Professor John Darling
But what can be done about it? The University of Wolverhampton's Professor of Neuro-oncology John Darling (pictured right) discusses the issue in light of this week's parliamentary debate.
While significant strides have been made in treating many types of cancer, for example acute leukaemia in children and breast cancer, over the last 30 years it has been harder to deliver significant improvements in survival in the most common types of malignant brain tumour.
This week’s debate in Parliament around the funding for research into brain tumours highlighted that more investment is needed if we are to make strides in their treatment.
There has been no lack of industry from the small number of people across the world who are interested in the scientific and clinical investigation and treatment of these tumours but the survival of patients with the most malignant brain tumours remains stubbornly high.
Some progress has undoubtedly been made with the introduction of new drugs and local treatments administered directly into the tumours. However, the efficacy of these approaches in terms of overall survival is small, making perhaps the difference of a few weeks or a month or two. Despite the best efforts of neuro-oncologists there has been no breakthrough moment that at a stroke has improved patient survival.
Much useful biological information has been produced that should inform us of the behaviour of these tumours and their potential weaknesses, and many experts feel that we should be on the cusp of exploiting this biological knowledge for the benefit of patients.
Certainly neuro-oncology is a more respectable medical speciality or area for scientific investigation than it was 10 or 15 years ago but it still attracts significantly less funding than the suffering of brain tumours patients and the significant numbers of person years lost deserves.
In other areas of clinical neuroscience, radical new therapies are promised that will change the outlook for those suffering from some forms of dementia, stroke and Parkinson’s Disease in the next decade.
Brain tumour researchers remain frustrated, not because of the lack of ideas, but with the difficulties in funding research and the lack of opportunities to translate laboratory findings into new, effective, therapies.
There are too few people seriously interested in brain tumours and too few opportunities for young scientists and clinicians to stay in the field. The US provides greater opportunities for those wanting to pursue a career in neuro-oncology and there is always the temptation to young investigators with family commitments to move to more lucratively funded areas of cancer research.
More funding would go some way towards redressing these losses to the speciality.
Of course, a rapid and uncontrolled increase in funding might risk being wasted because of the lack of suitably experienced investigators to carry out the specialised cancer research of this kind.
A managed expansion of funding over the next 10 years say, that allows the brain tumour community to effectively grow capacity and efficiently use the new monies coming into this area of research would be the best way forward.
This in turn would enhance the likelihood of a sea change in the provision of evidence based effective therapies for these tumours, delivering not just marginal improvements in survival of a few weeks but years, or even decades, of increased life expectancy.
The relationship between the greater cancer research community and neuro-oncology has been a troubled one. It has long been argued that research into cancer more generally will benefit brain tumour patients. There does not seem to be a great deal of evidence for this.
Malignant brain tumours, with limited options for big surgical resections and significant radio- and chemo-sensitivities, throw up whole new areas of difficulty not seen elsewhere in the body.
Of course, few, if any, have suggested that neuro-oncology research might have benefit to understanding cancer outside the CNS.
However, over the next decade mainstream cancer research and therapy and neuro-oncology will collide as the number of patients presenting with intracranial metastases seems set to grow exponentially.
This unexpected rise in these cases, no doubt through an unintended consequence of better treatment of primary disease elsewhere in the body, will provide neuro-oncology new challenges in areas where there has been little research clinically or scientifically and no real idea of how these cases should be managed in the numbers that will be appearing.
There must be funding for research in this area and investment in those who will be expected to treat them.