29 August 2018

To commemorate both the spotlight on cancer awareness as part of the NHS 70 celebrations and Blood Cancer Awareness month, we interviewed BSH member Dr Graham Collins who told us about his time working in the NHS, and how the treatment of haematological cancer has changed during his career. Dr Collins, a Consultant Haematologist at Oxford University Hospitals, also gives advice about those wanting to pursue haematology as their specialty of choice, and the rewards and challenges that it brings.

What led you to a career in haematology, and to your specialist area of work?

I didn’t want to be a haematologist at first. Infection and autoimmune disease were my main areas of interest so rheumatology or infectious diseases appealed. However as I went through my junior doctor training and came across haematology patients, the concept of immune system cancers (which lymphomas and leukaemias basically are) and transplanting immune systems seemed very interesting. So I applied for an SHO job in haematology at UCH for 6 months and absolutely loved it. I really enjoyed the day to day management of patients who were often very sick, but could sometimes be cured of their disease. Lymphomas in particular I found to represent a very diverse group of diseases some of which were very aggressive and others were extremely indolent. The range of management options was also huge: from watch and wait, to haploidentical allogeneic stem cell transplantation. So once I was coming to the end of the registrar training I decided to sub-specialise in lymphoma medicine.

I’m largely known in the field for an interest in Hodgkin. This happened rather by accident. When I was looking for a PhD project, a supervisor basically had one all lined up looking at the molecular biology of the Reed-Sternberg cell. Once I had embarked on the project, colleagues started treating me as an expert in Hodgkin lymphoma so I started behaving like one! When I became a consultant I joined the NCRI Hodgkin study group which has been a really wonderful experience, working with enthusiastic and committed collaborators.

What advice would you give to someone considering a career in haematology?

It’s unusual to come across a haematologist who regretted their choice of specialty. The training is challenging and the exams for FRCPath are difficult. But the career itself is endlessly fascinating. Haematologists have the reputation of being ‘nerdy’ which is probably true and a lifetime of learning is important in any specialty – haematology being no exception. Many will opt to do research as part of their training, but this is not necessary by any means. There is also increasingly an appreciation that clinical research (which usually gains an MD) is just as valuable as laboratory research (which usually gains a PhD) and many centres are now able to provide clinical research options.

What is the most rewarding and most challenging aspects of your job?

The most rewarding aspect by far is having the privilege of seeing a patient through probably the most harrowing period of their life – the diagnosis and treatment of a blood cancer. It is also fantastic to manage these patients as part of a wider team with dedicated consultant colleagues, specialist nurses and pharmacists to name but a few.

The most challenging part is wading through the ever increasing bureaucracy without becoming too frustrated.

How has your specialist area of work developed and innovated in your time working in the NHS?

There have been lots of developments in the lymphoma field. Some are due to new therapeutics. Ibrutinib and other BTK inhibitors are game-changing medications when it comes to treating relapsed mantle cell lymphoma and Waldenstrom macroglobulinaemia. Working in early phase trials I’m also aware of a number of other very active therapeutics which I’m confident will benefit patients and improve outcomes in the field. CAR T-cells also are a very innovative development although it’s a shame that the UK has not been involved in the development of these products to any great extent. It will be interesting to see how the NHS enables provision of these treatments.

There have also been significant changes in the way we work. Due to bed pressures, much more of our work is now aimed at delivering day treatment, or ambulatory care. I see this as a great benefit to patients as hospital admission is rarely welcomed.

Finally – I welcome the emphasis the UK government are putting on clinical trials. Although the government no doubt has financial reasons for this, I do see trials as the only way our field will develop and trials also offer an excellent way to access new lines of treatments for patients.

How can the NHS ensure that it continues to be at the forefront of your specialist area of work?

Whilst there is an emphasis on trials, the UK is still behind in its ability to deliver. Sadly the UK has a reputation for being slow to open trials and that is my experience. There are multiple layers of approvals in the UK which are not all needed in other countries and this means pharma are not always keen to bring their trials here. A focus on how we can cut down unnecessary red tape and regulation around trials would be hugely helpful.

I have been impressed recently with how NICE seem to have speeded up their single technology appraisal process meaning we’ve had fairly rapid access to drugs such as PD1 inhibitors in Hodgkin lymphoma. However with the number of agents in trials, this will represent a considerable challenge for them to maintain this output. Rapid assessment is vital to translate the results of trials to patient care.

What does being a BSH member mean to you?

BSH to me offers a community of likeminded professionals who are interested in haematology and are keen to improve patient care for haematological disorders. The newly formed lymphoma Special Interest Group (SIG) chaired by Kate Cwynarksi is a fantastic forum providing clinical update and discussion of areas of debate within UK practice. The annual meeting is a real highlight offering not just a chance to update CPD but more importantly to meet old and new friends and to form or strengthen scientific collaboration.

*The contents of this article do not reflect an official BSH position. We would value your thoughts on this article and hope it provokes discussion within the haematology community.


Read more about the spotlight on cancer as part of the NHS70 celebrations

Get involved in Blood Cancer Awareness month


Join the BSH Lymphoma SIG 

BSH events: Register for our Lymphoma SIG event - Dilemmas in the Lymphoma MDT

  • Dr Graham Collins
    Lymphoma specialist at Oxford Cancer and Haematology centre