Image: Professor Paul Workman
Professor Paul Workman’s intellectual and scientific motivation to pursue a career in cancer research has always been matched by a personal motivation too. As a leader in the field of discovering molecularly targeted cancer drugs, the aim of helping patients achieve longer and better-quality lives has been at the heart of his own research. But he also learned early on exactly what cancer means to patients and their families, having lost both his parents to the disease.
Paul’s father was diagnosed with inoperable bowel cancer in his 50s while Paul was doing his PhD on new cancer drugs and didn’t live long enough to see him finish his thesis, while his mother died, later in life, as a result of a rare bone cancer (a chordoma tumour), having had no real drug options available to her following surgery and radiotherapy. Paul is now working on discovering new drugs for this cancer.
When Paul was diagnosed with prostate cancer following a routine blood test for prostate-specific antigen (known as PSA) in October 2022, he approached the situation with decades of cancer research experience, leadership and knowledge behind him.
“When my urology consultant confirmed that I had cancer, I found that my reaction was certainly, of course, to feel concerned, but also to be quite calm and pragmatic. I had known that this was a possible outcome, especially given how common prostate cancer is, with one in eight men diagnosed with this disease in their lifetime. My main response was that this was a challenge to tackle and that with my expert medical team we would do this by taking a practical and logical approach, based on scientific evidence. It certainly helped that I was told my cancer was localised, small volume, of intermediate risk and likely to have a favourable outcome. I’m well aware that many others have much more difficult news to take in.
“As a cancer scientist, I’ve been fortunate to have a mechanistic insight into cancer and its treatment, and so probably a greater preparedness to face my diagnosis. It helped also that I knew that there were curative treatments available to me and that the side effects are usually mild – and this has proved to be the case so far. I was able to keep working, albeit quite a bit from home and at a lower intensity, and keep up my regular swimming most days, even on treatment dates, which I found really helpful.
“There is no doubt that my expert scientific knowledge has helped me to understand what I was being told. I could understand the numbers, I was comfortable asking all the necessary questions, I had read the publications, and I knew lots of experts whose opinions I could seek, which I duly did. I felt part of, and confident with, my expert medical team around me and this active participation in my treatment plan gave me reassurance and motivation.”
“I was involved in bringing the MR Linac to the ICR and The Royal Marsden”
“I did a year of active surveillance before deciding, with great support from my medical team and family, that for me it was better to go for curative treatment rather than continue with the more passive observational approach. I knew that there was a significant risk of the cancer needing to be treated at some point over the next 10 years and I preferred to be proactive and take that interventional step earlier, while in my early 70s, rather than having the treatment perhaps later on. I also think it suited me psychologically to be proactive rather than more passive. With the medical team we discussed the options of surgery versus various types of radiotherapy, and for me the benefit versus possible adverse effects calculation clearly favoured radiotherapy.”
The first step in Paul’s treatment was to undergo, in late January this year, a surgical prostate procedure in preparation for his radiotherapy. This went very well technically but knocked him back for several weeks due to unluckily developing an infection, fever and experiencing side effects from the high doses of multiple antibiotics. Once fully recovered, and happily being able to attend and give three invited talks on his work at the major American Association for Cancer Research meeting in San Diego in early April, he then underwent five treatments, known as fractions, of targeted external beam radiotherapy. This was delivered in June on the state-of-the-art magnetic resonance linear accelerator (MR Linac) machine at The Royal Marsden in Sutton.
The MR Linac precisely locates tumours using magnetic resonance imaging (MRI) and within the same machine tailors the shape of X-ray beams to the tumour in real time, thereby delivering doses of radiation with a very high level of accuracy, even to tumours that are moving – for example as a patient breathes or the bladder fills – thus maximising the dose to the cancer while minimising potential harm to surrounding healthy tissue.
Working together, the ICR and Royal Marsden have a long history of major contributions to the laboratory development and clinical application of radiation beam-shaping, co-developing what’s called ‘intensity-modulated’ radiotherapy (IMRT), which means the shape of the beam is made to fit, or conform, closely to the tumour volume – and The ICR worked closely with the Royal Marsden to open the UK’s first MR Linac unit in 2016 , with the help of a major grant from the Medical Research Council. As the ICR’s Chief Executive and even earlier, Paul was involved in the decision-making, funding and organisation that brought the MR Linac to the Sutton campus.
Also as ICR CEO, Paul attended the official opening of the MR Linac facility, where the Mayor of London, Sadiq Khan, described it as “groundbreaking” with “the potential to transform the care that cancer patients receive”. Little did Paul realise at the time that he would become one of those patients.
“I had been a member of the senior ICR leadership group involved in the process to bring the MR Linac to the ICR and The Royal Marsden. Of course, I couldn’t know at the time that I would later benefit myself from this amazing technology. I do though remember a presentation by Professor Uwe Oelfke, Head of the Joint Department of Physics at the ICR and The Royal Marsden, showing the amazing accuracy of the MR Linac in prostate cancer and thinking that if ever I had to have radiotherapy, then that would be the way to go for me. I am tremendously lucky to benefit in this way – there are currently only two MR Linac machines in NHS cancer centres in the country, and I was able to have my treatment at Sutton and carry on working. The irony is that I am someone who has spent their whole career discovering new cancer drugs, yet my treatment was not drug-based at all: it was radiotherapy for my localised cancer.”
“Radiotherapy is not scary”
Paul experienced relatively mild side effects, mainly fatigue, from his treatment, which was deemed to have been successful. And his recent results show that his PSA has dropped to a very low level. He now wants to ensure more people understand the benefits of highly targeted, curative radiotherapy treatments.
“While I was ICR CEO, I gave many talks to supporters and donors and would speak often about our latest innovative drug discoveries and also our great advances in technical radiotherapy. Everyone always wanted to hear about the drugs, but there was a relative lack of interest – and I think perhaps a bit of a fear – around radiotherapy, even though radiotherapy is a highly effective treatment, contributes to cure in about 40 per cent of patients, and benefits many others as well. I think the reason may well go back through eons of time in our evolution to when our ancestors used to eat medicinal plants and extracts in an attempt to cure their ills. So, this is seen as ‘natural’ and drugs are a continuation of that ancient healing tradition. But I think people’s perceptions are that there is nothing normal about radiotherapy, it’s much more high tech – involving huge machines and radiation, so it’s less intuitively familiar and probably more scary. My own experience was not like that at all.
“In fact, the main concern for me was actually my claustrophobia, but I was able to overcome this by finding that I could peek out of the end of the MRI tube, by having relaxing Bach music piped through headphones, and by being able to chat with the radiographers during the one-hour treatment sessions.”
With his treatment complete, Paul says he is now in the fortunate position to be able to move forward and continue life more-or-less as normal. From the autumn of this year, he will have quarterly, simple PSA blood test checks for a year, then twice a year for the next four years, and then annually after that.
“Becoming a cancer patient has definitely affected me”
Paul acknowledges that while every patient handles their diagnosis and treatment differently, in his case his experience as a cancer patient has given him a new-found perspective.
“Becoming a patient has definitely affected me, but the difference is subtle. It has not made me a different person, but it has caused a significant shift in my outlook. I have more insight and additional empathy for patients and their families and friends. My relationship with cancer is more personal now. I can understand for example the feeling of vulnerability and the worry that patients and loved ones can have. These days, when I speak to members of cancer survivor programmes and patient advocates, as I did at the AACR conference, I can be open with the audience and share that I too am a cancer patient and that I know how they feel. I think I can better understand what cancer patients and their loved ones are going through.
“And I can speak from a personal perspective about how research is transforming the treatment of cancer and how it’s only through research that we can continue to make further inroads into outcomes.
“I’m very fortunate in that my prognosis was a good one and that I’ve been able to approach my cancer in a pragmatic, informed and logical way, a bit like how one would carry out a set of tactical moves in a game of chess or a sports match. Maybe if my diagnosis was different, I would see it more as a battle, but at the moment I feel it’s more of a journey, which I’m still on, of course. Fingers crossed that the good prognosis predictions play out.
“With my treatment now completed, I can thankfully crack on with my research to improve cancer treatment and with the rest of my life.
“I’m enormously grateful to my wonderful, expert medical team at the Royal Surrey, ICR and Royal Marsden, to my brilliant family and to all my friends, colleagues and others who’ve supported me and wished me well.”
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