s biology and improve treatment outcomes. These academic institutions, together with many others globally, are actively searching for breakthrough therapies for patients battling glioblastoma. University medical research groups can receive funding from medical research charities, as well as governments. However, a private company may licence a technology from a university or research institute and fund, or co-fund, clinical trials.
 
The Case for increased government funding for GBM R&D

In Part 1, we described how glioblastoma is characterized by its rapid progression, resistance to conventional treatments, and complex biological nature, which contribute to the difficulty in developing effective therapies. The intricate interplay between tumour cells and the brain, along with the blood-brain barrier, makes drug delivery and targeted treatment options particularly challenging. Given the multifaceted obstacles involved, it seems unreasonable to expect private entities to solely bear the burden of funding R&D for such a rare and complex disease. Glioblastoma affects a relatively small number of individuals, limiting the potential market for pharmaceutical companies and MedTechs. The high costs associated with R&D, clinical trials, and regulatory approval create a significant financial risk for private investors. The lack of substantial profitability prospects may discourage private entities from allocating resources to GBM research. In contrast, governments have a vested interest in public health and can allocate funding based on societal needs rather than immediate profitability.

Government-funded research can foster collaboration among scientists, clinicians, and institutions. By providing a platform for shared knowledge, data, and resources, governments are well positioned to facilitate scientific breakthroughs for complex conditions. GBM research would benefit from collective efforts, allowing scientists to efficaciously pool their expertise to accelerate progress. Government funding can enable the establishment of research consortia, collaborative networks, and specialized centres dedicated to glioblastoma R&D. Developing innovative therapies for the condition requires sustained long-term commitment. Private entities may be inclined to prioritize shorter-term projects with faster returns on investment. In contrast, governments have the capacity to pursue research with longer horizons and tolerate greater risks. By investing in long-term R&D, governments can support the exploration of unconventional ideas, disruptive technologies, and novel approaches that may yield significant advancements in glioblastoma treatment. Also, government involvement in funding R&D can prioritize the development of therapies that are accessible and affordable to all patients. Private entities may choose high-profit-margin treatments, potentially leading to a lack of affordability for many individuals. Government-funded R&D initiatives can ensure that breakthroughs in GBM treatment reach the wider population, reducing health disparities and ensuring equitable access to potentially life-saving interventions.

 
Chinese R&D in novel GBM therapies

In a thought-provoking book, Technocracy in America, Parag Khanna presents an argument that challenges the conventional wisdom surrounding economic systems and their impact on technological development. Khanna highlights the success of China’s blend of market economy and state-owned enterprises in fostering the growth of cutting-edge medical technologies. Drawing comparisons with Western liberal democracies, Khanna suggests that China’s technocratic approach, characterized by strategic direction and state-led initiatives, offers distinct advantages in driving advancements in the high-tech medical sector. Khanna prompts us to reassess our assumptions about the most effective pathways to progress in the realm of medical technology.

The development of a ‘Healthy China 2030’ is central to the Chinese Government’s agenda for health and development, and has the potential to reap benefits for the rest of the world. President Xi Jinping has put health at the centre of the country’s policy-making machinery, making the need to include health in all policies an official government policy. The Chinese government has expressed a commitment to supporting biomedical R&D, including efforts aimed at addressing rare diseases like glioblastoma. Specific initiatives may receive funding and support through programmes such as the National Natural Science Foundation of China (NSFC), China's National Key R&D Programmes (NKPs), and collaborations between domestic academic institutions, research centres, and pharmaceutical companies. In China, efforts are underway to develop innovative immunotherapeutic approaches, including immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapy, and peptide-based vaccines. These approaches aim to enhance the immune system's ability to recognize and eliminate GBM cells. China is also exploring gene therapy approaches for GBM treatment. One notable example is the use of genetically modified viruses to deliver therapeutic genes directly into tumour cells. Researchers have conducted clinical trials, such as using oncolytic adenoviruses and retroviruses, to induce tumour cell death and stimulate the immune response against glioblastoma. Nanotechnology-based strategies are being explored to improve drug delivery and enhance the efficacy of GBM treatment. Scientists are developing nanoparticles and nanostructured systems capable of crossing the blood-brain barrier and delivering therapeutic agents directly to the tumour site, which aim to increase drug accumulation in tumours while minimizing systemic side effects. China is also involved in stem cell-based therapies that hold promise for glioblastoma treatment. Researchers are investigating the use of neural stem cells, mesenchymal stem cells, and induced pluripotent stem cells for targeted drug delivery, immune modulation, and regenerative purposes. These approaches aim to improve patient outcomes and overcome treatment resistance to GBM. Further, Chinese researchers are investigating the potential of traditional Chinese medicine (TCM) for glioblastoma treatment. Studies have focused on identifying bioactive compounds from medicinal plants and evaluating their anti-tumour effects, as well as exploring the synergistic effects of TCM in combination with conventional therapies.

 
Takeaways

This Commentary describes some of the ongoing developments of novel therapies for GBM mainly at the company level and suggests reasons why it is unreasonable for private companies to bear the main burden of finding therapies for glioblastoma. We also suggest that ongoing R&D initiatives at the company level should be approached with caution as their effectiveness and safety are still being investigated through clinical trials. Further, we mention that universities and research institutes worldwide are actively engaged in R&D programmes, involving multidisciplinary teams dedicated to various aspects of GBM. These efforts encompass understanding the underlying biology, exploring innovative treatment strategies, conducting clinical trials, and investigating novel therapeutic approaches. Further, we suggest that because GBM is a public health issue, governments might consider increasing their investments in, and their coordination of, GBM R&D. The Commentary draws attention the Parag Khanna’s book, Technocracy in America, which encourages us to re-examine our assumptions about the most effective policies to accelerate the development of medical technology and suggests that China’s model of state capitalism appears to have advantages over Western liberal democracies.

Regarding medical R&D landscape at the company level, it seems reasonable to suggest that the unique challenges and market dynamics associated with glioblastoma may lead to a more significant presence of smaller MedTechs and start-ups in this field. Such entities often possess the ability to focus on niche areas and take risks in pursuing innovative solutions. Their streamlined decision-making processes and flexibility in allocating resources specifically to GBM research, driven by scientific curiosity, patient advocacy, and potentially disruptive innovation, provide them with a competitive advantage. Conversely, many large diversified MedTechs may be less inclined to invest in GBM R&D compared to more prevalent cancers such as breast, lung, or colon cancer. This is primarily due to the relative rarity of GBM, resulting in a smaller patient population. From a business perspective, the smaller market size may be less financially attractive to established MedTechs seeking larger patient populations with higher profit potential. The highly complex and challenging nature of glioblastoma, including its location, infiltrative behaviour, and resistance to standard treatments, poses significant obsacles in developing effective therapies. The complexity and risks associated with GBM R&D present substantial challenges for many companies with more extensive resources and stakeholders to manage, as the potential for failure or setbacks is higher.
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Dame Deborah James, who died aged 40 of bowel cancer, spent the last 5 years of her life raising awareness about her type of cancer, but also fighting to make personalised medicine more widely available for cancer patients.

Personalized medicine is therapy customized for an individual and has become more readily available as the cost of gene sequencing has been significantly reduced. An example is when treatment is targeted to a specific type of cancer cells.

HealthPad had partnered with a consortium of leading cancer specialists to explain what personalised medicine means and what it can do for cancer patients.

The HealthPad Team would like to join the many people who have admired Dame Deborah for her courage and determination.

Thank you and farewell, BowelBabe.

#bowelbabe #damedeborahjames #personalisedmedicine

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Over the past decade HealthPad has published ~30 Commentaries on significant developments in cancer therapies. On this World Cancer Day, we would like to share our contribution, to show how scientific knowledge and therapies have progressed to improve the lives of people living with cancer. The genesis of the HealthPad platform owes a lot to Professor Hani Gabra, a cancer expert who, together with many of his colleagues, believe that it is important to provide people with easy and convenient access to premium information to help them make informed medical and lifestyle choices and improve patients’ treatment journeys. 
 
 
In addition to our Commentaries, HealthPad has built a unique and exclusive premium cancer content library of >1,100 videos, which address peoples’ frequently asked questions across several cancer pathways. The videos have been contributed by leading oncologists and scientists from world renowned medical institutions across the world and can be accessed anytime, anywhere, anyhow.
 
We reconfirm HealthPad’s commitment in helping to make cancer less scary by empowering people with the knowledge we have gathered and shared in our Commentaries.
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Parkway Cancer Centre

Cancer Treatment Centre

Parkway Cancer Centre offers comprehensive cancer treatment in Singapore with a highly skilled, multi-disciplinary team comprising consultant medical specialists, nurses, counsellors and other para-medical professionals to meet the specific needs of cancer patients.


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Ayaansh Hospital

Best Women's Cancer Hospital | Cancer Specialist in Bangalore
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Ayaansh is the Best Women's Cancer Hospital in Bangalore to offer all types of Gyne Cancer Treatment by the Women's Cancer Specialist in Bangalore.


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  • The burden of breast cancer throughout the world is significant and increasing
  • Research has shown that a cheap pill (anastrozole) halves postmenopausal women’s risk of breast cancer and continues to be effective seven years after women stop taking the drug
  • Anastrozole has fewer side-effects and is more effective than comparable treatments
  • Government watchdogs both in the UK and US recommend anastrozole
  • But the uptake of the drug in the UK is relatively low
  • Doctors are not prescribing anastrozole and women are not availing themselves of the drug
  • The UK’s NHS should employ new behavioural techniques to influence and change doctors’ and patients’ decisions and increase the uptake of anastrozole to reduce the burden of breast cancer

Will behavioural techniques improve breast cancer outcomes?
 
Being a woman and growing older are two unavoidable risk factors for breast cancer. Indeed, most breast cancers are found in women who are 50 years or older. Despite significant advances in diagnoses and treatments, breast cancer is one of the rapidly increasing cancers among women and a significant cause of cancer-related morbidity and mortality worldwide.  Breast cancer alone accounts for 30% of all new cancer diagnoses among females and has become a major 21st century health challenge.
 
Study shows long term benefits of a cheap breast cancer pill

Research findings reported in the December 2019 edition of The Lancet and also presented at the  December 2019 San Antonio Breast Cancer Symposium in Texas, show that a cheap pill, anastrozole,  if taken once a day for 5 years, not only halves postmenopausal women’s risk of breast cancer, but continues to be effective seven years after stopping treatment, which for the first time, suggests a long-term benefit.
 
Relatively low uptake
 
The UK’s NHS watchdog, the National Institute for Health and Care Excellence (NICE), suggests that hundreds of thousands of healthy older women should take anastrozole to cut their risk of breast cancer and recommends that the drug is offered to postmenopausal women at moderate to high risk of breast cancer unless they have severe osteoporosis. However, evidence suggests that some doctors in the UK are not prescribing anastrozole and some women are not availing themselves of the drug despite its demonstrated clinical benefits and the fact that anastrozole is supported by NICE.
 
Jack Cuzick, the lead author of The Lancet 2019 paper, who is Professor of Epidemiology and the Director of the Wolfson Institute of Preventive Medicine at Queen Mary UniversityLondon, is concerned because although anastrozole is, “An agent that looks really effective with minimal side-effects and is available on the NHS in the UK; its uptake has been quite low with only a tenth of eligible women receiving it”. Cuzick’s concerns are echoed by Delyth Jane Morgan, Chief Executive of the charity Breast Cancer Now, who said: "It is worrying to hear that anastrozole may not be being offered to all that could benefit. We need to understand the extent of this potential issue. It's essential that we raise awareness of this option among doctors and patients".
 
 In this Commentary
 
Part 1 of this Commentary explores some of the reasons for the relatively low uptake of anastrozole. Part 2 describes new behavioural techniques, which could be cheaply and easily employed by health systems to increase the uptake of anastrozole and dent the burden of breast cancer. Also the Commentary: (i) describes breast cancer, (ii) provides some epidemiological facts of the disease, (iii) estimates the cost to treat breast cancer in the UK, (iv) describes hormone receptor positive breast cancer, (v) explains how anastrozole works and (vi) reports the findings of The Lancet 2019 study.

 
Part 1
 
 
Breast cancer
 
Cancer is a group of diseases that cause cells in your body to change and spread out of control. Most types of cancer cells eventually form a lump or mass called a tumour and are named after the part of your body where the tumour originates.

 

Breast cancer is characterized by the presence of cancer cells in the tissue or ducts of your breast. Most breast cancers begin either in the breast tissue made up of glands for milk production, called lobules, or in the ducts that connect the lobules to the nipple. The remainder of the breast is made up of fatty, connective and lymphatic tissues. Advanced breast cancer refers to cancer that has spread outside of your breast to lymph nodes and/or distant locations in your body, often invading your vital organs.
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Epidemiology of breast cancer
 
Breast cancer is a common malignancy. Although more and more women are surviving the disease, each year in the UK there are over 55,000 new breast cancer cases: which equates to over 1,000 diagnosed each week. In the US, there are some 250,000 new breast cancer cases diagnosed each year: nearly 5,000 a week. Between 1993 and 2016 the incidence of breast cancer in the UK increased by 24%. Over a similar period, breast cancer incidence in the US declined, but an increasing trend of some 1.1% was observed among American Asians. In China, between 2000 to 2013, breast cancer increased at an annual rate of around 3.5%. Breast cancer rates in China are higher in urban areas than in rural areas: the higher the population density, the higher the rate. It is not altogether clear why breast cancer incidence is increasing. Experts suggest that breast cancer is a complicated disease with a variety of causes. Most cases of the disease are not linked to a family history. Around 5% of people diagnosed with breast cancer have inherited a faulty BRCA1 or BRCA2 gene. However, if you have a faulty gene, it does not mean that you will automatically develop breast cancer, but you are at higher risk. Out of every 100 women with a faulty gene, between 40 and 85 will develop breast cancer in their lifetime. Optimal therapy for breast cancer often requires several different treatment modalities including surgery, radiation, chemotherapy and hormone therapy (see below).
 
Cost of breast cancer treatment in the UK
 
The cost of treating breast cancer in the UK is significant and rising. Findings of research on the treatment costs of breast cancer published in the August 1999 edition of The Breast estimated that the average cost per case of breast cancer in the UK to be £7,247 (US$9,418).  Although the estimate is dated, it provides a guide. With 55,000 new cases of breast cancer diagnosed each year, the annual cost of treating the newly diagnosed alone, would be about £0.4bn (US$0.52bn). According to the UK charity Breast Cancer Now, an estimated 840,000  women  living in the UK have been diagnosed with breast cancer and the charity predicts that this figure will increase to 1.2m over the next decade. Thus, ceteris paribus, we can assume that the current annual cost  of treating breast cancer in the UK is significantly higher than £0.4bn and this figure is expected to increase substantially by 2030.
 
 
Hormones and hormone therapy
 
Hormones are chemical messengers secreted directly into your bloodstream, which carry them to organs and tissues of your body to exercise their functions.  Oestrogen and progesterone are steroid hormones produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women. These hormones play a critical role in regulating reproduction. Oestrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.
 
Similar hormones are produced artificially either for use in oral contraceptives or to treat menopausal and menstrual disorders. Oestrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive (or hormone-dependent) breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors, which become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes that can stimulate cell growth.
 
Anastrozole is a hormone therapy (also called hormonal therapy and endocrine therapy), which slows or stops the growth of hormone-sensitive tumours by either blocking the body’s ability to produce hormones or by interfering with the effects of hormones on breast cancer cells. Anastrozole blocks a process called aromatisation, which changes sex hormones called androgens into oestrogen. This happens mainly in the fatty tissues, muscle and the skin and needs a particular enzyme called aromatase.
 
 Prescribing anastrozole
 
Anastrozole belongs to a group of drugs called aromatase inhibitors, which are specifically designed to treat postmenopausal women diagnosed with hormone-receptor-positive, early-stage breast cancer.  It is most often prescribed as an adjuvant therapy (after surgery) to decrease the risk of your cancer returning but can also be used in the neoadjuvant setting (prior to surgery) to decrease the size of your cancer in the breast. Hormone blocking therapy is also used to treat breast cancer that has recurred or spread. Most hormone blocking therapy drugs such as anastrozole are taken daily in pill form.
 
Anastrozole also may be given to reduce the risk of breast cancer in women who have not had breast cancer but have an increased risk of developing it because of their family history. Most experts suggest that your breast cancer risk should be higher than average for you to consider taking anastrozole as a preventative strategy. If your cancer is hormone receptor negative, then anastrozole will not be of any benefit, because these cancers do not need oestrogen to grow and usually such cancer cells do not stop growing when treated with hormones that block oestrogen from binding.
 
Reasons for the relatively low uptake of anastrozole
 
There are at least three probably reasons for the relatively low uptake of anastrozole. These include: (i) doctors becoming so used to prescribing the gold standard tamoxifen as an adjuvant hormone therapy, (ii) doctors wanting to be convinced about anastrozole’s long term benefits, and (iii) doctors wanting assurance about anastrozole’s minimal side effects.
  
Tamoxifen
 
Tamoxifen is the oldest and most-prescribed aromatase inhibitor and for the past three decades has become the standard of care as the adjuvant treatment of postmenopausal women with hormone-responsive early breast cancer. The drug reduces the risk of breast cancer returning by 40% to 50% in postmenopausal women and by 30% to 50% in premenopausal women. Notwithstanding, over the past two decades a new generation of aromatase inhibitors have been developed, and anastrozole is one of these. How does anastrozole compare with the gold standard tamoxifen?

Tamoxifen and anastrozole compared
 
Findings of two long-term comparative clinical studies undertaken in North America and Europe involving over 1,000 women with oestrogen receptor positive advanced breast cancer, showed that anastrozole is better than tamoxifen for: (i) increasing the time before the cancer returns in those who experience recurrence, (ii) reducing the risk of the cancer spreading to other parts of the body and (iii) reducing the risk of a new cancer developing in the other breast.

Significantly, studies have shown that anastrozole avoids two of tamoxifen's more serious side-effects: an increased risk of developing a blood-clotting disease and an increased risk of developing womb cancer.  Anastrozole can make bones weaker and so it is not recommended for women with osteoporosis and also it can cause stiff joints, hot flushes and vaginal dryness, which clinicians need to recognize and manage. But overall, the benefits of anastrozole over tamoxifen were maintained without a detrimental impact on quality of life. However, anastrozole is not a therapy for  premenopausal women because it blocks the hormone oestrogen and in effect creates a drug-induced menopause.


Part 2

Increasing the uptake of anastrozole
 
For healthcare systems to function effectively and efficiently we expect doctors and patients to behave rationally and make effective and efficient decisions. Traditionally, the rational choice model, which is predicated upon the belief that all human beings (including doctors and patients) act rationally in their own self-interest, has been used to influence people to behave in desirable ways. However, evidence suggests that, despite the well-founded theory and sound evidence to support it, the rational choice approach does not appear to work that well in practice.



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Behavioral scientists not doctors will prevent CVD

 A newer theory to explain peoples’ choices and behaviours
 
A newer approach to influencing behaviour, which builds on decades of research by Nobel prize-winning psychologist Daniel Kahneman, and described in a book published in 2008 entitled Nudge, by Nobel Prize winning economist Richard Thaler and Harvard Law School professor Cass Sunstein, suggests that no choice is ever presented in a neutral way and people - including doctors and patients - are susceptible to biases that can lead them to make suboptimal decisions. The authors suggest that many decisions and consequent behaviours are made automatically rather than after a considered rational decision. And this applies to decisions about your health.
Policymakers have been quick to latch onto the possibilities of these new behavioural techniques. Following the publication of Thaler and Sunstein’s book in 2008, President Obama set up a “Nudge Unit” in the White House and the UK Government, under Prime Minister David Cameron, set up the Behavioural Insights Team, popularly known as the Nudge Unit, in 10 Downing Street, and other governments around the world have since followed suit.

Nudges
 
Nudges are particular types of interventions, which are used to change peoples’ behaviour and improve outcomes at lower cost than traditional tools across a range of policy areas. Nudge techniques have been used in healthcare to influence behaviour and decision making to improve patient outcomes. For instance, the behavioural analysis of the decision-making that leads to a patient taking one drug instead of another. A research paper published in 2015 by the UK’s Health Foundation entitled “Behavioural insights in healthcare” suggests that health messages are often inconsistent and confusing to patients and framing them using social comparison via descriptive social norms (pointing out what is commonly done) or using injunctive norms (pointing out what is approved of) has been demonstrated to change patients’ behaviour and thereby have the potential to improve patient outcomes.
 
Information design
 
Behavioural techniques suggest that more attention should be given to the design of health information because the design and the way information is presented can influence and change doctors' and patients’ behaviour. Clinical guidelines, patients’ checklists and decision aids can all be improved in terms of text and language (e.g. the use of “plain English” and behaviourally specific, concrete statements and presentation of risk) and appearance (e.g. colour, visual stimuli, images etc).
 
HealthPad advocates that health information can have significantly more influence on the choices that doctors and patients make and on their  behaviour simply by presenting critical information in a video format. Over the past few decades people have moved away from consuming information in written and audio formats to consuming information predominantly in a visual format.  
 
Shift to consuming information in video format
 
Consider the following as being indicative of this shift. 82% of Twitter’s 330m average monthly users consume information in video format. The video channel You Tube has over a billion users and more than 500m hours of video are watched on the channel each day. 72 hours of video are uploaded to You Tube every 60 seconds, and more video content is uploaded onto the channel in 30 days than the major US television networks have created in 30 years. To further put things into perspective, in 2017, 56 exabytes (equivalent to 1bn gigabytes) of internet video content was consumed on a monthly basis, and this figure is expected to more than quadruple to 240 exabytes per month by 2022.

Today, almost all industries,  with the exception of healthcare, use video formats to communicate and the overwhelming majority of people who have consumed information in video format say it has influenced their choices and changed their behaviour. With video becoming the most significant influence on consumer decisions, it seems reasonable to suggest that more health information needs to be communicated in a video format if it is to influence and change doctors’ and patients’ behaviours in order to improve medical outcomes, increase the quality of care and slow and prevent chronic lifetime diseases.
 
Prompts cues reminders and audits
 
Prompts, cues and reminders have been demonstrated to be generally effective “nudges” that can successfully change the behaviour of healthcare providers and consumers, as well as being relatively inexpensive and easy to administer. Audit and feedback “nudges” are also effective. A set of best practices derived from systematic review evidence suggests that various nudge-type interventions (notably information design and presentation) may offer new ways to enhance choices and change behaviour.
  
Takeaways
 
The burden of breast cancer is huge and increasing globally. Research has demonstrated that a cheap pill, anastrozole, halves postmenopausal women’s risk of the disease and continues to be effective seven years after women stop taking the drug. We suggest that healthcare systems should consider using new behavioural techniques to influence and change doctors' and patients’ decisions to increase the uptake of anastrozole to help reduce the burden of breast cancer. Evidence suggests that nudge-type interventions, if suitably applied, can influence and change the behaviour of doctors and patients and thereby contribute to the reduction of the burden of breast cancer. However, given the newness of these techniques the quality of evidence available about their impact is relatively thin and patchy. Notwithstanding, this suggests a need for more quality evaluation and synthesised evidence of nudge-type interventions, their behaviour change potential and their impact on reducing the burden of breast cancer and other chronic lifetime diseases.
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Dr Mohit Saxena Cancer Specialist

Best Cancer Specialist Gurgaon

Dr. Mohit brings,cancer specialist in Gurgaon has over 13 years of experience in oncology across some of the best hospitals in India such as Artemis Hospital (Gurgaon), VPS Rockland Hospitals (Manesar & New Delhi), Gujarat Cancer & Research Institute (Ahmedabad), and G.C.S. Medical College & Hospital (Ahmedabad). He completed his MBBS and MD in Medicine from Sawai Man Singh Medical College (Jaipur) and DM in Medical Oncology from Gujarat Cancer Research Institute (Ahmedabad). He holds a number of achievements, presentations and publications to his credit. His areas of interest include solid malignancies like breast, colon, lung, prostate, etc. and hematological malignancies like leukemias, lymphoma, and myeloma.


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