The surgical research charity Saving Faces and its National Facial, Oral and Oculoplastic Research Centre (NFORC) believe the best way to conduct successful research that has an immediate impact on patient treatment is not competition amongst hospitals and their surgeons but collaboration: Collaboration within our specialty to study many patients yielding rapid results; and collaboration with other specialties, such as psychologists and laboratory scientists or even other surgical groups. This is the best way to find answers to thorny research questions.
Facial and oral conditions like head and neck cancer, facial injury, disease and disfigurement are very common. But research to improve their treatment is very poorly funded despite these disorders resulting in life-changing impacts on appearance, speech, eating and breathing.
The Alan Rickman Professor will be an outstanding, internationally respected Facial surgeon with a track record of game-changing research. They will Head the National Research Centre (NFORC). The key to their success will be collaboration with hundreds of surgeons in the UK and abroad doing nationwide multi-centre research. This clinical and translational research model will rapidly deliver answers to which treatment works best for these conditions and that’s exactly what the Alan Rickman Professor will do.
The videos below explain the need for research in facial injury, disease and disfigurement and the types of research that the Professor will do.
Brent Hoberman
I am proud to support Saving Faces in this project to fund a professor who will determine best treatment practice for all facial and mouth diseases.
It may surprise everyone that this isn’t already known. I deal in Big Data and that is what is needed and what this professor will deliver doing nationwide and maybe even international research with thousands of patients.
Like most families, when one of our family had a serious life-threatening disease that needed surgery, we thought that we needed to find the most skilful surgeon. Fortunately, before treatment began, we found out that there were many ways of treating the problem, all of them relatively successful, but they had never been compared to see which one was best of all. So what was really needed was to find a surgeon who knew which operation was best for the patient. Even the most skilful surgeon will not achieve as good a result as a less skilful surgeon if they do not choose the best treatment for that particular patient.
I was amazed to find out that Alan Rickman understood this and supported this research and I’m delighted that the Professorship will be named after him as the Alan Rickman professor of head and neck cancer, facial injury and disfigurement.
Please help me deliver this project by donating as generously as you can but even more importantly spread the message amongst your friends and family so that they do the same. We can all be proud of the thousands of lives and faces that we will save each year when this Professor becomes a reality.
The following studies initiated and led by Saving Faces and its National research Centre are examples of the types of research that the Professor will lead.
Click on the study titles for more information.
Listen to Professor Iain Hutchison on BBC Radio 4 The Today Programme with Sarah Smith discussing the ground breaking results of the SEND study here.
The key to this study’s uniqueness and success, where nearly 1000 other studies on the same topic had failed, was that it was a multi-centre, nationwide study involving 68 UK surgeons at 27 UK hospitals treating 614 patients in a reasonable time scale. Unfortunately, this type of collaboration among surgeons and their hospitals is rare and as a result many single hospitals (even the most famous ones) run studies that don’t collect enough patients to find an answer to what treatment is the best for the patient. SEND compared two standard treatments for early mouth cancer. The study showed that one method, taking out the neck glands as well as the cancer, cures 30% more patients. As a result every year the lives of 30,000 patients with early mouth cancer are saved worldwide. That’s one patient every 15 minutes.
SEND also looked at functional, social and emotional outcomes such as speech, eating and appearance. We found that the patients who had the longer operation had as good quality of life as those that had the shorter one. The overall costs between the two treatments averaged out to be the same because when the patients who had the smaller operation got cancer again they needed much bigger treatment with a second operation and radio- and chemotherapy.
The findings are applicable for all surgeons worldwide because of the large numbers of surgeons from different backgrounds who operated on the patients. This large collaborative trial is exactly the type of research that the professor will lead.
The impact for doctors and surgeons, scientists and, most of all, their patients
The SEND study has had a worldwide impact. The results published in the British Journal of Cancer (BJC) have been read by over 12,000 people and institutions across five continents and have been cited in more than 70 articles or books. The impact of this paper puts it in the top 4 percent of all medical articles. The results have already prompted:
- a new Cochrane review three years after the last one;
- a pan European position paper promoting the changes we advocated
- a letter from the President of the Union International Cancer Control (UICC) Geneva to the BJC especially praising our Quality of Life and resource use research, and they finished with “we stand the risk of subjecting our patients to poorer disease control by observing the neck in spite of having [this paper’s] irrefutable evidence in favour of END (elective neck dissection)”;
- and a commissioned paper for the Journal of the National Comprehensive Cancer Network (NCCN) in the USA – the NCCN generate the guidelines for all cancer treatment in the United States. Our paper was entitled “Time for a change in guidelines”. This paper published in April 2021 has already been downloaded or read in full over 2,400 times and concludes: “There is now quantifiable information on the benefits for survival with the longer operation. This knowledge enables surgeons to inform patients and their families about the benefits and drawbacks of opting for or against END, and thereby allows them to participate in treatment decision-making”.
Many people think they should identify the most skillful surgeon or go to the best hospital. However, what they really need to know is what is the best treatment for their condition. Even the most skillful surgeon can’t compensate for using the less successful treatment. Studying with so many surgeons means we can judge a successful treatment irrespective of which surgeon performs it.
Read the full paper here.
This is an example of what is called translational research. This is where surgeons treating patients, partner with scientists working in the laboratory to find blood or saliva markers that will guide better ways of diagnosing or treating patients.
Barts And The London medical school, Queen Mary University of London have developed the world’s first PCR test for mouth cancer. The test has now been proved with patients from China, India and the UK, with the results published in the international journal, Cancers. The inventor, Dr Muy-Teck Teh, named the test the Quantitative Malignant Index Diagnosis System (qMIDS). Saving Faces and the National Research Centre funded this research.
The test is quick and easy. It only needs the PCR machine used in COVID testing and a technician to operate it. It could be rapidly rolled out around the world at very little extra cost. A tiny sample (the size of half-a-grain of rice) is taken from the suspicious area in the patient’s mouth and the test only takes 90 minutes after reaching the technician – similar to a COVID PCR test. Until now, there has been no perfect way to identify lesions likely to develop into cancer.
qMIDS diagnostic accuracy would mean that 90% of low-risk patients could be discharged from hospital to go back to their dentist or GP for review. Or they might be tested in the dentist’s surgery and only referred to secondary care if they were high risk. High-risk cases could also be detected in the pre-cancer period and treated definitively, thereby saving the patient’s life with minor surgery, better cure rates and quality of life, as well as a huge reduction in health service costs.
Since this study included researchers and patients from three countries, the results could be generalised to a wider population across the world. This study is a prime example of collaborative research that has improved the care and treatment for people with a facial condition, which is the type of research that the Alan Rickman Professor will lead.
Read the full paper here
The vast majority of patients will receive some form of radiotherapy during treatment for cancer. We know that radiotherapy causes narrowing of the blood vessels and fibrosis (something like scarring) of skin and fat and muscle. In the head and neck, many patients report some degree of swallowing problems; but some patients can’t swallow at all and have difficulty opening their mouth, so they will need to be fed through a tube in their stomach for life. Radiotherapy’s impact on the blood supply to the jawbone, may cause rotting and fractured jawbones and holes in the facial skin. We currently have no means of predicting how individual patients with head and neck cancer will react to radiation.
Saving Faces is conducting a genome wide association study to identify genes which predict for severe radiation complications in patients. Identification of the genes could then in the future, help to tailor treatments for these patients. The study will also determine the frequency of these problems.
Saving Faces and the National Research Centre are studying 1,000 patients from 16 radiotherapy hospitals. This is another example of collaborative research with many doctors, surgeons and research scientists working together to find answers to very difficult questions.