National cancer centre is good ideaBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7185.736c (Published 13 March 1999) Cite this as: BMJ 1999;318:736
- Karol Sikora, Chief, WHO Cancer Programme
EDITOR—Britain is indeed one of the few countries not to have a single focus for teaching and research for cancer, as Waxman and Gibson point out.1 Even in many low resource environments considerable effort has been made to concentrate expertise. At a time when cancer treatment is likely to change owing to the impact of new molecular treatment strategies, the need for a leading institution has never been greater. But Waxman and Gibson stop short of being specific.
Where should such a centre be located, and how should it relate to existing institutions? Do we really need massive new funding, or can it be created out of existing resources? Most national cancer centres are based in capital cities. London already has the United Kingdom's largest concentration of cancer research, care, and education in an amalgamation of the Institute of Cancer Research, the Royal Marsden Hospital, Imperial College (University of London), the Hammersmith Hospitals, and the Imperial Cancer Research Fund. Already good clinical and scientific collaboration exists between these groups. If we brought in the huge volume of international practice that is in many small and poorly organised private hospitals in west London we would really have a powerful grouping, both intellectually and financially.
What is needed to bring this concept to fruition is political will and capital investment by the public and private sectors, jointly, to create a single site. This would defuse the usual interpersonal bickering that characterises hospital and university mergers. The centre would be a natural site to coordinate the new structure of cancer centres and units that is gradually building up throughout the United Kingdom.
As well as developing the treatments of the future such a centre would monitor the availability of care throughout the United Kingdom and ensure equity of access; act as a gold standard for cancer care and form part of the National Institute for Clinical Excellence; be an attractive site for the pharmaceutical industry, which spends an estimated £150m a year on cancer research in Britain; and provide an international focus at a time of great global change in the way in which cancer is managed.
Persuasion, imagination, and determination are the keys to this ambitious project; let us hope that now this debate has been started it will gather momentum.