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James Douglas

James Douglas

Urological Oncology

Mr James Douglas is a Consultant Urological Surgeon at University Hospital Southampton and holder of a Research Leaders Programme (RLP) award.

His research focuses on improving treatment for people with bladder and kidney cancer.

The ‘Cinderella’ of urological cancers

Bladder cancer is the ninth most common cancer in the UK, and the fourth most common in men. It has the highest recurrence rate of any cancer, making it one of the most expensive to treat.

Despite this, bladder cancer receives less than 1% of dedicated UK cancer research funding, and is the only one of the top ten most common cancers where survival rates are not improving. This has led to it being called the ‘Cinderella’ of urological cancers.

“Bladder cancer research is historically under-funded,” James explains. “Prostate cancer and breast cancer have a lot of public attention and attract adequate funding. In comparison, celebrities don’t share the news that they’ve got bladder cancer, and as a result it does not get prioritised.”

Bladder cancer can be divided into two types. The most common, affecting around two thirds of people with the condition, is known as non-muscle-invasive or early stage bladder cancer. These tumours readily recur in the bladder, which results in invasive ongoing checks and surgery.

“Many of these patients are never really discharged, due to recurrences and risk of recurrences,” he says.

The remaining third have a more aggressive type. They either have muscle-invasive or metastatic bladder cancer. Patients with this can have blood in their urine, urinary frequency or in the worst scenarios pelvic and bone pain. Without treatment, they would die within 12-18 months.

The gold standard treatment for muscle-invasive bladder cancer that is not metastatic is to have surgery known as a cystectomy, where the bladder is completely removed. Some patients also have chemotherapy or immunotherapy. If it spreads to other parts of the body, the cancer is said to be metastatic, and palliative systemic treatments are used.

Personalising treatment

James plans to use his RLP award to increase the number of commercial trials at UHS for bladder and kidney cancer. This will give patients with these cancers more opportunities to take part in research.

In some cases, taking part in trials may allow patients to access treatments not currently available on the NHS. For example, they may be able to have antibody drug conjugates (ADCs), which have been approved for use in the USA. These use antibodies to specifically target and kill cancer cells, meaning they have fewer side effects than standard cancer treatments.

“They’re complete game-changers,” says James. “In the advanced, non-curable setting we’re getting some amazing results.”

James also plans to build on his research into personalised medicine. Each cancer patient has tumours with different genetic changes, known as mutations. Personalised medicine aims to target treatments to patients, based on their cancer’s mutations.

“The ultimate goal for all cancer, but particularly bladder and kidney cancer, is personalised or precision medicine,” says James.

‘Untapped resource’ for the NHS

James did his MD with Prof Simon Crabb in Southampton. He then did a fellowship in Vancouver, where he showed that genetic sequencing of bladder cancer samples can help predict how patients will respond to chemotherapy. This has now led to the GUSTO trial, jointly run by Prof Crabb.

He has also been Principal Investigator on the POTOMAC bladder cancer trial, and recruited the first bladder cancer patient to the 100,000 Genomes Project.

Yet he says that, since becoming a consultant, he has been unable to use his training and experience effectively, as his clinical commitments take up all his time.

“The NHS is full of trained scientists (PHDs and MDs) working as clinicians,” he explains, “but all that scientific training is not being used, so there’s a big untapped resource.”

By providing dedicated time for research, James says that the RLP is allowing doctors like him to make full use of their training and experience.

“The RLP certainly shows that UHS values research,” he says. “It’s something that should be applauded, because by investing money they’re freeing up clinicians’ time. I expect those clinicians will deliver and the patients will benefit. I think it’s brilliant.”

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