Head and neck regenerative cell therapies

About the research

The use of cell therapies to enhance tissue healing is an emerging field within regenerative medicine. During Nick’s PhD he developed a novel method for delivering cells to surgical wounds within the head and neck. He is currently trialling two types of cell therapy in the laboratory using this technique. One involves taking surface (epithelial) cells from the throat of a patient, growing in a culture dish and then transplanting back into the same patient to improve healing. The second involves grafting a type of stem cell from discarded umbilical cord which has been proven to enhance tissue repair and regeneration. Unlike epithelial cells, these stem cells can be transplanted without the risk of rejection from the recipient and can therefore be used as an “off the shelf” treatment. This greatly cuts down on cost and increases scalability.

The current phase of the research is funded through the MRC (animal based part of the study), the NIHR (Nick is an NIHR clinical lecturer) and a small grant from the Royal College of Surgeons.

Preparing for PPI

To prepare for PPI in this research, Nick attended a workshop about PPI that was run by the National institute for Health Research. He was also given advice by the PPI Manager at the Biomedical Research Centre at University College London Hospital. The BRC gave Nick a bursary to help him to run a PPI activity.

Planning for PPI

Nick wanted to check whether the potential treatments he was exploring would be acceptable.

“We’re looking at two potential treatments. The one we develop will be based on the results we get from the various experiments we’re doing, but if patients were to say that the idea of taking pre-grown cells from a patient and then putting back into them was unacceptable, and that there’s no way they would want to go through an additional operation as part of a clinical trial, then we wouldn’t pursue that idea. The other possible treatment is a stem cell graft - cells taken from the umbilical cord and from donated placenta. If patients were to say, there’s no way I want discarded products of birth being used as a treatment, we wouldn’t pursue it. Once you get to the stage of a large animal study it’s very expensive and it’s the sort of thing you only want to do once. So we need to make sure we design something that is going to be acceptable to patients.”

Nick decided to seek the views of head and neck cancer patients. He approached cancer specialist nurses who run a patient support group for head and neck cancer patients. He wrote a very short piece about his research and he then invited patients to get involved. He has also approached a group of laryngectomy patients, supported by speech and language therapists. They emailed group members on Nick’s behalf. “So I didn’t really recruit people myself, I based it on people who attend groups and aren’t bothered about getting on a tube.”

Nick decided to run a discussion group. “We thought about doing a Skype type exercise, especially for the airway patients, because they have more difficulty mobilising. But for head and neck patients, they can mobilise, they do come to this sort of group, and I felt it would be better to get them in a room. Also, I’ve got experience of focus groups – they’re a good way to canvas opinion, they are relatively easy to set up, everyone knows what they’re getting.”

Six people agreed to get involved.

The PPI manager at the Biomedical Research Centre linked Nick up with Derek Stewart, a throat cancer survivor, patient activist and facilitator. Nick used a bursary from the BRC to employ Derek to co-facilitate the discussion group.

The PPI activity

The discussion group was held in the hospital’s cancer support centre. The agenda, developed in partnership with Derek Stewart, is here.

“I think it went really well, the patients seemed really happy to be involved and they had a lot to say about different treatments. It was interesting to hear their perspective. Derek was great. Having him there made the whole thing a bit more impartial, and he’s very good at running those sorts of things. It was a really positive experience.”

Six people felt like the right number. “Any more would have been too many.”

Nick believes that the fact that some people already knew each other helped things to go well. “They were quite happy to talk openly because it was an existing patient group. They already had experience of talking with each other and they knew each others’ faces. I think that helps because they’re feeling in a better place to talk about what they really feel, rather than coming into a room where they don’t really know anyone.” It was also useful having a clinical nurse specialist, who knew all of the patients, in the room. She was available to offer support, if needed.

Impact

The main impact the meeting had on Nick was to reassure him that he was heading in the right direction. “I don’t think I had any massive revelations, but it certainly confirmed what I believed and it reassured me that the things I thought were true were actually true. What I’ve really taken out of this is that we’re on the right track, and we’re producing something that patients would be interested in, and that they would be willing to be part of a trial.”

Follow-up

Nick plans to continue to involve patients throughout his research. “Hopefully I’ll build up a group of people. I will involve them as I look towards a bigger grant and the clinical trial.” Nick plans to continue to use discussion groups, but will also use email: “I would always prefer to run a discussion group - I like the face to face contact, and I find it works better. If I wanted more of a quick answer on something a bit smaller, then I would contact people by email to ask for their views. But when I’m developing plans for the next phase of my research I’ll definitely spend the time to get everyone in the room.”

He’s also aiming to involve airways patients because his research could be used for this group.