5 minutes with: Dr Ajay Aggarwal

Dr Ajay Aggarwal is a Consultant Clinical Oncologist at Guy’s & St Thomas’ NHS Trust, London, specialising in the delivery of radiation and systemic therapies for cancer. He is also Associate Professor at King’s College London and the London School of Hygiene and Tropical Medicine. He is Co-Director of the Global Oncology Group at King’s, and Co-Director of the MRC Clinical Trials Unit at University College London.

Dr Aggarwal’s main research areas are Health Services Research and Global Health. He has been the recipient of two fellowship awards from the National Institute for Health Research (NIHR), in 2014 and 2020. His 2020 NIHR Advanced Fellowship is a four-year programme of research to inform different options for the re-design of NHS cancer treatment services. This is aimed at optimising equity, access and outcomes, using both qualitative and quantitative “big data” methods (epidemiology, GIS and econometrics).

In his role as the Oncology Coordinator for the UK National Prostate Cancer Audit, Dr Aggarwal led the development and delivery of the first ever national public outcome reporting programme for radiotherapy. His research has contributed significantly to national and international policy discussion around the affordability of cancer care and the value of new technologies in cancer medicine, which has directly influenced the WHO Cancer Drug Pricing and Benefits Taskforces. As co-chair of the Health Economics in Radiation Oncology (HERO) group within ESTRO (European Society for Radiation Oncology), he is leading the value-based health care initiative and working with the European Commission to support reimbursement policy for medical devices in cancer care.

He has previously worked at the World Health Organisation in Geneva, and he belongs to ongoing global health projects in South Africa, Botswana and Zambia aimed at building radiotherapy capacity and cancer research capability.

When/where do you get your best research ideas?

When I’m talking to someone about something completely unrelated but interesting, or when I’m listening to a lecture on a different discipline or area of interest.

Which failure(s) changed you the most?

It’s a volume game. There are always more losses than wins as an academic, especially to begin with. Experience also plays a big role. Don’t be despondent about failure — this is the key to ensuring best outcomes. I also learnt at an early stage (the hard way) the importance of preparing for interviews and putting effort into applications, whether for a job or other position.

What is the best piece of advice (work or life) you’ve been given?

Do things that you enjoy, and stay fit and active. Also don’t overstrain yourself in trying to rush towards the end goal — it takes time!

I’m inspired most by…

Authors and film directors, for their vision and simultaneous ability to articulate this creatively. Also Olympians — particularly how they both harness and bring together life experience, talent and dedication to achieve their goals.

What is an event that changed your life?

Changing my A Levels the day before I was due to start term (from Economics, Politics and French — to Biology, Chemistry and French). Doing a BSc in Management during medical school, coupled with my medical elective at the World Health Organisation, was also key in shaping my career trajectory. These both paved the way for my current career in health systems research and global oncology.

What is the next big thing in cancer prevention research?

Implementation science and health systems research, with a particular focus on quality improvement.

On the implementation science side, only 50% of all proven innovations actually reach those in need of them. With quality improvement, designing more equitable systems would have a considerable impact on the extent to which survival outcomes – in the UK and beyond – might be improved.

What is your favourite paper that you’ve published in the last 5 years (the one you’re most proud of)?

I’m most proud of a multidisciplinary project I led during the pandemic: The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. It became clear at the start of the first lockdown that the public health measures introduced could result in significant delays to cancer diagnoses. Without targeted strategies in place, they also posed significant risks (and probable impact) for longer-term survival rates.

Over four weeks in April/May 2020, I worked as part of a newly formed group of collaborators. In this, I led an analysis to produce the evidence necessary for mitigating against these risks. This evidence made clear that delays in the system – in particular the pausing of screening and routine referrals – would have a knock-on effect on cancer outcomes longer term. The paper was used in parliamentary enquiries, to support the management of cancer services during the pandemic.

Undertaking the project in such a short period of time was incredibly tough (its normal timeframe would be 9-12 months). However, the shared commitment of all collaborators meant we were able to produce timely evidence to inform policy at a critical moment.

Which books have greatly influenced your life?

Thinking Fast and Slow (Daniel Kahneman); The Plague (Albert Camus); The Grapes of Wrath (John Steinbeck).

What are bad recommendations you hear in your area of expertise?

Networking is unquestionably recommended, as something universally good. Whilst it remains very important, it is the quality and trust within those networks which are most important. These are the factors which help both to stimulate and to sustain your work, so do your due diligence first. Mentorship is also just as important as attending lots of professional courses.

Positive feedback, in turn, is something important for development. However, creative tension from disagreements is also critical to developing ideas and research themes. Having people who challenge you, while not always giving positive feedback, is often no bad thing.

In the last five years, what have you become better at saying no to (distractions, invitations, etc.)? What new realisations and/or approaches have helped?

I think knowing what energises and de-energises you is super important at work. If you don’t have the right balance, it is hard to maintain motivation and not become distracted. Listen to what your brain is telling you and know when to stop doing something that doesn’t work for you. Go with your gut. Your instincts are usually right.

When you feel overwhelmed or unfocussed, what do you do? Or which questions do you ask yourself?

What is under my control? Who can support me? What have I already achieved?

The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorses those views or opinions.