‘Physicians and engineers need a physical location where they can mingle’

‘It is becoming increasingly important to figure out how we can continue to provide sustainable oncological care,’ says Dennis Schaart, theme leader Oncotech within the Delft Health Initiative. Technology can play an important role in this quest. Next to improving proton therapy, Remote Oncology has a high priority as well.

‘I remember visiting one of the large universities in the United States,’ Schaart says. ‘I was still working in industry, wearing a suit and tie, a little overdressed, carrying my laptop. A person exits the treatment room. I look at her and realise that she is my age. I must have been 27 years old. My life could have been so different.’ It is his drive for doing cancer research. ‘You meet patients, you see the impact of cancer on people’s lives, and it becomes a part of you.’

‘Cancer is the number one cause of death in the Netherlands. On top of that, it is becoming a chronical disease. What can be the role of technology in adapting to this change? How can we minimise the burden for the patient?’

Gateway

‘It is fair to say that OncoTech was launched because TU Delft, LUMC and Erasmus MC established HollandPTC – the proton therapy clinic on the TU Delft campus, which also includes an extensive research programme on proton therapy,’ Schaart says. ‘But it certainly wasn’t the start of cancer research at TU Delft. It just wasn’t very visible as it was kind of hidden in the nooks and crannies of the University. The idea was to integrate all this research, using the proton therapy clinic as a flagship. But that certainly isn’t the only research activity.’

‘Stimulating cross-campus collaboration is our top priority, and a perfect fit to the philosophy of Delft Health Initiative 2.0. You need to combine several disciplines to advance oncological care, and that is something we don’t yet do often enough. In our effort to change this, we put the spotlight on young and promising researchers, the so-called Rising Stars of TU Delft.’

‘The role of OncoTech is not limited to the TU Delft campus. We want to be the gateway between TU Delft Researchers and the outside world, presenting TU Delft as an attractive R&D partner for medical institutes, within the convergence with Erasmus MC and Erasmus University Rotterdam, and within collaborations such as HollandPTC and Medical Delta.’

Protons

‘Technology plays an important role in all phases of cancer care – prevention, diagnosis and treatment. Right now, we put a lot of effort into proton therapy (irradiating cancer with protons rather than gamma rays). A few years ago, we opened this proton therapy clinic where we treat patients but that also houses a lot of research facilities. At HollandPTC, physicians, biologists and (TU Delft) engineers roam the hallways and bump into each other. The facility produces excellent results. And proton therapy is growing rapidly. Globally, the number of institutes has doubled in only three years’ time.’

‘Proton therapy is a very advanced, highly accurate treatment. It reduces the side effects of radiation therapy suffered by patients. It is, however, still a very expensive treatment. We want to change that.’

‘Radiotherapy is a fractionated treatment. The treatment is spread-out over multiple days to allow healthy tissues to heal. It does, however, mean that a treatment can last for thirty days, requiring a patient to come to the clinic each working day over a period of six weeks. We want to reduce this high number of fractions by increasing the accuracy of the treatment. Put simply, if healthy tissues do not receive any radiation, they don’t need time to heal. It will take a while to reach the holy grail of treatments consisting of only a single fraction. We do, however, believe that continuous technological improvements will allow us to reduce the number of fractions substantially.’

‘If we, for example, acquire high-definition pictures of the patients in real-time, during their treatment, we are able to adjust to proton beam on the spot to treat the right location. This kind of technology is currently non-existent, or hardly available.’

Remote Oncology

‘Next to proton therapy, we also put a lot of research effort into Remote Oncology, together with the Erasmus MC Cancer Institute. Fueling this research is a combined need to lower costs and to improve the quality of life of patients. Cancer is the number one cause of death because of population ageing. At the same time, we can treat cancer much better. This means that the number of patients increases, with many more of them requiring longer-term care. This process is expected to continue in the decades ahead.’

‘This raises the all-important question of how we can continue to provide sustainable oncological care. When I entered the field of cancer research twenty-five years ago, we only cared about improving the quality of a treatment. Now we also have to worry about maintaining capacity and keeping costs in check, while minimising patient burden.’

‘It is a challenge for us, engineers, to help reduce costs. It turns out that the majority of costs is related to personnel, with medical-technological equipment covering only about 5% of the healthcare budget. The number of man-hours ‘spent’ on oncological care is off the chart. Therefore, the solution is two-fold: How can we increase efficiency and how can we move care outside of the (relatively expensive) hospital walls. What kind of care can only be provided by a regional care centre, and what kind of care can we safely apply at home? Technology will play an important role in implementing this transformation – think of data technology and wearables for monitoring and screening in the comfort of a patient’s own home. I see a lot of potential: tiny smart devices, low power, low cost. Next to a technological challenge, Remote Oncology is an organisational challenge as well, one that offers opportunities to reduce the impact a care pathway has on a patient’s well-being. We want to increasingly make use of the experience already available at TU Delft in optimising so-called patient journeys.’

Physicians and engineers

‘My entry into medical field was purely coincidental,’ Schaart says when asked about the collaboration between physicians and engineers. ‘Physics mesmerised me and I intended to continue in fundamental physics research. It just so happened that, right after obtaining my master’s degree at TU Delft, an opportunity opened up to do short-term research at a company into a specific type of radiotherapy. It was a project I greatly enjoyed, and the company asked me to join them full time to work on another project.’

‘We always collaborated with hospitals to incorporate our technology into clinical practice. You then start noticing what these hospitals really need and how you, as an engineer or a physicist, can address their needs. By definition, oncology is a race against the clock. Physicians are always in a hurry; engineers can take a bit more time.’

‘During my time at this company, I also learned the importance of developing technology in close collaboration with physicians, taking into account the needs of the patient, of course. It is important to leave your desk from time to time.’

Coffee machine

After a number of years, Schaart returned to do – sometimes very fundamental – research at TU Delft. He believes such fundamental research to be a very promising avenue for OncoTech. ‘Treating cancer means you have to understand cancer, all the way down to the molecular scale. Given our great experience in and knowledge of nanotechnology, these Fundamentals of Oncology can lead to many cross overs. And, as TU Delft, there is a lot we can contribute to a somewhat higher level – the microscopic level – as well. Think of cancer-on-a-chip as an alternative to animal testing.’

‘OncoTech and its flagship, the proton therapy clinic, are flourishing,’ Schaart concludes. ‘I am convinced that this success is largely the result of having a physical space where various disciplines come together. We run into each other at the coffee machine, and the ideas just keep coming. A bottom-up approach often leads to the best research projects. We therefore invite anyone interested in oncology-related topics to get in touch with us.’