Department of Precision Health expands its cancer expertise

Sophie Pilleron joins LIH with a project to reduce disparities in cancer outcomes

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• Département Santé de Précision 
• Cancer

Dr Sophie Pilleron, established researcher in the field of cancer epidemiology, joins the Luxembourg Institute of Health after winning funding for her REDICO project. In a short interview, she tells us all about her past, present and future.

• Tell us about yourself.

My name is Sophie Pilleron, I am 42 years old and I have two daughters. I am a cancer epidemiologist specialising in cancer and ageing. I am currently working at the Nuffield Department of Population Health, Big Data Institute, at the University of Oxford, UK, and was just awarded a 5-year ATTRACT grant by the FNR.

• What brought you to Luxembourg?

As shown by the 2^nd National Cancer Plan, there is a strong will at the national level to improve cancer outcomes, especially for older adults. However, research in cancer epidemiology remains underdeveloped in Luxembourg: this provides a unique opportunity to develop this discipline in the country.

I am also at a turning point in my career where I have gained enough knowledge, skills and confidence to set up my own research group. The ATTRACT funding offers me a chance to do exactly that. Aside from the science, Luxembourg is an attractive country to live in, known for its quality of life, and multiculturalism.

• Your ATTRACT project, REducing DIsparities in Cancer Outcomes – REDICO, just received two million € funding. Can you tell us more about the project and how it fits within the national strategy to fight cancer?

The REDICO programme, involving epidemiologists, clinicians, qualitative researchers, statisticians, and data scientists, is a participatory research programme combining both quantitative and qualitative approaches. We’ve included older patients with cancer from the start of the programme, to ensure that our research takes their needs into account.

The REDICO programme, which will start in the beginning of 2023, has four specific objectives, each targeting a different key moment in the cancer journey:

1 – Time to diagnosis: We will aim to comprehensively understand factors influencing time to cancer diagnosis in older adults with the goal to develop strategies to reduce it, and ultimately improve cancer outcomes.

2 – Treatment decision-making process. We will observe and analyse how cancer treatment decisions are made to identify areas that need improvement, and propose tailored training to medical staff. To do that, we will capture patient’s experience on the treatment decision-making process; we will explore what and how information is shared between physicians and patients during medical encounters and try to understand how physicians make their final decision when confronted with little evidence.

3 – Treatment in older patients with cancer. Older adults are seldom included in clinical trials leaving clinicians without strong evidence-based treatment strategies for their patients. We will use cancer registry data linked to treatment and hospitalization data to estimate the effect of anti-cancer treatment (e.g., chemotherapy) on toxicity and survival in older patients in England and Luxembourg.

4 – Personalizing cancer care in older patients. We aim to develop a digital decision aid tool based on geriatric assessment items (eg. comorbidity, frailty, functional status, cognitive disorders) using the digital twin approach – an innovative methodology that relies on artificial intelligence. This will be used in clinical practice to help oncologists identify older patients who would benefit the most from treatment and those with vulnerabilities that could be mitigated before undergoing treatment.

The project is in line with the 2^nd Luxembourg National Cancer plan, particularly with Axis 4 “Prevention, Screening & Epidemiology”, Axis 7 “Pediatric Oncology & Geriatric Oncology”, and Axis 8 “Clinical and Translational Research”. It also fits well with national research priorities defined by the FNR in collaboration with the Ministry of Higher Education and Research, particularly in terms of “Personalized care”.

• Can you tell us about your research to date, in particular what led to the REDICO project?

For the past five years, my research has been dedicated to improving our epidemiological understanding of cancer in older people through the description of the cancer incidence at global and regional levels (e.g. Latin America and the Caribbean), and of cancer survival based on age at diagnosis.

I was the first to describe the global cancer burden in older adults. In a highly cited work, I provided critical insights for policymakers to inform the development of cancer control policies for the rapidly growing older population. Notably, my work has attracted the attention of the Union for International Cancer Control, a key NGO that works to advocate for better cancer control programmes.

While most studies on geriatric oncology are clinical, I described survival in older people at a population level. My research allowed me to highlight a different pattern of age-related differences in cancer survival based on the cancer prognosis: age gap in survival of cancers with good prognosis increases as the disease spreads, while for cancers with poorer prognosis, gap reduces as the cancer becomes more advanced. These findings suggest improving early diagnosis and treatment outcomes may help reduce the age-related disparities in cancer outcomes and are the foundation of the REDICO programme.

• Why the Luxembourg Institute of Health?

My research group will be hosted by the Department of Precision Health led by Dr Guy Fagherazzi at the Luxembourg Institute of Health (LIH).

The Department of Precision Health at the LIH has widely contributed to several axes in the 2020-2024 National Cancer Plan, as well as in the development of the National Cancer Registry. It has listed the development of cancer epidemiology research as its top priority for 2022. The REDICO programme is therefore perfectly in line with the LIH’s research strategy and development.

My research also fits well with the National Centre of Translational Cancer Research (NCTCR) initiative led by LIH Professor Simone Niclou, particularly with the Flagship Programme on Prevention and Care that aims to: “develop and strengthen cancer epidemiology and health systems research, with a specific focus on tailored cancer prevention and screening, cancer etiology, quality and access to cancer care and unmet needs in oncology”.

• What do you hope your REDICO project will achieve?

By the end of the 5 years of the programme, I hope that my team and I will be able to formulate recommendations to improve cancer outcomes in older adults and to translate them into real-life interventions.