With a healthy glow and a beaming smile, eighty-one-year old Ivor Knight welcomes me to our interview with a plate full of biscuits and a mug of freshly brewed tea. His general chat and jolly personality puts me immediately at ease, so that I feel as if I am meeting up with an old friend rather than meeting a man that I have never met before to discuss his lung cancer treatment.
Ivor is not your stereotypical cancer patient, if there is any such thing. He is full of jokes, laughter and life but that is not to say that he has had an easy ride.
Ivor discovered his illness in the spring of 2013, when, like many other lung cancer patients, he started coughing up blood. His working years were spent as a postman in the Falmouth area so fitness has always been part of his life and even now he keeps himself healthy through his Keep Fit class.
He may have never discovered anything was wrong if it wasn’t for that day that he coughed blood after exercise, but he describes how he had his suspicions, ‘at my age, you think there has got to be a reason for it and the first thing you think of is cancer.’
Unfortunately, Ivor’s fear turned into reality, as he recalls his reaction to when he was diagnosed with small cell lung cancer, sat in front of the doctor with his daughter by his side for support, ‘I smiled. It didn’t make any difference to me because I had just lost my wife.’ After losing a partner and then just days after her funeral discovering that you yourself have cancer, many people would have had a depressive view of the world, but not Ivor, ‘If you don’t have the right attitude, you will struggle,’ and he is a strong believer that a positive mind set you can get through just about anything.
‘This is the one that gets you through; it is the attitude of mind. I never once thought that I wouldn’t get better-never once’
When imagining an Oncology Department, which is an area of a hospital dedicated to treating cancers, it is very easy to come up with images of a miserable, dark place where everyone is going through a lot of pain from their treatments. But the Treliske’s Sunrise Centre is far from that. ‘You are on your way up again when you are down here’ smiles Ivor, who has become quite fond of the place where he can always come for a chat and a cup of tea with the ‘incredibly friendly’ staff.’
‘I’m lucky really; some of the people that come up here are unbelievable. I mean they are on deaths door but they come in here with a smile, have a cup of tea and then go off and have their treatment-it’s marvellous.’
Although there is a vast amount of planning involved in preparing an individual treatment for the patient, the actual process of being treated is fairly simple and only takes a matter of minutes. The patient is taken into the room where they are accurately positioned to align their tumour is in relation to the radiation field with the help of the radiographer which, according to Ivor is one of the worst parts because ‘they are bloody freezing cold! Pardon my French but their hands are like icicles’
During the treatment the patient is left alone with the radiographer controlling the machine from a monitor outside the room. The actual treatment only takes around three minutes and has no immediate side affects, and much to his delight, this means that Ivor can drive himself to and from the hospital, ‘I drive myself here everyday, have my treatment and then go home again.’
Fortunately for Ivor, the survival rates from lung cancer have a much higher survival rate here in Cornwall and the treatment is considered to be in the top 3% of the country. This incredible statistic is down to the Sunrise Centre, and the new innovative technologies that the staff are supporting.
In particular one piece of new technology has being making an enormous impact to cancer treatment in Cornwall-the new, top of the range linear accelerator (radiotherapy machine) TrueBeam that Ivor is being treated on. This ‘shiny, space-age’ machine can do something called intensity modulated radiotherapy (IMRT), which means that it is even more precise than the older models of the machine, which are still NHS standard, as well as being able to adapt to the shape of the tumour easily.
TrueBeam cost three-million-pounds and was installed at Treliske’s Sunrise centre nearly a year ago. The installation involved a 242 square metre extension and took over 18 months to construct and test. Exciting the department has just secured funding for a second machine and works are underway.
Treliske was one of the first hospitals in England to go clinical with this new technology. Although the previous machines used for radiotherapy were also linear accelerators (LINAC), the comparisons are astounding, and in the words of practising consultant, Dr Talbot, ‘if you just took the old machine and the new apart they would be much of the same but in reality, the difference is like comparing a ford fiesta with a formula one car.’
While the new technology isn’t necessary for all types of radiotherapy it is transforming the treatment of some cancers, such as those in the lung, prostate, face and neck as it is able to closely conform to the tumour shape and avoid other sensitive structures which maybe nearby, allowing larger doses to be given to the tumour. It also has the facility to scan before treatment is delivered allowing the most accurate positioning of the patient (this is known as Image Guided Radiotherapy).
‘The X-Ray production is the same as the old machine but the big differences are the speed that it can deliver the radiotherapy treatment, the complexity of the types of beam that you can produce, the shapes of the beams and how intense they are is much more flexible.’
Ivor who claims that he hasn’t felt ill since the day that he was diagnosed could just be lucky, but more likely he is having less side affects to the radiotheraphy treatment because he is being treated on TrueBeam.
Dr Toby Talbot explains that TrueBeam has extreme precision, which means that the tumours can be blasted with higher levels of radiation, which, in the past risked damaging healthy surrounding cells. It is when these surrounding cells get damaged that patients get side affects, but as TrueBeam is so precise and less healthy cells are being exposed to the radiation patients like Ivor are experiencing less side affects. ‘Before we always had to be careful because there is a chance that you were hitting a major organ or something critical like the spinal chord, whereas on the new machine we can see that those things are out of the way, which gives us more confidence to treat aggressively.’
‘We can see the benefits in terms of reduction in side affects, speed of treatments and we know that if we are giving that dose to the right spot that we will be curing more tumours.’
The installation of TrueBeam means that more and more patients in Cornwall are getting access to life changing IMRT/IGRT radiotherapy. This is important to meet current government targets to provide this type of treatment for 24% of patients. Dr Talbot states: ‘I am definitely treating tumours on the new machine that I would have felt very unconfident in treating on the old machine, I am treating patients in a way that two years ago I wouldn’t have treated.’
Dr Talbot has been practising in Oncology for over 10 years and the developments in radiology and radiotherapy in that space of time alone is nothing short of staggering. ‘The big differences are that when I first started there was no image guidance, or very little, often we didn’t even have good CT scans, the treatments would be much more simple and what that really means is that you end up giving a much higher dose to areas that you didn’t really want to, meaning that we were curing less cancers, mainly because we were worried about side affects.’
He recalls that when he first started practising in 2003/4 Toby recalls that, ‘all of the buzz was around drug treatment for cancer’ and he even heard that ‘radiotherapy was going to become a redundant technology’ and describes how ‘the reality is that although drugs have got better, nobody foresaw the big change in technology.’
With technologies changing and developing faster than ever before, the future for radiotherapy is looking bright. It is incredible that a therapy that was once deemed as verging on redundant is today curing more cancers than any other drug treatment or therapy. ‘I put it all down to computers, we are curing more cancers today than ever before because of radiotherapy’ describes Dr Talbot, enthusiastically, ‘as computers have got more and more powerful so have the complexity of radiotherapy, and they are linked absolutely’ and is always looking forward to the next innovation that will help cure even more cancers.
It is this persistence and enthusiasm, which is a noticeable attitude across the entire Oncology department at Treliske that has helped them secure funding for a second TrueBeam machine. This means that even more patients across Cornwall will be able to access life saving IMRT treatment. Technology is constantly evolving with more exciting treatment advances ahead.