Think back to March 2020. Risk, fear and huge uncertainty was everywhere. With businesses shuttered and schools closed, the very fabric of normal everyday life had become undone overnight and none of us knew when (or if) it could be put back together again.
 
That’s how it was for the bulk of the population but imagine if you, or a loved one, also had cancer. At the same time as you’re facing up to the horror of this disease, a deadly virus is suddenly on the loose, rendering previous assumptions obsolete, uprooting planned treatment plans and casting further doubt over both present and future.
 
What impact did covid have on chemotherapy? Should you still go to the hospital and adhere to planned appointments? Did the virus have more impact on those already clinically vulnerable? As the pandemic took root, such questions ricocheted around the health establishment and answers came there few.
 
And that’s where Dr Lennard Lee came in.
 

Adjusting to a new reality
Dr Lennard Lee, Academic Clinical Lecturer in Medical Oncology at The University of Oxford headshot It’s fair to say that in addition to his white lab coat, Dr Lee wears many hats. He is chatting to me from his office at the University of Oxford, where he is an academic clinical lecturer in medical oncology. He is also a senior clinical research fellow at the University of Birmingham, and also works for NHS England’s Cancer Programme, as clinical advisor for cancer innovations and diagnostics – quite the portfolio career. The irony that I am recovering from Covid when we speak is lost on neither of us.
 
When the pandemic began in March 2020, Dr Lee was focusing primarily on his lab-based research but, like many others, was soon redeployed to support the National Health Service. As medical practitioners and policymakers were grappling with the onset of the virus, those focused on cancer were also trying to understand what the implications were for their patients and treatment plans – and the disruption was acute, amongst patients and practitioners alike.
 
“Many patients at the time were not turning up for their appointments – there was plummeting demand for their treatments and cancer services as patients wanted to try and protect the NHS,” recalls Dr Lee. “And at the same time, the UK’s network of 86 cancer centres were going on the blink, one by one. Warnings were everywhere, such as the one from Imperial College which said 500,000 people were going to get coronavirus and would be at severe risk of dying immediately. This meant the cancer centres were faced with a really terrible decision about whether to keep going with cancer care or not.”
 
As a result of these warnings, there was a split amongst the medical professionals, with many advocating closing down the centres and stopping the chemotherapy, and the others lobbying for them to stay open and continue treatment plans, as long as it was safe to do so.
 
It was a hugely difficult quandary – one that would have major implications for many patients. Dr Lee and his colleagues in Birmingham (Professors Middleton and Cazier, Dr Roland Arnold and Dr Claire Palles), though, were not about to take a guess or go with the narrative being spun by ill-informed or statistically flawed “research”.  They wanted to know for sure what the best course of action would be, predicated on sound clinical evidence.
 
“We decided that we needed data,” he explains. “We needed to know for certain if chemotherapy could be safely given.” But wanting data is one thing, actually finding and using it is quite another.
 
So how did they do it?
 
 
“Warnings were everywhere, such as the one from Imperial College which said 500,000 people were going to get coronavirus and would be at severe risk of dying immediately. This meant the cancer centres were faced with a really terrible decision about whether to keep going with cancer care or not” Dr Lennard Lee, Academic Clinical Lecturer in Medical Oncology at The University of Oxford
Deploying the data

Client Conversation: Fighting Covid, Fighting Cancer - deploying data icon Unfortunately, when the pandemic began there was something of a blank canvas, one that slowly began to be filled in by WhatsApp messages aplenty. These communications were filled with a wide variety of reporting, some saying that their patients had died, others saying that theirs had survived – real time data analytics in action. But more needed to be done.

“That’s when we pulled together a consortium, the UK COVID Cancer Programme where all the cancer centres could share information about who was at risk and who wasn’t,” explains Dr Lee. “We worked flat out through the rest of 2020 into 2021. We worked out that blood cancer patients were safe and we had to keep going with chemotherapy because, basically, we weren’t causing excess covid risk by giving them this treatment – it was more about other factors, such as age, ethnicities and other vulnerabilities, rather than the chemotherapy which was driving the risk.”

The project was one of the first pandemic population-scale projects for cancer patients globally and, as such, it played a pivotal role in giving cancer clinicians in the UK and around the world the necessary reassurance to continue with cancer care in the midst of the fight against covid.

“We pushed back very strongly against the messages from China which were all about having to stop cancer treatments,” recalls Dr Lee. “By contrast, we took an evidence based approach and this resulted in a number of academic evaluations, including one in The Lancet that has been cited something like 900 times. Our consortium is very proud of that because the whole world followed – everyone started opening their centres and offering more treatments again, which had a direct and positive impact on patients.”
 
 
“We worked out that blood cancer patients were safe and we had to keep going with chemotherapy because, basically, we weren’t causing excess covid risk by giving them this treatment – it was more about other factors, such as age, ethnicities and other vulnerabilities” Dr Lennard Lee, Academic Clinical Lecturer in Medical Oncology at The University of Oxford
Enter the vaccines
As the pandemic progressed, the arrival of the vaccines heralded a game changing moment – suddenly the light at the end of the tunnel had gotten a lot brighter. But for cancer patients and their doctors, the vaccines also prompted further uncertainty about their safety and efficacy.
 
“Our community was completely thrown again but we made the case strongly that our patients should be given vaccines and should be among the first recipients, along with the elderly,” says Dr Lee. “But then what? Could they be fully protected and go out to live their lives as normal?”
 
To gain further clarity, Dr Lee – who by now was working at the Department of Health and Social Care (DHSC) – entered into collaboration with Prof Peter Johnson and teams at the UK Health Security Agency to use the DHSC’s EDGE Platform, a BAE Systems-designed single platform which houses consumable terabytes of data, all within a secure environment now owned by the UKHSA.
 
“It was a platform that was fit for purpose, had the data we needed in usable formats and the tooling that allowed us to run analysis on cancer patients, at an unprecedented scale,” says Dr Lee. “It was a very good programme that was ready to deliver where there was clinical need,” says Dr Lee. “It’s not just reliant on single centre studies, but population scale analytics which means you can go into a lot more detail. Our results were incredibly interesting – some patients gaining high effectiveness, but then others not getting very good protection at all. This level of detail was necessary to make all the right strategic decisions.” 
 

Doctor’s orders
Client Conversation: Fighting Covid, Fighting Cancer - doctors orders icon The young Lennard Lee was always destined for a medical career, it transpires. “I’ve always wanted to be a doctor,” he reveals. “I’ve always wanted to make sure we can offer hope and quality of life for the people who need it. One-in-two of us is likely to get cancer in our lifetime – it’s so common and it’s also incredibly fast-paced. New drugs come out every quarter, each time delivering incremental gains in terms of outcomes by buying people an additional few months or few years.”
 
And that’s why the pandemic was so particularly impactful for the cancer sector as all of a sudden, all that progress was at risk. “Everything we’d worked for could have fallen apart if our community agreed that cancer care should be stopped or curtailed,” he says. “So the whole community came together to help ensure it clinical benefit was maximised.”
 
Yet it was by no means straightforward. Dr Lee and his colleagues had to navigate an environment where there was often elements of sensationalism, conspiracy theories and a reluctance to rely solely on the word of experts. Amidst these unstable foundations, he reiterates that their primary mission was to protect the doctor patient conversation by empowering the doctor to give the best information to the patient.
 
“If you don’t have evidence to call on then you can’t be a good doctor to your patients,” he says, “Yet, this was the difficult scenario. Hundreds of thousands of doctors needed to come together to make these evaluations available. Fast forward to today, though, and the data we now have makes that a much better consultation and this protects and delivers a good doctor patient relationship – 86 cancer centres used this data to make sure it was the safest and best possible interaction – as well as feeding it upwards beyond their units to a national level.”
 
It's also important to note the sheer innovative nature of this work. Never before had there been this type of nationwide dataset, as each cancer centre previously relied on their own individual metrics – which rendered detailed analysis impossible as it was separate and uninterpretable. “These studies used to be very small and fragmented and we would struggle to see the woods for the trees,” admits Dr Lee.
 
“But the strength of the UKHSA EDGE platform and approach was that there was a comprehensive evaluation across all the centres using a dataset that already existed through the national testing infrastructure. We now had the power of size and we were able to track trends and rare events, as well as real-time hospitalisation data, which was hugely powerful.”
 
 
“The strength of the UKHSA EDGE platform and approach was that there was a comprehensive evaluation across all the centres using a dataset that already existed through the national testing infrastructure” Dr Lennard Lee, Academic Clinical Lecturer in Medical Oncology at The University of Oxford
Capturing the lessons
Client Conversation: Fighting Covid, Fighting Cancer - capturing lessons icon Today, Dr Lee is hard at work juggling his myriad different roles, but the pandemic is rarely far from his thoughts. But when asked to identify the key lessons learned from the past couple of years prompts the first pause in our conversation.

“Firstly, you have to maximise the data and infrastructure strengths you’ve got,” he says, after a moment’s reflection. “It’s about extracting the full value of the data you have. Not using data is itself a choice and it’s a choice which may result in adverse effects as we wouldn’t know what is happening to people.”

He goes on to cite the critical value of the collaborative approach. “Our network is made up of 250 people all inputting their insights and knowledge,” he points out.

“Everyone accepted that a collaborative approach was crucial and so you should always link up as many people as you can. But we also benefited from the structure of the UK health system. What we did was world leading. Our colleagues in the US wanted the recipe for what UKHSA did – their fragmented system with different providers isn’t ideal for learning when you’re in a pandemic.”

So that’s Dr Lee’s story, but it’s a story that is yet to reach its concluding chapter. His network is still operational and is now one of the longest running of those set up during the pandemic. “We will continue as long as there is excess risk,” concludes Dr Lee.  “We want to maintain the balance of benefit for cancer patients, in terms of giving them the best quality of life and prolonging their time they have left, and that’s where the data is so important in allowing them to live the best life they can.”

Cancer patients wouldn’t have it any other way. 
 
 
 

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About the author

Andy Lethbridge is Global Consulting Director and Head of Consulting, Central Government, at BAE Systems Digital Intelligence 

andy.lethbridge@baesystems.com

 
 
Further reading
  • Delivering data dividends: lessons from the pandemic. Data has proven to be a pivotal weapon in the fight against Covid-19 but its effective deployment has not always run smooth. Here, Andy Lethbridge chronicles his experiences navigating the uncharted and unexpected at the heart of the UK’s early pandemic response
  • Health check: charting the ethical use of data. Data now plays in any major public health programme – but seizing the opportunities it presents is one thing, protecting the privacy of individuals is quite another. However, that’s exactly what happened during the Covid-19 response, as Nick Rhodes and Andy Lethbridge explain
  • Real-time decisioning and psychological safety. As employees grapple with ever more decisions to take and data to understand, psychologically safe work cultures have never been more important.  Holly Armitage explains why taking the right decisions in real-time is as much about mindset and culture change, as it is technology and processes
  • Resilience – so much more than we think. Andy Lethbridge reflects on his experiences and lessons learned from working at pace, in high pressure environments over the last 18 months
  • Data, data everywhere, too much for us to link? Policymakers are increasingly reliant on data to strengthen government performance and drive better, more citizen-centric public services. But this evolution does not always run smooth. Here, Andy Lethbridge spotlights the themes and challenges we are seeing in our day to day work across central government