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In conversation with consultant clinical oncologist Dr Petra Jankowska

From September, Dr Petra Jankowska will begin her role as the newly elected medical director, professional practice, clinical oncology at the Royal College of Radiologists. She caught up with Julie Penfold to discuss her aims in the role, her passion for clinical research and improving patient care and her hopes for the future of oncology.

With such an esteemed career in clinical oncology, one might imagine this was always the career that Dr Petra Jankowska had in mind. Yet, she didn’t always plan to be an oncologist.

‘I originally thought I was going to be a respiratory physician. I spun around doing lots of different jobs in my training that I thought would be good for respiratory medicine, but I ended up doing oncology and fell in love with it,’ she recalls.

Now, Dr Jankowska is a consultant clinical oncologist at the Beacon Centre at Musgrove Park Hospital in Taunton, Somerset, UK, where she specialises in the treatment of patients with lung cancer and head and neck cancer. She was instrumental in the development of what has become a centre of excellence for cancer treatments, cementing the Beacon Centre’s reputation nationally.

She relishes the fast-moving pace of both oncology and radiotherapy and the way in which this allows clinicians to support patients in different ways.

‘There are lots of developments happening in both radiotherapy and in systemic therapies,’ she explains. ‘It’s always interesting, no single day is the same as the next and it’s a specialty that really holds the patient at the centre of all of our endeavours.’

New role, extended ambitions

Dr Jankowska has a keen interest in peer review of radiotherapy contouring. ‘Peer review can help to foster a more open, transparent and supportive way of working while improving treatment outcomes,’ she says.

Following her election as the Royal College of Radiologists (RCR)’s next medical director, professional practice (MDPP), clinical oncology – a role that will commence on 1 September 2024 – Dr Jankowska hopes to support the wider implementation and development of radiotherapy contouring peer review in oncology services across the UK.

The second edition of the RCR’s guidance on target volume definition and peer review, which Dr Jankowska co-authored, was published in 2022. But peer review has as yet not been routinely rolled out in every UK centre, and it is Dr Jankowska’s ambition to see it implemented in all oncology departments.

‘The idea of peer review is it provides an opportunity to have a second look at your work,’ she says. ‘When you come to do contouring peer review with a colleague, you might spot a lymph node that you previously missed due to poor lighting or simply work fatigue, for example. We want treatments to be precise and accurate and peer review can ensure we get it right.’

Harnessing the use of artificial intelligence (AI) could help to streamline how peer review is carried out to free up clinicians’ time. This could be especially beneficial for departments that have a smaller number of clinicians who may otherwise have to carry out peer reviews with colleagues at other centres remotely, where this would also impact on the time of another clinician.

‘It may be that AI or computer-assisted learning machines could help by doing a first read or first contour of radiotherapy outlines, although we’re certainly not there yet,’ Dr Jankowska explains. ‘Most of the AI tools I’ve come across have been in the context of contouring the organs at risk rather than the actual cancer target, but it’s a step in the right direction.’

Implementing innovations

Musgrove Park Hospital already has several AI tools in use. One is used in radiology for triaging the many chest X-rays coming through from primary care. This helps with identifying abnormal X-rays that need to be prioritised for human reporting, and a similar tool is used in assessing X-rays of trauma patients to identify fractures.

AI tools are also used to identify small lung nodules – triaging them according to risk of malignancy – which is particularly useful in the context of lung cancer screening, she explains.

Also in the cancer diagnostic realm is the potential for increased use of what patients often refer to as the ‘blood test for cancer’, Dr Jankowska says. Genomic analysis for circulating tumour DNA in this way, even in advance of a biopsy being carried out, can help clinicians to look for molecular mutations of certain cancers and assess whether particular targeted treatments might be helpful.

In terms of radiotherapy developments, Dr Jankowska says: ‘The UK is a little behind Europe in terms of its proton and heavy ion work because of lack of infrastructure. But what we can do well is work collaboratively across the UK with our members and fellows to have a unified, non-postcode-lottery type of cancer care. That’s where we really can find our strength and follow a little in the footsteps of countries such as Denmark.’

Focusing on late effects of treatment

One of the biggest challenges Dr Jankowska sees affecting cancer treatment trajectories is that delayed effects of radiation therapy can occur many months and often years after a patient has undergone treatment and this can have a significant impact on their quality of life. Late effects services can help with symptom management and offer much-needed patient support, which is something else that’s top priority for Dr Jankowska.

‘We have to move from a place where we follow up people for five years and then discharge them if they are cured after radical or adjuvant treatment,’ she says. ‘It’s important there is recognition that some of these treatments do cause late effects.

‘Having these services for patients enables them to get back into the system if they do have longer-term side effects. While it’s great if we’re getting better outcomes and people are living longer as a result of good treatments for cancer, it’s not so great if we’re not also managing those late side effects.’

Undergoing clinical research

Dr Jankowska’s recent clinical research has focused on how radiation can be combined with other systemic treatments, particularly immune checkpoint inhibitors such as the much-investigated programmed death-ligand 1 (PD-L1) expression.

‘We know that lots of cancers have a high expression of PD-L1 and we have a number of treatments for that expression,’ she explains, ‘and we also know radiotherapy can upregulate those receptors.’

When immune checkpoint inhibitors are used after patients have had radiotherapy, there’s a potential synergy in how the two treatments work together. This is seen when immunotherapy has been used after concurrent chemoradiotherapy for lung cancer that couldn’t be operated on but was non-metastatic and was therefore potentially curable.

‘Before the PACIFIC clinical trial, lung cancer five-year survival rates were in the region of 20-25% but that has almost doubled now to around 44%,’ Dr Jankowska says. ‘It’s a phenomenal difference and there’s definitely something about the synergy in which radiotherapy works with immune checkpoint inhibitors that needs more exploration.’

She next awaits the results from the CompARE trial. Her team contributed to the national recruitment of oropharyngeal cancer patients with intermediate or high-risk features to take part in the study. It compared a combination of the chemotherapy drug cisplatin and radiotherapy with four other treatments to see which is optimal, as well as considering how treatments affect people’s day-to-day lives.

The first data could be available as soon as mid-2025 and Dr Jankowska and her team are already eager to learn what the results will show and determine how they might have a positive impact on patient care and outcomes.

A beneficial balancing act

The two-month countdown to Dr Jankowska starting her MDPP role is almost here, and once underway she will combine this work with her consultant role at the Beacon Centre. ‘I won’t be relinquishing any of my clinical work as I don’t have that luxury,’ she explains. ‘I work in a rural district general hospital where we don’t have a wealth of doctors to take on some of my clinical work.’

But she views this as a distinct advantage and says doing something that’s completely different to the clinical role can be ‘invigorating’ and ensures her finger remains on the pulse of clinical practice and faculty activities. Indeed, combining her roles will enable her to keep abreast of new developments and the direction of travel within oncology and radiology nationally, across Europe and beyond.

‘This will help me to bring ideas back to my department and share learnings from my clinical work with the RCR’s members and fellows,’ she adds.

This dialogue with members and fellows is something she’s particularly keen to generate and she would like to see them all being really engaged with the Royal College so it can continue to be a growing support for them.

What will be central to this is members and fellows feeling valued and heard. ‘Part of this is recognising that our workforce is our biggest asset,’ she adds. With a keen interest in the development of supportive medical leadership, Dr Jankowska is primed and ready to nurture the current and future workforce to ensure the implementation of best practice across the sector for the benefit of clinicians and patients alike.