Dr Stephen Robinson, Clinical Oncology Registrar (ST6) and University Hospitals Sussex Medical Doctoral Fellow.
How long have you been a clinician and researcher?
I have come full circle, having been a medical student in one of the first cohorts of students at Brighton and Sussex Medical School (BSMS) and graduating in 2015. Following graduation, I joined the Academic Foundation Programme based in Sheffield where I was able to undertake a 4-month research placement in addition to my clinical training. I was subsequently successful in applying for an Academic Clinical Fellowship to continue my training as a researcher whilst starting my training as a clinical oncology registrar (a doctor who uses drug treatments and radiation to treat cancer). At this point I was on searching for options to take the next step in my research career and undertake a PhD when I then heard about the opportunity to return to Sussex as a Medical Doctoral Fellow. I successfully applied to become a UHSussex Medical Doctoral Fellow and started my PhD with Professor Giamas at the University of Sussex in January 2023.
How did you get involved in research?
I have always been passionate about research as a way to advance knowledge and improve the way we care for and support patients. Throughout my time at BSMS I was able to join in several small research projects, undertake an excellent intercalated degree at Brighton University performing laboratory research and undertook an extended individual research project as an integral part of my medical degree. Following these experiences, and with the support of Professor Chevassut at BSMS, I was able to spend some time researching techniques for diagnosing blood cancers that I was able to write up and publish as a research article. I continued to choose to make research a part of my training and am grateful to be able to return to Sussex to continue my research journey.
What is your research about?
Following previous work by Professor Giamas’ laboratory, I am hoping to develop a blood test as a liquid biopsy technique for the most aggressive brain tumour called glioblastoma. Extracellular vesicles are tiny particles that all cells (including cancer cells) release to communicate with their surroundings. These particles are small enough that they can exit the brain and can be found in blood, whilst their contents can tell you about what cell they came from. This suggests that by performing a blood test and then capturing and analysing these particles, information can be gained about a person’s cancer. We will compare the contents of these particles from blood samples of patients with glioblastoma and matched healthy volunteer blood samples to see if we can find a difference which can be used as a biomarker signature.
What inspired you to be interested in your research subject?
Pushing our collective knowledge of how to manage and support patients forward has been a driving force throughout my career, and so I was always on the lookout for opportunities to get involved in different research projects. I was extremely fortunate that Professor Chevassut was willing to support my development by helping me to develop my first semi-independent research project, whilst Professor Richard Simcock in Oncology at UHSussex was instrumental in helping me understand the need to embed patients’ needs and experiences into developing and conducting research projects that drive forward patient-centred care.
What opportunities have you had to develop your research at the Trust?
UHSussex, and BSMS, have provided several opportunities to help develop my own research. Most recently, the Trust’s Medical Doctoral Fellowship scheme has provided me the time and opportunity to really focus on my own research through conducting a PhD. The senior clinical researchers in the oncology department, especially Dr Duncan Gilbert and Dr Rebecca Herbertson, helped me develop my application for this scheme and I was fortunate enough to be successful. Additionally, the development of the Sussex Cancer Research Centre through the support of UHSussex, BSMS, the University of Brighton and University of Sussex, is an excellent step forwards in linking up all the different cancer researchers across Sussex to provide new collaborations and research support
How do you plan to develop your research further, in the future?
Once we have shown that our blood test can be used to find a glioblastoma biomarker signature, we will need to see how this signature changes over time and in response to treatment. Therefore, we are in the process of developing a clinical study which will allow us to collect several blood tests from patients with glioblastoma in Sussex as they go through their standard treatment. We will also look to compare the signature identified for patients with glioblastoma to the signature identified from other types of brain tumours including patients with brain tumours secondary to a different cancer (called brain metastases). This will allow us to refine the signature to be even more specific for patients with glioblastoma and should hopefully allow us to identify similar changes in the different conditions that drive brain tumour development.
Why is it so important for research to be accessible for all patients and staff?
We know that research is the best way to develop new ways to manage our patients, and so the best way to help our patients in Sussex is to provide access to research. However, historically, accessing research studies has not always been an option for some patients whether due to age, having other medical conditions or other reasons. If these patients are not included in research, then the evidence we use to decide on how best to manage these groups of patients is more limited. Therefore, to be able to improve outcomes for all patients, we must therefore ensure that research is accessible for all patients as well.
What are you most proud of achieving during your research career so far… that has improved/brought/changed/done for your patients?
One of my most significant accomplishments is developing a national database of patients with glioblastoma following a recent change in how we diagnose glioblastoma. Despite an overarching National Health Service, there is no standard process to identify all patients with a particular condition. Whilst some details are automatically collected, this often lacks detail and limits the ways that you can investigate the information. Therefore, we have less knowledge of UK based glioblastoma patients than might be expected. I was able to bring together almost all UK centres to help provide a detailed look at glioblastoma in the UK. Through investigating this database, I will be able to determine how well patients do with treatment compared to the published clinical trial evidence (which is often only tested in highly selected patients). Through developing this database, I had the opportunity to present the findings from my work as oral presentations at the British Neuro-Oncology Society Annual Conference (the leading brain tumour conference in the UK) and I am looking forward to publishing the findings so that more people can hear the results, and we are in the process of developing a tool that can help to provide more personalised prognostic information to patients.
What techniques and equipment do you use to conduct your research?
When I’m based in the lab, I spend most of my time processing and analysing blood samples to capture these tiny particles called extracellular vesicles. This means I do lots of pipetting (transferring small but accurate volumes of liquid from one place to another) and using advanced machines to find out different things about the particles including their size, their shape, their number, what is inside them, and what makes up their surface. This last step is performed using a very special machine called the Leprechaun. This machine was very generously funded by the My University Hospitals Sussex charity and is one of only a handful in labs across the world. I also spend a lot of time trying to build links with other doctors and researchers across the UK and the world. A big limiting step in my own and others research is access to patient samples (blood samples in this case). Through developing links with other researchers, this can help provide access to more samples or to allow samples to be investigated in the most efficient way.
What impact is your research having / or will have on patients?
Developing a blood test to help with the diagnosis and monitoring of patients with glioblastoma, and other brain tumours, would be revolutionary. If a blood test can inform us about a person’s brain tumour, then we can refine our ability to provide a prognosis and decide on a treatment plan. It would be a significant step forward. One example is that currently after treatment for a glioblastoma, patients have regular MRI brain scans to check if the tumour has come back. Unfortunately, lots of patients’ brain scans cannot give a final answer as the tumour coming back can look the same as the brain’s response to treatment. If this happens, then patients need to have repeated brain scans normally over a period of a few months to try and help give an answer as to what is going on. This leads to significant anxiety for patients and a feeling of helplessness in the doctors looking after them. If our blood test can help give a better answer, then this ability would enable more frequent monitoring, lessen costs and delays, and reduce anxiety for both doctors and patients. It might also allow patients to start appropriate treatment earlier if that’s necessary or provide reassurance if the tumour hasn’t come back.
What advice would you give to someone working at the Trust considering research?
I would strongly encourage anyone considering research to go for it! Healthcare staff are in the best position to identify gaps in our knowledge, or processes that can be improved, to support their patients. Whilst research is not always an easy or simple process, as long as you find something that interests you and remember why you chose to get involved in research, then the process can be extremely rewarding. And with the excellent support of UHSussex can also be really fun!