Metaphors and concepts (5)

I have saved some of the ideas that have proved to be at the heart of my creative research for the latest batch of concepts to emerge from the conversations and research into the cancer ecosystem. And following on from this post I will start to share some of the creative and visual ideas i have been working on – but without posting these concepts first, they would make much less sense. So here goes!

“Hypoxia“

A state of insufficient oxygen. This can happen at the centre of a tumour when the blood vessels do not penetrate to the centre of the tumour, and tends to start happening once the tumour gets to around 1cm. In medical convention, fully oxygenated blood is represented by the colour red, less oxygenated by blue (thinks arteries versus veins). Severely hypoxia tends to be represented by dark blue or black.

In the middle of a tumour the environment for cells is often both hypoxic and toxic – cells that survive these conditions are preselected to be tough, resistent, intransigent.

“Angiogenesis“

The process by which new blood vessels form from existing blood vessels. This is initiated through cells signalling that they are becoming hypoxic. Cells in cancer tumours send lots of these signals and new blood vessels then begin to grow around and into the tumour to try and bring oxygen to the hypoxic cells. The blood vessel growth can be very disordered and excessive as compared with normal vessel growth. The Childhood Leukaemia team shared this image with me of blood vessels from a tumour.

“Mosaic Vessels“

Occasionally blood vessels that grow in cancer tumours as part of angiogenesis include tumour cells as part of the blood vessel structure itself, so that ‘normal’ epithelial cells and abnormal cancer cells form the wall of the blood vessel together. These are mosaic vessels.

“Morisita Index”

The Morisita Index is drawn from statistical study of populations and is a measure within a population of how mixed up or separate the different elements of a population is. In relation to the cancer ecosystem, it measures the degree to which different types of cells – eg epithelial cells, immune cells, tumour cells – are aggregated or segregated. As well as being applied to the nature of different tumours, the index can also be applied to human populations, for example, in a working environment, to express how combined or segregated they are.

“Liquid Tumours“

I have always thought of cancer tumours as something solid. Some hard and unyielding, some softer or floppier, but I had not really considered that tumours could be liquid. Whereas, solid tumours are indeed solid and lumpy, liquid tumours, eg leukaemias and lymphatic tumours, flow.

How all this relates to the London Cancer Hub?

In some ways the easiest concept to apply directly to the LCH is the Morisita Index. In fact, in conversation with one of the researchers who introduced me to the Morisita index, we discussed how he had been drawn to work at the ICR by the multidisciplinary nature of the teams there. I observed that this seemed like a Morisita measure in the workplace…

Other concepts here are less obviously applicable to the LCH directly. Nonetheless I feel that they have relevance to the work i am doing in relation to the LCH as well as the cancer ecosystem. Hypoxia and angiogenesis are to be interpreted literally as part of the cancer ecosystem, but they function rather well as metaphors in the context of the LCH. They are also potentially visually very interesting.

Taking specifically the idea of hypoxia and its relationship to angiogenesis, here is some of my thinking. In the body there are areas that require more oxygen; in organisations there are areas that require more resources or attention. In both cases these call for more connectivity and greater flow though – with the cardiovascular system through the growth of blood vessels, in terms of organisations perhaps one can read stronger relationships, more interaction, greater communication. Where an area of a body is cut or hurt, new blood vessels grow. For new areas of organisation, it is may be necessary to grow new routes of communication, new career paths, new sources of resource. To which you can equate angiogenesis.

These metaphors also work for me in relation to an issue that has troubled me in running the parallel between ideas about the evolution of an ecosystem at the LCH and the study of the cancer ecosystem. Cancer, obviously, is profoundly threatening to the organism. whereas the developing ecosystem at the LCH, one hopes, is going to result in a healthy symbiosis, a mutual thriving. I find the ideas of angiogenesis helpful in relation to this, in that angiogenesis can be a system that functions in a positive, orderly way in a healthy body, bringing oxygen to growing or healing tissue. However, in cancer it can also ‘overgrow’ into a support system for malignancy, playing a role in metastasis as a route through the body. So you can view angiogenesis from both a functional and dysfunctional perspective, as potentially ordered or disordered.

From both the conversations I have been having and my reading, I realise that angiogenesis is no longer the newest focus of research. It was very much at the forefront in the 1990s and 2000s when an active research priority for curing or preventing cancers was developing and deploying angiogenic inhibiting drugs. However, it remains a central part of the cancer ecosystem, and while i was researching at the ICR the Childhood Leukaemias team published several new papers suggesting that new understanding of the role of hypoxia in TP53 mutations could really illuminate what’s going on when cancers metastasise,

The London Cancer Hub – a wilderness or a garden (or something in between)?

As the project evolves(!) it feels like time to reflect on some of the things I’ve learned about the LCH as an entity as well as continuing to update this blog with all the concepts and metaphors I’ve drawn from the conversations about cancer research.

And now that I’ve talked to a variety of folk based at the Sutton site from the ICR, the Royal Marsden and also from the London Borough of Sutton I am both a whole lot clearer and a whole lot less clear on what the London Cancer Hub actually is.

A view across the LCH from the ICR access road to the new Innovation Gateway site

Fundamentally, it seems to me that the ‘London Cancer Hub’ is an idea. It’s not the only example of a ‘hub’ that brings together similar types of organisation in one site with the aim of maximising the potential of the co-sited organisations by placing them together. See for example, this article by UK Research and Innovation outlining collaborations across the UK, several of which include co-location, or this one about the Imperial College White City Life Sciences campus. What makes the London Cancer Hub unique is its tight focus on the science of the prevention and treatment of cancer.

But beyond that simple explanation of a shared goal, I have been struggling a little with what actually binds the London Cancer Hub together, and what differentiates it from other partnerships and collaborations that are aimed at cancer treatment and care. And when I started to delve, I realised that I had arrived with a whole set of assumptions, many of which I am only now becoming aware. And because I am dealing with snapshots, transient impressions and fragments of explanation, which are the nature of the types of conversation I have been having, it’s going to be a little tricky to pin down what I mean, but here’s an attempt.

When I heard about the London Cancer Hub, I assumed that there was some sort of integration effort that was bringing all the disparate elements of the London Cancer Hub into some sort of intertwined relationship. By that I don’t mean at all that I thought there was going to be a single overseeing organisation or that the different parts would become a single body, but I did think there was probably a sort of masterplan that was dedicated to ensuring the different organisations would begin to intermingle more, and to encourage cooperation and cross-fertilisation of ideas and activities.

And now I am not so sure this is the case. (And as ever, i may be mistaken, but if so, that in itself may be indicative of something). Whilst there is clearly significant collaboration going on – in particular I know there are lots of positive and proactive interconnections between the ICR and the Innovation Gateway, and the ICR and the Royal Marsden have a longstanding relationship – I am more unclear about how the LCH as a whole will be becoming actively more than the sum of its parts? And how it will be significantly different or more than the existing partnerships. Here are some questions (in no particular order) that have arisen for me so far from that point of view:

How will people know that this is now – or becoming? – the London Cancer Hub? Several of my interviewees so far have not appeared to know what I meant by ‘London Cancer Hub’ without an explanation from me. Is that timing? Does it matter? How does that change if it does matter?
Who – if anyone – takes the overview of the experience of a member of the public visiting the site, wandering around, and crossing boundaries, visiting different organisations? Does the idea of a visitor experience that crosses between areas matter? Will there be a single map? And/or am I in such a unique position that its unlikely to matter to anyone else?
How is the aesthetic experience of the site managed as a whole? Maybe that’s not important, given that there is always going to be a mish-mash of interesting buildings from different eras, but maybe there are things that might bring a useful coherence? Or maybe different identities as you traverse the site is grounding?
How about the staff experience of being part of a London Cancer Hub? Will there be ways to encourage curiosity or collaboration between the people in different organisations beyond what is structurally necessary?
How will the serendipitous discovery of overlapping interests happen as a result of the Hub’s existence? Who provides space for people from different organisations to intermingle randomly and interestingly – or who will in the future? So far the only place on the site that seems to specifically cater for staff from across the site is the small social club with a once-a-week bar. Is anyone responsible for creating these sorts of spaces? Or is that not how things work? Or maybe just not yet…

More than one of the people I have spoken to so far has looked at me blankly when I’ve asked about what makes the Hub a Hub beyond all being in the same place. I am fully aware that it’s very early days for the London Cancer Hub and maybe it’s too early for these sorts of questions. And maybe ultimately it doesn’t matter. But maybe it does? It would certainly matter if the bonding and binding has an impact on the research, treatment and care of patients and the inspiration, motivation and satisfaction of staff?

A garden run wild between the Innovation Gateway and one of the demolition sites

Thinking about all of this in direct relation to the questions I’ve outlined as my research project, it feels like the underlying question is one of whether the London Cancer Hub equates more closely to a wilderness or a garden. If it’s the former, the assumption would be that everything will grow together organically, creating its own ecosystem like a true, untampered-with, natural habitat, a wild area where species settle into their own relationships as they wander through the uncharted spaces. Or is it more like a garden? In that case, there would be dedicated horticulturalists planting, tending, pruning and nurturing amd mapping our the whole plot.

Given all the effort going in to the creation of the LCH and the high stakes of its success, my guess is that it needs to be a garden. And while there are definitely a lot of gardeners within individual areas, some of whom are also tending the boundaries, it would be interesting to understand the design for the whole landscape.

And finally – i need to think about why i am using landscape metaphors and not bodily ones!

Visiting the ICR and the LCH Site

My first visit to the Institute of Cancer Research was utterly fascinating both in terms of developing an understanding of key concepts about the ecology of cancer and of getting a sense of the London Cancer Hub itself. I was lucky enough to meet with researchers from two different teams and was slightly punch drunk with ideas and information by the end of the day. Rather than write about the meetings here one by one, I plan to use this blog to think about some of the concepts and ideas and how they might translate into relevant artwork. These will unfold over future posts. This post is actually about my first visit to the site in concrete terms, how i found it, how it looked and how it felt to be there for the first time.

The LCH is near Belmont in Sutton. I was unfamiliar with my route to it by road, or the lie of the land around the LCH. I was surprised to come across the site as i was making my way through a warren of residential streets; the LCH nestles amongst the housing, mostly hidden from view.

The first buildings I saw as I came onto the LCH site (via the signposts to the ICR – there are a variety of access points) were some old brick Hospital buildings, presumably Victorian and presumably part of the Royal Marsden, past or present? The bulk of the original Royal Marsden on this site is actually midcentury, and was officially opened in 1963, but I couldn’t see much of that from my approach. I carried on past towards the ICR.

As I carried on down the access road, I came to the new ICR campus – brand spanking new buildings set in flat green parkland, some of which is earmarked for further development.

From windows of the Centre for Cancer Drug Discovery you can get something of the lie of the land. As well as being able to look over many of the different constituent parts of the Royal Marsden, it’s also possible to view the Innovation Gateway site – still very much a work in progress.

I spent pretty much all my day in the Centre for Cancer Drug Discovery where I had meetings in the purpose built meeting rooms as well as having a chance to talk to some researchers in their offices and to look at the labs used by the Cancer Evolution team.

As one might expect, everything was subject to secure access – you needed a pass to get into any of the buildings, and each of the office areas and also clearly the labs required a pass to access them. I was struck by the contrast between corridors and meeting rooms, which both felt a bit stark, mainly quiet and empty, and the offices and labs which were busier both with people and with papers or equipment. In the labs I got to borrow white and blue lab coats, depending on area, to adhere to the health and safety protocols. Odd how much it felt like dressing up.

As we walked around between meetings I was trying to get my bearings (and anyone who knows me knows that’s a feat – I could get lost in a small box) but even more, I wanted to take in the feel of the place. It’s much too early to do anything here other than record very first impressions, but those impressions are very much of a work in progress, a stitching together of the very old, the very new, and all the things that came in between. It gave me a real insight as to where the project stands at the moment; the LCH is not so much an entity as an idea that is beginning to take physical shape.

And that led me to question how far the LCH is also taking organisational shape – is that totally conceptual still or is it having any impact on working practice?