Mr Tim Duncan specialises in the treatment of both early and advanced stage gynaecological cancers. He has a research background in tumour immunology and takes part in many important clinical trials in gynaecological disease. Mr Duncan works at Norfolk and Norwich University Hospital (NNUH), which has been internationally recognised for providing excellent surgical care to women with ovarian cancer.
We find out about his day-to-day life at the Norfolk hospital and his research into women’s health.
A typical day is…
Predominately clinic-based, with a number of specialised clinics and two days of theatre in a week. Each day, the key is to integrate excellent diagnostic standards and patient assessment with high-quality treatment – particularly when it concerns the surgical side of ovarian cancer. This requires long hours in the operating theatre and intensive time on the wards, where we ensure post-surgery patients are fully prepared for subsequent chemotherapy. The interface between surgical and chemotherapy services is crucial to achieving the best outcomes for our patients, so the weekly multidisciplinary team meeting is a very important part of the week.
Your most memorable work moment is…
Seeing a patient’s artwork that she had produced depicting her feelings throughout her journey from diagnosis, surgery, chemotherapy and thankfully remission. The images were stunning and highlighted the impact the diagnosis of advanced ovarian cancer has on a woman and her family. She found comfort through her art work and felt this was an effective way of communicating her emotions during her treatment. This highlighted to me that there are many remarkable ways in which women cope with this challenging disease.
The worst part of the job is…
Not being able to achieve cure, or at least long term remission, for patients. With work focussing on earlier diagnosis, better surgical techniques and novel chemotherapy strategies, I hope that someday we will see positive outcomes for all patients with ovarian cancer.
The best part of the job is…
Working in such a dedicated team who have a shared goal to offer world class care for all women with gynaecological cancer. Gynaecological cancer produces many hurdles and it is only through effective team working that the excellent outcomes we strive for can be realised. I am proud to work with some fantastic colleagues. The service we provide is not down to one or two individuals and a strong team is needed to offer the high quality care we strive for.
Speaking of fantastic teamwork, Norfolk and Norwich University Hospital has a European certificate for advanced ovarian cancer surgery...
Yes, the ESGO certification for advanced ovarian cancer surgery was a major accolade for our department. It demands a consistently high standard of surgery, which is rigorously assessed to ensure the quality of care is of the highest level. It’s recognition of years of work and service development from the whole team, which saw the refinement of clinical pathways, active involvement in clinical trials, and taking on specialist surgical techniques.
What do these specialist techniques involve?
The gold standard of ovarian cancer surgery is to remove all visible disease. Numerous trials have demonstrated that if this is achieved, the effectiveness of chemotherapy, and therefore patient prognosis, is improved. Ovarian cancer surgery can be lengthy and complex. Currently not all centres offer such surgery, but it’s pleasing to note that the UK is now coming around to this concept. I hope many other centres are able to deliver this standard of care soon. It would be fantastic if other teams were able to achieve ESGO accreditation.
How does research feature in life of a gynaecological surgeon?
When I was training in Gynaecological Oncology in Nottingham, I was able to spend time with a fantastic research team and investigate a number of molecular markers that could predict ovarian cancer tumour behaviour. The most interesting part was uncovering the relationship between cancer and the immune system, where (in a process we call “immune editing”) cancer cells managed to evade detection.
Now, I lead the postmenopausal bleeding service; this service rapidly assesses women in a one-stop clinic. I also lead in the delivery of national and international gynaecological clinical trials within the department where I’m the principal investigator for a number of trials at any one time. These are hugely important studies because they inform us of how new treatments can improve patient care.
How can we create better treatments for women?
I passionately believe that a centre that embraces new developments through clinical trials represents the future of care for women with gynaecological cancer. I am proud to work in one such unit, it forms part of our everyday work, with patients constantly being assessed for suitability for involvement in appropriate studies. Clinical trials are the only way in which we can develop new treatments to enhance patient care.