New study launched to improve care for hard-to-treat cancer

Cancer patients in Southampton are taking part in a new study to help improve decision-making and treatment for oesophageal cancer.

The VALUE study is assessing how useful an endoscopic ultrasound (EUS) scan is for guiding treatment decisions. This involves putting a camera down the oesophagus (food pipe).

University Hospital Southampton (UHS) is one of the first three UK sites now open and recruiting patients.

The study is being run by researchers at Cardiff University and coordinated by the Southampton Clinical Trials Unit.

Choosing the right scan

Currently, there are large differences across the country in how patients with oesophageal cancer are assessed. This means patients at different hospitals may receive different care.

Oesophageal cancer is often diagnosed at a late stage. This makes it more likely that the cancer has spread, and there are few treatment options available. Because of this, just one in 10 patients survive more than five years after diagnosis.

To decide on the best treatment for a patient, doctors use scans to assess the cancer. They also look at the surrounding tissues and organs, to see whether the disease has spread.

The EUS scan involves putting a flexible camera into the patient’s mouth and down the oesophagus. This allows the doctor to examine the cancer and surrounding area.

Dr Kieran Foley is Chief Investigator of the VALUE study. He is consultant radiologist at the Royal Glamorgan Hospital and Velindre Cancer Centre. He is also clinical senior lecturer at Cardiff University.

“We know from a UK-wide survey of doctors who treat oesophageal cancer that the use of EUS scans varies widely amongst different hospitals,” he says.

“There is also limited evidence for exactly how useful the EUS scan is compared to other methods such as PET scans.

"This, combined with unequal access to EUS across the UK, could potentially lead to different decisions on how patients are treated between the hospitals using EUS and those where it is not used.”

Understanding treatment decisions

Dr Foley is working with the team at the Southampton Clinical Trials Unit (SCTU) to run the study.

The teams aim to find out if EUS is an effective tool for making treatment decisions, and if so, whether it should be used more widely. 180 patients will take part at eleven UK oesophageal cancer centres.

“Doctors will be asked to record what the best treatment plan for each patient would have been, before knowing the results of the EUS,” says Ben Lindfield from SCTU.

“They will then re-consider the treatment decision using the new information that EUS provides. This will help us to understand how EUS changes treatment decisions.

“Patients and doctors will also be asked to complete interviews about their thoughts and experiences regarding EUS, to help the team better understand how and why decisions about EUS are made, and when it might be most effective.”

Gathering evidence

The VALUE study is now open. It is recruiting patients at UHS, Castle Hill Hospital, Hull and Glasgow Royal Infirmary. It will also open at a further eight sites in the UK.

Dr Foley continues: “Using the evidence gathered in the VALUE study, we hope to be able to make recommendations about the usefulness of EUS for doctors making treatment decisions for patients with oesophageal cancer, and whether EUS should therefore be used more consistently across UK hospitals.”

The study is being funded by a research grant from the National Institute for Health and Care Research (NIHR).