Facial deformation in childhood cancer survivors: ‘We need to improve our radiotherapy approaches’

Bringing people and science together

Lucy is a radiotherapy researcher at the Christie NHS Foundation Trust, where she currently holds the position of NIHR doctoral clinical and practitioner fellow. She also had a baby last year – which has made the research process rather more hectic than she might have hoped. “When I was writing my research proposal and going through the competitive funding application process for the fellowship I was heavily pregnant, and and had my baby just weeks before the interview,” she says. 

“So my life at the moment has been complete chaos! I am enjoying being a mum to a lovely little girl who has started walking and running around now like a little tornado.”

Over the past few years, Lucy has worked across research fields including proton beam therapy and the Christie’s novel magnetic resonance linear accelerator (MR Linac) service. But as of 1 October last year, she has commenced a three-year fellowship with the NIHR on their Clinical Academic Pathways as a clinical doctoral and academic fellow, all in service of her three-year clinical PhD. 

Now six months in, a lot of Lucy’s time has been spent working with her patient group, developing the facial structure atlas, and creating her study protocols in preparation for getting ethical approval. The next step is to obtain NHS HRA approval to carry them out, which Lucy hopes will allow her to truly get started on them towards the end of this year.

Before this Fellowship, Lucy was successful in being awarded the NIHR pre-doctoral bridging scheme, a six-month programme that helped her develop the project proposal and her patient advisory group. Lucy’s journey to this point, however, has not been anywhere near simple. Before she became a radiographer, Lucy was a professional contemporary ballet dancer who attended a vocational classical ballet school in London and worked for several years as a dancer. It was only after suffering an injury in the course of her profession that she decided she wanted a change of career. “When I was looking to retrain after my wonderful, albeit short, dancing career, I always knew that I liked working with people and liked the idea of working within a healthcare environment,” she says. 

“I didn’t necessarily want to be a doctor or a nurse, and radiotherapy offers some of the benefits of these roles. We get to work with patients and we get to build that rapport, but we also get to work with complex, advanced technologies, and it's bringing those worlds of people and science together. 

“And then with that research element, you get to try to improve what you deliver. Not the same as what you do as a dancer, but the concept of always trying to improve your technique, what you deliver to patients, it matches up. If I hadn’t had my professional dancing career, I don’t think I would have had the resilience to go down this path.”

Lucy completed her undergraduate degree at St. George’s, University of London in 2013 with clinical placements at the Royal Marsden, before moving to the Christie – primarily because of the opportunities for research provided to allied health professionals, she says. In 2018, the Christie opened the first NHS centre for high energy proton beam radiotherapy in the UK. Previously, patients were sent abroad as part of the NHS Proton Overseas programme. A second centre has since opened at University College London Hospital.

One of Lucy’s research aims is to understand how proton beam therapy, specifically, affects the later development of childhood cancer survivors. This is because proton beam therapy has the capacity to be more targeted, more conformal, permitting lower radiation doses to close by healthy tissues, making it much more likely to be used with children. “I've always had an interest in paediatrics,” Lucy adds. “I’m keen to develop improved treatments so that we can improve the experience for patients.”

After working her way up the ranks of radiotherapy into more senior positions, Lucy moved over to the proton beam centre upon its opening, before it was clinically operational. There, she found opportunities to participate in service development and improvement projects while the proton beam service was still in its infancy. The Christie was the first cancer centre to treat NHS patients in the UK with high energy proton beam therapy. In fact, Lucy – alongside a fellow radiographer – treated the first ever patient at the centre. 

Lucy then moved to a research radiographer post, where she brought her experience with radiotherapy to clinical trials. “That five years of experience really helped me understand the research delivery process,” she explains. “While I was in that role, I was able to undertake more service development, service valuation and small scale radiographer-led research projects.

“Then I started on the pre-doctoral bridging programme, and now I’m doing my PhD with funding from the NIHR. I’ve got a very supportive supervisory team with both clinical and academic excellence to help guide me and the project. I’ve had quite the circuitous route to get here!”

Lucy’s big jump from ballet dancer to research radiographer, to researcher and now to PhD candidate, wouldn’t have happened, she says, without the support of the people around her. She advises any radiographers – or prospective researchers – to just get involved and ask questions. “You don’t necessarily have to be leading that research,” she adds. “It’s quite a big jump from having no part in research to leading a project, so get involved in service improvement projects and audits. Speak to your patients, because they’re the ones using the service, and they can help you define your project aims and what’s really important to them.”