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Jane Blazeby: passionate leader in evidence-based surgery
Perspectives
Profile Jane Blazeby: passionate leader in evidence-based surgery 20 years have passed since the publication of a Lancet editorial “Surgical Research or Comic Opera: questions but few answers”, yet it still resonates with surgeons. “We often refer to it in lectures and at meetings”, says Jane Blazeby, Professor of Surgery at the School of Social and Community Medicine at the University of Bristol, UK. “We’ve changed the title a bit, and we now talk of moving from slapstick to symphonies, and it is symphonies that we are after today”, she says. Blazeby has been a consultant surgeon at Bristol for the past 16 years, and today spends most of her time directing strategic projects, including a Royal College of Surgeons (RCS) trials centre, and a UK Medical Research Council (MRC) hub for trials methodology research. These two programmes are closely interlinked, as Blazeby explains: “It’s quite a juggling act between the two, but by innovating new methodologies in feasibility studies and PhD research programmes, we can potentially improve the quality of trials”. She also spends a third of her time in clinical work and is part of the oncall surgery rota, where her years of experience in uppergastrointestinal surgery is often called upon. “I took a surgical registrar through a splenectomy for a spontaneous rupture at 2am recently. It’s important for me to keep my feet on the ground as a hands-on surgeon when time permits.” Born into a non-academic family, Blazeby qualified from the University of Bristol’s Medical School in 1988. Surgery became her path of choice from her deep interest in people, and of “taking things apart and putting them back together again, rather like my bicycle when I was a child”, she says. “I also loved surgery because of the need to make clinical decisions and act upon them. I enjoy leading and working in teams”, she adds. After spending a year as an anatomy lecturer at Bristol, Blazeby’s passion for surgical research was ignited at the department she works at today. In collaboration with the European Organisation for Research and Treatment of Cancer Quality of Life Group, she led the development of questionnaires to measure patient-reported outcomes (PROs), work which has since been adopted across many spheres of surgery, notably in surgical oncology. The legacy of her early research lies in trials that report PRO data, but are surgeons changing practice as a result? “That is the big question, and the answer is probably not as much as we would like”, Blazeby says. “We very much need surgery to become less eminence-based, and more evidencebased. This would involve surgeons improving how they communicate PRO data, as patients often want to know how surgery impacts on their quality of life”, she says. Since the turn of the millennium, Blazeby has moved into trials research, as an outcomes specialist. An MRC clinician scientist fellowship award in 2000 helped fund an MSc in epidemiology and public health from the London School of www.thelancet.com Vol 388 October 1, 2016
Hygiene & Tropical Medicine. “As a trainee surgeon I never saw trials taking place, or even a patient being randomised into a trial. This is the culture that needs to change. Everyday surgical practice should mean participation in trials”, she says. At Bristol, surgical training now includes trials training. This also takes place at six other RCS surgical trials centres across the UK, with Bristol and Blazeby at the forefront. Her earliest work in randomised trials was difficult, but instructive, as her research team struggled to enrol patients to a feasibility trial comparing chemoradiotherapy with chemotherapy and surgery for patients with squamous oesophageal cancer. “I learned so much from this, it led directly to the successful ROMIO trial, comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer”, she says. Blazeby’s work on the ongoing Bluebelle study has the potential to change surgical practice, since it compares wound healing with or without surgical dressings. “I really thought this lovely idea for a trial would not get off the ground, but fortuitously I overheard a conversation between two surgeons who were talking about complex surgery to revascularise an infarcted bowel on a young girl called Bluebelle”, she explains. “I attended her operation and discovered that it is common for paediatric surgeons not to use dressings at all. We therefore designed a feasibility study, now in a randomised pilot phase, to establish if a definitive trial of dressings or no dressings will be possible.” Jenny Donovan, Professor of Social Medicine at the University of Bristol, first worked with Blazeby in the early 1990s, and says, “it was clear in those early days that Jane had a clear-sighted determination to ensure that evidence of benefit should be combined with technical expertise in surgery. Challenging the surgical establishment to include quality-of-life assessment was not easy, but quite remarkably, Jane’s vision of evidence-based surgery is now coming to fruition through her leadership of important RCTs in surgery, focus on quality, and inspirational encouragement of the next generation of surgeons in training.” Looking ahead, Blazeby anticipates stopping clinical work within the next 5 years, while extending her work in surgical research to evaluate methods for surgical innovation, and in establishing safe governance for the adoption of new procedures. When not working, she relaxes into family life with her artist husband Nick and their three teenage children. She also enjoys helping with the communications training of women leaders at Woodlands Church in Bristol. “What I really love is thinking and writing, and doing surgery, so as I begin to wind down my clinical work, I hope there is a lot more thinking and writing time ahead”, she says.
Richard Lane 1367
Profile Jane Blazeby: passionate leader in evidence-based surgery 20 years have passed since the publication of a Lancet editorial “Surgical Research or Comic Opera: questions but few answers”, yet it still resonates with surgeons. “We often refer to it in lectures and at meetings”, says Jane Blazeby, Professor of Surgery at the School of Social and Community Medicine at the University of Bristol, UK. “We’ve changed the title a bit, and we now talk of moving from slapstick to symphonies, and it is symphonies that we are after today”, she says. Blazeby has been a consultant surgeon at Bristol for the past 16 years, and today spends most of her time directing strategic projects, including a Royal College of Surgeons (RCS) trials centre, and a UK Medical Research Council (MRC) hub for trials methodology research. These two programmes are closely interlinked, as Blazeby explains: “It’s quite a juggling act between the two, but by innovating new methodologies in feasibility studies and PhD research programmes, we can potentially improve the quality of trials”. She also spends a third of her time in clinical work and is part of the oncall surgery rota, where her years of experience in uppergastrointestinal surgery is often called upon. “I took a surgical registrar through a splenectomy for a spontaneous rupture at 2am recently. It’s important for me to keep my feet on the ground as a hands-on surgeon when time permits.” Born into a non-academic family, Blazeby qualified from the University of Bristol’s Medical School in 1988. Surgery became her path of choice from her deep interest in people, and of “taking things apart and putting them back together again, rather like my bicycle when I was a child”, she says. “I also loved surgery because of the need to make clinical decisions and act upon them. I enjoy leading and working in teams”, she adds. After spending a year as an anatomy lecturer at Bristol, Blazeby’s passion for surgical research was ignited at the department she works at today. In collaboration with the European Organisation for Research and Treatment of Cancer Quality of Life Group, she led the development of questionnaires to measure patient-reported outcomes (PROs), work which has since been adopted across many spheres of surgery, notably in surgical oncology. The legacy of her early research lies in trials that report PRO data, but are surgeons changing practice as a result? “That is the big question, and the answer is probably not as much as we would like”, Blazeby says. “We very much need surgery to become less eminence-based, and more evidencebased. This would involve surgeons improving how they communicate PRO data, as patients often want to know how surgery impacts on their quality of life”, she says. Since the turn of the millennium, Blazeby has moved into trials research, as an outcomes specialist. An MRC clinician scientist fellowship award in 2000 helped fund an MSc in epidemiology and public health from the London School of www.thelancet.com Vol 388 October 1, 2016
Hygiene & Tropical Medicine. “As a trainee surgeon I never saw trials taking place, or even a patient being randomised into a trial. This is the culture that needs to change. Everyday surgical practice should mean participation in trials”, she says. At Bristol, surgical training now includes trials training. This also takes place at six other RCS surgical trials centres across the UK, with Bristol and Blazeby at the forefront. Her earliest work in randomised trials was difficult, but instructive, as her research team struggled to enrol patients to a feasibility trial comparing chemoradiotherapy with chemotherapy and surgery for patients with squamous oesophageal cancer. “I learned so much from this, it led directly to the successful ROMIO trial, comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer”, she says. Blazeby’s work on the ongoing Bluebelle study has the potential to change surgical practice, since it compares wound healing with or without surgical dressings. “I really thought this lovely idea for a trial would not get off the ground, but fortuitously I overheard a conversation between two surgeons who were talking about complex surgery to revascularise an infarcted bowel on a young girl called Bluebelle”, she explains. “I attended her operation and discovered that it is common for paediatric surgeons not to use dressings at all. We therefore designed a feasibility study, now in a randomised pilot phase, to establish if a definitive trial of dressings or no dressings will be possible.” Jenny Donovan, Professor of Social Medicine at the University of Bristol, first worked with Blazeby in the early 1990s, and says, “it was clear in those early days that Jane had a clear-sighted determination to ensure that evidence of benefit should be combined with technical expertise in surgery. Challenging the surgical establishment to include quality-of-life assessment was not easy, but quite remarkably, Jane’s vision of evidence-based surgery is now coming to fruition through her leadership of important RCTs in surgery, focus on quality, and inspirational encouragement of the next generation of surgeons in training.” Looking ahead, Blazeby anticipates stopping clinical work within the next 5 years, while extending her work in surgical research to evaluate methods for surgical innovation, and in establishing safe governance for the adoption of new procedures. When not working, she relaxes into family life with her artist husband Nick and their three teenage children. She also enjoys helping with the communications training of women leaders at Woodlands Church in Bristol. “What I really love is thinking and writing, and doing surgery, so as I begin to wind down my clinical work, I hope there is a lot more thinking and writing time ahead”, she says.
Richard Lane 1367