Transcript Disclaimer – Please note that the following transcript has been machine generated by an AI software and therefore may include errors or omissions.

Robin Daly
Hello and welcome to the second series of Cancer Talk, the podcast that explores the benefits of integrative oncology, an approach that brings together standard oncology practice for the raft of lifestyle and complementary approaches in order to provide broader, more holistic care to improve quality of life and outcomes for people with cancer. I’m Robin Daly, founder of Yes to Life, the UK’s integrative cancer care charity, and one of the hosts for the podcast. Series 1 of Cancer Talk was aimed at initiating conversations about integrative oncology and bridging the gap between mainstream and integrative medicine practitioners. And the Series 1 episodes are still available from Yes2Life.org.uk forward slash podcasts and major podcast platforms.

Dr Penny Kechagioglou
Hello, I’m Dr Penny Kechagioglou, I’m an NHS Clinical Oncologist and co-host for the broadcast and in addition to treating patients with all the regular modalities in use within healthcare, I have a passion for integrating evidence- supported lifestyle and complementary medicine into patient protocols. I’ve witnessed first have the enormous benefits this can deliver to patients and their carers. in Series 2 of the broadcast we are planning focused conversations with healthcare professionals, working directly with people with cancer and applying integrative oncology in contemporary clinical practice with the aim of strengthening the clinical voice and evidence for integration, influencing the wider community including academia and research and beating the case for an integrated UK model of care.

Robin Daly
Great to be back for another Cancer Talk, another great guest, maybe you’d like to introduce him.

Dr Penny Kechagioglou
Hi, Robin, great to be back and our first podcast since this September. I’m delighted to introduce Dr Deepak Ravindran, who is a consultant in pain medicine and honorary professor at Teeside University. Welcome, Deepak.

Dr Deepak Ravindran
Thank you much, Penny and Robin, for having me on this podcast here. And it’s a pleasure to talk to you today about various things around pain management and the way forward with cancer pain management specifically.

Robin Daly
lots to talk about. Great, brilliant to have you here. Do you want to tell us maybe a little bit about this is a very particular specialism you’re in there, how come you became involved in that? What was your path to get there?

Dr Deepak Ravindran
I’ve been here in the UK for close to 21 years now and working predominantly within the NHS until last month really and my background has with most consultants in paid medicine in the NHS and in the UK, most of our backgrounds are in anesthesia. I trained, my post-graduation specialism was in the field of anesthesia and I’ve had training in India where I primarily qualified and then I with the Royal College of Anesthetic here in the UK and I got the opportunity to do the one-year fellowship in pain management at UCL London and at the Royal National Orthopedic Hospital in Stanmore. that’s where I did my one-year pain fellowship and this was way back in 2009 when our understanding of pain was still very much I’d like to say biomedical in its approach in its management and over the last 15 years during my time as a consultant in the NHS I was full-time working in the NHS at the Royal Berkshire Hospital in Reading from 2010 up until July 2024 and over these 14 years the realization is that a lot of what we as pain specialists get taught about pain management needs to be enhanced and sort of integrated with a much broader outlook towards pain management and that can be applied to many other sub-specialties within pain management for example in cancer pain management or nerve neuropathic pain management or some other conditions which are very unique and rare within the pain field and that has made me appreciate that we need to be going upstream we need to be really going at the source of the complexity which causes chronic pain and we need to be approaching things from a much more integrated fashion that’s why in the last month after about 14 years I’ve taken the opportunity to see and work with primary care and with the primary care network specifically to see how we can use models that are unique to integrative and lifestyle medicine-based approaches and how can we then bring them for chronic pain management in primary care closer to the patient’s own closer to the GP practices and that might be a much better way of managing pain at least that’s my belief and and and that’s kind of led me to where I am but it is very much as going back to your question a field that’s within anesthesia but is a sub-specialty within anesthesia and in most parts of UK and Europe that’s where most of your pain specialists do come from.

Robin Daly
That’s amazing.

Dr Penny Kechagioglou
Very interesting to hear that you’re moving to primary care for that exact reason for looking upstream. And as you say, pain is quite a complex area, isn’t it? It’s got physical, it’s got psychological components, but if it’s not managed well, it can lead to serious socioeconomic outcomes. obviously you’ve been experiencing secondary care now in primary care. I mean, what have you seen the evidence being? And is the model appropriate in managing pain or can we do more?

Dr Deepak Ravindran
Oh, without a doubt, we can do much more. And I do particularly think that the opportunity for doing more is actually in primary care for a variety of reasons. I think within secondary care, it’s really good for the more complex picture of pain management, you know, where you do need interventions for some groups of patients. You might need nerve block. for example, in cancer pain, there’s certainly a role for what we call nerve burning or nerve ablating blocks. You might need through sometimes procedures that involve putting a drug in the spinal cord called intrathecal. these are very specialized procedures that still need sterility, still need secondary specialist review and complex understanding. Sometimes you have the overlap of mental health, which is quite a lot. Actually, 60 percent of patients with chronic pain will have coexisting depression or anxiety. And up to 30 to 40 percent will have coexisting trauma and PTSD like symptoms. the evidence wod say that you do need specialist approaches in that secondary care traditionally as offered and sometimes even tertiary care, which is what the university hospitals or certain very niche hospitals in London or Cambridge or Oxford or further up north, Birmingham and Liverpool can offer. But we’ve al realized that there is a big gap in the middle from where the patients want some good, sensible integrative advice around pain management to then what gets provided in a secondary or a tertiary care service in a multidisciplinary or interdisciplinary team with pain consultants, specialists, pain nurses, pain physiotherapists, psychologists, as well as occupational therapists. But there’s a big gn between, wherein we need to be doing a lot more to empower our patients to give opportunities to our primary care colleagues to al support the treatments that are maybe initiated in secondary care, but then need to be continued in primary care. And this is where the opportunity lies, because with chronic pain, exactly as you outlined, it’s a complex condition. There is much influence of the social determinants of health into what goes into the final pain experience. And much of it is coming from an understanding of the neuroscience, of the evidence that is emerging from our studies and looking into how the brain and the spinal cord and the nervous system responds to protection and threat. I think all of this,m happy to unpack it a little bit more in the next few questions, hopefully. But ultimately, what we realized is we need to be able to create an ecosystem that the benefit or the treatment that gets started in secondary care by our specialist colleagues is then reinforced, enhanced and empowered. this empowerment is noust of our primary care colleagues, but al of our patients and the other allied health care professionals working. You know, the health coaches, the paramedics, the social prescribers, the care coordinators.

Dr Deepak Ravindran
I think if we all understand how to view and look after chronic pain, then that means that we are going to be much better in supporting our patients to look after themselves. And that might mean giving us an opportunity to come at it from multiple angles. that’s what I mean, the egrative lifestyle medicine based approach offers that opportunity and primary care offers that fertile ground to do this work in for probably best scalability and sustainability in my view.

Robin Daly
that empowerment was ng back to say important because my second-hand experiences of dealing with like a cancer situation and pain and pain management is that You know for a consultant is it’s a 10 or 15 minute consultation for the patient. It’s 24-7. If you need to conody else in order to deal with an acute situation to do with pain Well, you’re you’re just in bad and that’s all there is to it But if you got resources yourself on the hand that you can do something yourself. It’s completely different

Dr Deepak Ravindran
Absolutely. I think you said it well, Robin. It’s that 15 minutes, you know, when I wrote and I was preparing sort of the evidence and reading for my writing my book, I came across this point there that if you counted the sum total of what our patients would be having in terms of specialist consultations, maybe with a GP or with a consultant or with a physiotherapist, then in a year, at the most, they would have between three to five hours of meeting a professional. The remaining 8,755 hours in a year, they have to live with that pain. They have to know how to deal with it, how to deal with their relationships with social support, with society at large, and to do it effectively and to maintain that motivation, that knowledge, that empowerment, we realize is very difficult. that’s why in someys I’m really excited with some of the developments in primary care with the help of this coaching approach, which a lot of colleagues are being now asked to consider for long-term conditions in general. I think that’s all very important because it’s not what I tend to say is education without empathy is like throwing spaghetti at a wet brick. It won’t stick. if you can do the f saying this is how you look after your pain, but you approach it from an angle of empathy and then you sort of scaffold it with that bit of coaching and to say that, yes, we are there to back you up if required, I think that is going to be the magic sauce in which the best forward-looking approach to looking after someone and looking after themselves is made sort of normalized.

Robin Daly
Wonderful. Very good to hear you talk about empathy in this context, because you’re absolutely right. Trying to manage somebody’s pain with no empathy, well, it’s, you know, as you say, it’s not going to stick. Dealing with as difficult a situation as chronic pain needs care, basic care, and care comes from empathy. So, yeah, very good to hear you say that.

Dr Penny Kechagioglou
But from a cancer care perspece, as an oncologist, I see pain manifested in different ways. And sometimes, you know, the same interventions have different outcomes in terms of pain to different people. And you mentioned about the neuroscience around it. what are those determinant influences that make pain manifest differently to people, which I think is probably your really deep interest, I think.

Dr Deepak Ravindran
Indeed, and thank you for that question really. It allows me to sort of separate it out and tease it out in a couple of ways to answer that. The first thing is the neuroscience, as you mentioned, has undergone a sea change. We’ve always been taught, as a society, and specifically the medical teachings of the last 300-400 years, have been around understanding pain as a symptom of a danger. It’s almost taught us it’s a signal of danger. But what we’ve now really asking people to reframe in the last 20-30 years of the neuroscience is that pain is not necessarily a signal of tissue damage or danger every time, it is an infestation of the desire to protect. pain is fundamentally a protector. Now the question to ask then therefore is, what is it trying to protect against? this opens up a much better to look at it, in my view at least, is how do you then think about what is a danger and where is this danger coming from that the protection of pain is needing to be evoked and shown for. And that comes from how we view pain. We’ve always been again taught a myth that has been there is that there are these pain pathways you feel in cancer. For example, let’s take the example of someone having a tumor and we often think about pain as primarily a physical attribute, either the tumor is increasing in size or the tumor must be pressing on a nerve or the tumor must be affecting some chemicals in there or the immune system, the nervous system is affected and that’s causing an issue. What has changed now in our understanding is probably about three things. One is that there are no pain pathways as it was. even when the tumor presses on the nerve or grows in size, the signal that travels from this tumor goes through the nerves. There are no pain pathways, it just travels through the same nerves that are sending every other signal of touch, of movement, of air, of chemicals, of heat, everything is sent through the same set of nerve pathways and they go up to the spinal cord and then they go to the brain. When they reach the brain, the decision on where this is coming from, in what context is this coming from? Is this coming from a size that I’m seeing increasing in my thigh or inside? Is it coming with some other context associated with some constipation or some other symptom? It’s going to compare and saying, have I had this before or has someone I know had something like this before? in fact, the brain is almost crted some prediction models already in there to say, what does this signal most resemble? And if it decides the sum total of all this decision making through different parts of the brain is to say, I don’t know what the signal is but I need to protect, then it’s going to bring about the experience of pain.

Dr Deepak Ravindran
that in a way to me would be ableo explain why some people can have, for example, a sports person can have an ankle twist during injury and during a football game and continue to keep playing but someone else who has an ankle sprain, maybe in the midst of a busy road or at home, would have physically the same problem, an ankle sprain that has happened at a physical level but the intensity of the pain that they experience will be very different because the history is different, the context is different where they have been when the injury is different and if they have had this before in the context of cancer, it’s very much a problem because if you’ve gone through one experience before and you have a similar set of symptoms coming, you do not know, your brain would rather make the safe assumption that this is likely to be related to the previous experience rather than to say this is nothing to be worried about because if it does make the decision that this is something safe, I don’t need to worry about, the brain will not manifest the experience of pain. this is why some people could have symptom at all or not experience any pain and may sometimes present to the extreme end with a cancer problem that’s unknown. In my own experience in treating non-cancer pain lots of times, I have situations wherein people have no pain at all for an injury that in someone else would be very painful. We’ve now got MRI evidence of scans that have been done on people of their hips, of their knees, of their back. They have no pain at all and when MRI scans are done of these people as part of an experimental research trial, they will have disc bulges, they will have thinning of their bones, they will have the cartilage that has been much more thinned out in their knee or their hip. But they have no pain at all. And how would you explain that? That is explained by the fact that physically there is no connection between what’s seen on a scan and the intensity of pain and this is because our brain’s doing much of processing prediction in order to protect. And pain is a sign of protection. And what that leads to is now these three kinds of pain. If we can be absolutely sure that there is chemicals being released at the site of injury like a surgery or a fracture or a cancer that’s actively pressing on a nerve and causing release of chemicals, then that’s one kind of pain which will respond to drugs. If a nerve is being pressed to the point that the signals are impacted, that’s another kind of nerve pain which might occasionally respond to some drugs, but most of the time will be a struggle. then there’s this third group of condins like for example, fibromyalgia, many kinds of post cancer related chemotherapy related neuropathy and pains where there is no obvious evidence of nerve injury or damage. There is no obvious evidence of chemicals being released. But the nervous and immune system that has been impacted by the treatments and by the context has been amplified and sensitized that they have to be provided an integrative approach.

Dr Deepak Ravindran
Drugs, opioids, nerve medications, injections, surgeries are very unlikely to work in this group of conditions or in this group of cancer pain or non-cancer pain conditions. And we call that nosyplastic or central pain conditions.

Robin Daly
Well, fascinating stuff. Yeah, it really goes against the grain to think about pain as being something that’s essentially being manufactured in your brain rather than at the site of the problem if there is one. Fascinating stuff. very notable that you should be abto categorise the types of pain in this way and to know that there are a group of types of pain which is actually a waste of time trying to use all the conventional biomedical approaches on it and they need something different because that can save someone a lot of wasted use of these other approaches which are going to be useless and will make them depressed probably.

Dr Deepak Ravindran
I think the way I tried to explain that in my book, Robin, is if you do have the nociceptive pain where chemicals are released or neuropathic pain where the nerve is indeed injured or cut during surgery, those are the only two types of pain wherein drugs or injections or nerve blocks or even surgeries could make a difference, could. The operative would be good, not well, because you’ve got to balance it with the side effects and the problems that injections or medications, especially opioids or gabapentin like drugs have unfortunately now been presented to. But we realize that when the nervous and immune system is sensitized as a way of being overprotective, because that’s what the brain’s doing, reacting to protection, you need to find ways to calm the nervous and immune system down. That’s about first of all, primarily empathy, trust, support and providing safety. that’s the operating principle right now isow do you provide safety to an overprotective immune and nervous system and how do you go about facilitating that. Right now the research and the evidence says that if you do want to calm the nervous system down and you may choose to use medications as a way of calming the nerves down, but the other ways are the usual what we come and traditionally label as stress management techniques or breathing techniques or even for that matter things like yoga, these are all ways of calming the nervous system down. Calming the immune system down since most of the immune system is in and around the gut and the intestine. nutrition using nutritional approaches is a way of calming the immune system down. Sleep, mind-body techniques are all techniques that have the ability to calm both the nervous and immune system down depending on which part you go after. But ultimately if you provide safety in whichever shape, whether that’s a good communication strategy, whether that’s a empathetic attitude, whether that’s group-based approaches, whether that’s a coaching style, ultimately if you can provide safety to a threatened immune and nervous system then that itself will calm everything down and that’s where the concept of social connection, trying to go after loneliness and isolation is important in this post-pandemic world that we are part of.

Dr Penny Kechagioglou
this excitement of the nervous system, as you , and it tends to react, it’s almost like a traumatic response. Would you say that? It’s similar to that because obviously a cancer diagnosis creates fear for people, doesn’t it? It creates the unknown. It’s almost like going through a trauma initially, but al with lots of insults as the journey goes along and…

Dr Deepak Ravindran
No, you’re absolutely right, Penny.

Dr Penny Kechagioglou
isn’t it? Is that a good analogy? What would you say?

Dr Deepak Ravindran
absolutely spot-on analogy and in fact the research that has now come from, in fact if I may say, left field bears evidence to that. this is something that I think is applicable not just to non-cancer pain or cancer pain, but I almost call it and in my way of looking after my patients, it’s what I term as a trauma-informed approach. Fundamentally saying that the stress on the nervous and immune system is something that all humans are geared up to, as mammals, as an evolutionary species, we can deal with certain small periods of stress. Acute stress that comes and goes off is good. It builds resilience, it builds up our capacity of the immune system and the nervous system to respond. It provides a learning model that our brain can then understand and create a model for future use, but that is for short, acute periods of stress. But when you subject the nervous system and immune system to a continued period of constant intense stress, whether that’s a cancer diagnosis, the treatment, the various thing that goes on, and in the kind of trauma coming from a young childhood itself like abuse, neglect, or sexual abuse of any kind, familial dysfunction and witnessing that kind of stress on an ongoing period, the developing nervous and immune system gets changed in such a radical fashion that it maintains a much lower threshold to get activated in adulthood. indeed now we’ve got some data to say that the incidence of cancer is actually increased in people who have had significant adversity in their childhood, but have not necessarily had the resilience and the robustness to calm their nervous and immune system down at that time. it maintains a much heightened level into your adulthood. then when metabolic factors come or any other issue comes, it can spill over into an actual presentation of cancer. That is the evolutionary part, but in your view as well, the whole diagnosis of cancer, the treatment that go along, the chemotherapy, the immunotherapy, the repeated impact on the immune system, these are all essentially forms of significant trauma. I do see, and I think in your role you must be seeing much more than me, Penny, is that there are many patients who have had such a traumatic experience that the whole concept of coming to hospital or then having to now come to a pain clinic afterwards for a consequence of either surgery or chemotherapy or immune therapy, they really are not happy with it at all. They just don’t want that traumatizing. I think this is where integrative approaches really can help because traditional, my understanding when I look at how post cancer rehabilitation is done is once the secondary care often is very happy that they have controlled it, there seems to be a bit of a drop off where patients feel less than supported by primary care, by secondary care, and they don’t feel anywhere like back to normal,

Dr Deepak Ravindran
back to who they were before their identity has been stolen away by cancer. I think addressing the trauma, providing safety, calming the nervous and immune system down, bringing a sort of holistic approach, those are all opportunities and very necessary things to give longevity and meaning to life after cancer.

Robin Daly
It was crude to hear you say that. This is something in your life we’ve concentrated on quite a lot recently as if you like the opportunity that cancer presents, okay, nobody wants cancer, but as you said, cancer could be at the end of a very long road of disturbance of one kind or another, whether it was abuse, you know, something fundamentally wrong in somebody’s life. They didn’t manage to address, they didn’t want to address maybe, and cancer brings all of this up in their face, you know, it’s just like hitting a roadblock. And as such, it does present an opportunity to start another kind of life after cancer. And I think it’s something that needs talking about far more. We’re talking about as much as we can. I hope it’s going to be talked about more and more, but many people are finding that. I talk to lots of people who’ve found much peace through having cancer that they actually welcome the fact that they had cancer. You know, they say it’s the best thing that ever happened to them. That’s not uncommon in my experience, and which shows the depth of the change that’s possible through actually taking the opportunity of cancer. If it wasn’t that deep, they’d never be able to say it was the best thing that ever happened to them. it has to be very significant what’s possible.

Dr Deepak Ravindran
That’s interesting. it’s almost like many of these people find it as an opportunity to reset and look at their priorities, is that what it means?

Robin Daly
Yes.

Dr Deepak Ravindran
Absolutely. Yeah, that’s interesting and again, absolutely understandable as to why that’s happening there indeed some of the work that I’m doing now with I serve al as a chief medical officer for a Cambridge based hybrid startup called Bootrose bear and the founders Response to starting this was al from her own experience as a breast cancer survivor and how She noticed that there was this gap that cancer rehab and return to work We need to be talking about various ways of how we help people Feel normal talk about it get back to a life after cancer.

Dr Penny Kechagioglou
I think Deepak, it would help if we have those protocols of support and integration within our treatment protocols, isn’t it? A patient should not really look very far away to find those tools that can help them find that safety and support, whereas at the moment, these are two separate things. You are obviously quite passionate, you are moving into a different art of healthcare to try and see what change can be made from the primary care perspective.

Dr Deepak Ravindran
It is. I think, as you rightly said, Penny, we need to be able to bring together what’s been traditionally called as complementary and what’s been traditionally termed as conventional. that’s where I think this kind of lifestyle medicine and integrative approaches have a big opportunity. For me, you’re absolutely right that we need to be talking about it in every forum. We need to be talking about and doing it in secondary care specialist cancer services in tertiary care level 3 and 4 services like the way we talk about it. But I do tend to see that, unfortunately, you do have an interested clinician there driving it. Those are difficult to sustain and we need to have guidelines. I think this needs to be both a top-down and a bottom-up approach of bringing together the work in secondary or tertiary care especially. Primary care, I think I feel more optimistic and I feel there’s more opportunity because there’s much emphasis in primary care now on using health coaches, on using all these additional roles and responsibilities professionals like pharmacists and social prescribers and care coordinators to help people with long-term conditions like diabetes, like asthma, like obesity. I feel that it’s a slightly more open door to get that group of people to be trained up to be looking at pain, cancer pain and non-cancer pain and post-cancer rehabilitation using these skills that they have and bring those techniques in much quicker for our patients. While of course, guidelines change practice at secondary and tertiary level, we can get these things in because we’ve got social prescribing happening already. So you could potentially tap into the community resources or work with the community to create these resources and make people aware of resources that are already there. In that context, there are already some good guidelines. For example, I think this was the Society of Integrative Oncology and then the ASCO, the American Society of Clinical Oncology, they have together brought a wonderful piece of guidelines saying what is the evidence for integrative approaches for cancer pain, how do we go about it, what’s a good evidence for what kind of cancer pains there are and what kind of non-drug and drug-based techniques and especially integrative techniques. the resources are there. It’s about just bringing it to scale and doing it a little faster and quicker. So that’s where I see the opportunity for a more willing, probably a quicker rollout in primary care because there are already colleagues doing this for other groups of patients. doing it as a group-based approach using the same principles of coaching and empowering and social prescribing might be a slightly easier door to push.

Robin Daly
Makes sense. Makes sense. Okay. I love everything you’re saying. You’re clearly pushing the envelope on questioning, well, what is pain? How are we going to help people? We’ve got to do better than just dirling out some drugs that don’t necessarily work. You know, we have to offer more. It’s really great to hear. You’ve several times mentioned you’ve written a book on the subject. Do you want to tell us about that?

Dr Deepak Ravindran
been a little while now that it’s been out. the book is called The Pain-Free Mindset. It is written for the general public, it is not necessarily high flaunting academic stuff. It’s been written in a way, hopefully, that most of our patients will be able to understand, and it’s something that I’ve had a lot of good feedback from physiotherapy colleagues, from my own clinical colleagues, in terms of how it has been easy to explain pain to the patients, how to then think about pain as a protection mechanism, and then to say what are the ways that we can calm the immune and nervous system down. I’ve managed to look at the evidence as of 2021-2022 on the various non-drug and integrative approaches to pain management, apart from, of course, a focus on medications and interventions. But that is something I felt that it’s more important to have a balanced discussion around drugs and injections. I don’t want to be the one to throw the baby out of the bath water. I think for the right person, at the right time, there are some wonderful drugs, and there are injections that make a difference. But we need to be able to offer a more wider menu of options, not just to our patients, but al to our colleagues to educate them that there are more things that can be done, for which there is evidence, for which the patients will thank us, and for which we will get more job satisfaction and feeling of goodness when we can offer that kind of discussion and strategies to our patients. the most important thing is we need to be working with them. As Dalos said, sometimes you have to walk in front of the patient, leading them on. Sometimes you need to be behind them, sort of pushing them on. Most of the times you’d have to be walking alongside them, guiding them. And I think the art lies in knowing where to be walking with.

Robin Daly
Okay, brilliant.

Dr Penny Kechagioglou
the case. We know that if patients feel comfortable with their clinician and they trust and there’s a relationship, the pain improves and that’s real. Anxiety goes down and pain improves.

Dr Deepak Ravindran
Absolutely. And that’s where the safety aspect comes in, isn’t it? And that means you’re taking down a percentage of pain that is due to a threatened or hypersensitive or overprotective nerves in the immune system. And that, when you combine it with an appropriate integration of conventional and complementary approaches, I think that’s where the magic is.

Robin Daly
I think it must be beneficial for patients to learn about the model of pain that you just described in your book because of the empowerment that’s built into that model. If your pain is something that’s just being delivered to you by a problem in your body, it’s very different to when it’s something that actually is a response that you’re giving to a situation which you may have a measure of control over. You can modify this thing, I think it’s a fantastic thing for people to learn about.

Dr Deepak Ravindran
Absolutely Robin, I think you put it very well there. Thank you. That’s really well said.

Robin Daly
Okay, well, just got to say a big thank you to you. It’s been fascinating chat. I’ve loved talking about it. I haven’t particularly focused in this way talking to a pain specialist before, particularly about exploring these new models, new ways of looking at pain, and how all these different approaches can all come together to provide a much better service to the patients. I find it really fascinating. Thank you.

Dr Deepak Ravindran
Thank you, Robin. I’m really pleased that you and Penny have asked me to come on this and to talk about something that I’m hopefully very passionate about.

Dr Penny Kechagioglou
Thank you Deepak, that’s great. Take care.

Robin Daly
Thank you for listening to Cancer Talk. Do subscribe and look out for the next edition of our podcast. And if you have friends and colleagues interested in the development of UK Cancer Care, do pass on the details of Cancer Talk.