by ecancer reporter Clare Sansom

The fourth and final day of NCRI 2013 featured two contrasting plenary lectures; both were tour de forces, and both were given by clinicians.

First to speak was Sean Morrison of the Hertzberg Palliative Care Institute in New York, whose thought-provoking talk made the case for a palliative approach to the care of cancer patients extremely well.

Morrison began by highlighting the problems we all face as the population ages: not least the growing numbers of the seriously ill.

Cancer is largely a disease of the elderly, and as treatments improve people will be living with cancer for longer.

Survey data consistently shows that patients with serious conditions and their families are dissatisfied with many aspects of their healthcare.

Morrison sees palliative care – which he defines as specialist, multi-disciplinary care for people with serious illness, aimed at controlling symptoms and improving quality of life – as an important means of improving the quality of healthcare.

A large randomly controlled trial of palliative care as an addition to disease-specific treatment in cancer patients in the US found that those who were given palliative care had a better quality of life and lived longer, and that the average cost of their care was less.

Despite this, palliative care as a discipline is still rarely studied and poorly funded.

Perhaps controversially, Morrison ended his talk by speculating that one reason for this is our fear of death: a view of palliative care as symptom-related, holistic care of all seriously ill patients, many of whom will recover, may help overcome this problem.

Nazneen Rahman of the Institute of Cancer Research, London, gave the final plenary lecture on cancer predisposition genes.

Germline mutations in these genes convey a moderate or high extra risk of developing cancer.

There are currently about 114 known cancer predisposition genes, all discovered within about the last thirty years.

So far, predisposition genes have been discovered successfully using three techniques: candidate gene approaches, linkage analysis, and genome-wide (or exome-wide) scanning, and they have been associated with over forty different cancer types.

Rahman described a number of predisposition genes associated with her own specialty of breast cancer, starting with the well-studied genes BRCA1 and BRCA2.

Many mutations with different effects have been discovered in these genes, and the often quoted statistic that a BRCA1/2 mutation confers a 70% risk of breast cancer by the age of 70 is only true in cases with a very clear family history.

Finally, Rahman focused on one further breast cancer gene, the DNA repair gene PPM1D.

Most cancer-causing mutations in this gene truncate the protein product, which usually suggests a recessive phenotype and loss of function mutations; in this case, however, detailed analysis has showed them to be gain of function mutations.

The mechanism through which these mutations cause cancer is novel and is still not entirely understood.

All that remained after this lecture was for the conference chair, Harpal Kumar, to conclude the meeting.

Kumar announced the winner of the Twitter competition; made a presentation to the retiring NCRI President, Jane Cope; and invited delegates to come to Liverpool again for the tenth NCRI conference in November next year.

The winning tweet was posted by Stuart Griffiths (@Stu_P_Griffiths) of the Breast Cancer Campaign, and the 133 characters that won him £100 in Wisepress vouchers were these: “If you want a great, not just good, career do what interests you. My conclusion having heard Bruce Ponder talk this evening”.

And judging from the success of the 2013 NCRI conference it will interest me greatly to repeat the experience next year.