Stormont Group Says More Cancer Could Be Prevented

Almost 12,800 people in Northern Ireland are diagnosed with cancer each year and a significant number of these could be prevented through greater awareness, a new report from the All Party Group on Cancer (APGC) at Stormont revealed today.

The report highlights why cancer remains a major public health issue and the leading cause of death in Northern Ireland. It calls for legislative changes and a range of measures to be implemented with support from the statutory, voluntary, public and private sectors.


The APGC is made up of 18 MLAs and aims to reduce the impact of cancer on the local community. The APGC heard evidence on a range of issues from patients, clinicians and researchers from the voluntary, statutory and public sectors.  The Group’s Report makes recommendations on access to cancer drugs in Northern Ireland, the impact of welfare reform, policies to control tobacco and alcohol, inequalities in men’s health and the role of primary health care in cancer prevention.

Guest speaker at the launch of the report at Stormont was Professor Mark Lawler from Queen’s University Belfast.

The Group calls on the NI Executive to provide leadership and financial support to improve both population health and cancer services. Among the APGC’s  recommendations are:

  • Standardise packaging for tobacco and prohibiting smoking in private vehicles;
  • Implement changes in relation to alcohol pricing, health warnings and advertising;
  • Ensure training and support is available for practice nurses and GPs to deliver advice and information on cancer prevention messages in primary care settings;
  • DHSSPS and the Executive to work in partnership with the voluntary, statutory, private and public sectors to develop a strategy to improve men’s health and lower cancer incidence and mortality rates;
  • Take steps to ensure equity of access to cancer drugs in line with the rest of the UK;
  • Ensure that cancer patients are signposted to welfare advice as a routine part of their treatment.

APGC Chairman Tom Buchanan MLA said: “Cancer is a disease which has left its mark on many families throughout Northern Ireland and is a major issue for the Health Service.

“Around 245 people each week receive the dreaded news that they have been diagnosed with cancer and on average it claims the lives of 4,000 people each year. While survival rates are increasing through intensive research and improved treatments, much more needs to be done to help and support people living with this long term illness.”  

Vice Chair Cathal Ó hOisín MLA said: “Our lifestyle is an important factor in the prevention of cancer and while we cannot change our genetic makeup, we can take steps to lower the risk of cancer by following a healthy lifestyle.

“The APGC has already been instrumental in using its influence to improve services and will continue to raise awareness through public, professional and political avenues to help improve cancer services and develop policies to reduce the impact of cancer on our communities.”

Roisin Foster, Chief Executive of Cancer Focus, which holds the secretariat for the Group, said: “Cancer Focus’s mission is to decrease the burden that cancer imposes on our society, and the financial burden on our health service and on our economy, but above all the burden of ill-health and loss placed on individuals and their families.

“One of the approaches we take to our work is to raise public awareness of cancer - how we can lower the incidence of cancer and how we can best support people living with the disease. Central to this is effective public health policy and a commitment to continuous improvement in the range of treatment and services available to women, men and children with cancer in Northern Ireland.

“Tackling cancer is an All Party issue, transcending party political agendas. While there is clear evidence that links cancer to social deprivation, everyone in the community will have been affected by cancer. Over 70,000 people in Northern Ireland are living with a cancer diagnosis and one in three will have the disease at some point in their lifetime.
“We trust that our leaders will study the findings in this paper and endorse the recommendations so that fewer people are diagnosed with cancer, that those who are have ever improving outcomes, and that there are the support services to help them deal with the impact of the disease.”
The report reveals that:

  • Standardised packaging and legislation prohibiting smoking in private vehicles would be major steps towards reducing the impact of tobacco;
  • Alcohol consumption causes 4% of all cancers;
  • It is vital that primary care settings are supported in the delivery of cancer prevention messages; 
  • Men are at a significantly higher risk of developing and dying from nearly all of the common cancers;
  • 22 cancer drugs available to patients in the rest of the UK are only available in exceptional circumstances in NI;
  • People living with cancer are subjected to numerous financial pressures with many unable to continue in employment as a result of their illness.

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Queen’s University Discovery Signals New Treatment for Women at High Risk of Breast and Ovarian Cancer

Dr Kienan Savage

Cancer researchers at Queen’s University Belfast have made a breakthrough which could signal new treatments for women at high risk of breast and ovarian cancer.

Currently around one in 1,000 women in the UK carry what is known as a BRCA1 mutation - the same condition that prompted well-known actress Angelina Jolie to undergo a double mastectomy. They have up to an 85 per cent risk of developing breast cancer, and up to 40 per cent risk of developing ovarian cancer, in their lifetimes.

Until now, preventive surgery - mastectomy (breasts) and oophorectomy (ovaries) - has been the only way of reducing the risk of developing both types of cancers.

The new discovery by researchers in Queen’s Centre for Cancer Research and Cell Biology (CCRCB) may mean women affected with BRCA1 could use drugs, which are already available, to reduce their risk of developing the disease, rather than undergo irreversible surgery. In turn, such treatments would open up the possibility of some of these women, who might otherwise have an oophorectomy, still being able to have children.

The new research by Dr Kienan Savage and Professor Paul Harkin at CCRCB proves there is a direct link between high levels of oestrogen and DNA damage, which causes cancer, in the breasts and ovaries.  Specifically, the scientists discovered that the cells of women with the BRCA1 mutation cannot effectively fight the very high levels of oestrogen that exist in all women’s breasts and ovaries, leaving them vulnerable to DNA damage.  While this link between oestrogen, breast/ovarian cancer and BRCA1 mutation has been suspected by the scientific community for years, it has not been proven until now.

Dr Kienan Savage, from the CCRCB, and who led the research, said: “This discovery is very significant in the management of women with the BRCA1 gene mutation. It’s the first really credible evidence that oestrogen is driving cancer in women with a BRCA1 gene mutation. Because of this discovery, we now have the opportunity to propose an alternative treatment to surgery. It also opens up the possibility of pausing treatment for a period in order for women to have children, if desired.

“What also makes this exciting is that there are drugs already on the market which turn off oestrogen production. In theory, we could use these drugs to chemically reduce oestrogen production in women which could negate the need for irreversible surgery.” 

The Queen’s-led research, which has been ongoing for four years, was carried out with funding from Cancer Focus NI and Cancer Research UK. It is carried in the latest edition of the prestigious USA-based journal Cancer Research.

Professor David Waugh, Director of the Centre for Cancer Research and Cell Biology at Queen’s, said: “This breakthrough by researchers at CCRCB is great news for women with the BRCA1 gene and the cancer research community as a whole. It is pivotal in that it reveals more about the mechanisms behind breast and ovarian cancer.

“This work of Dr Kienan Savage and Professor Paul Harkin is further example of the world-leading research being undertaken at Queen’s which continues to advance knowledge and change lives.”

Roisin Foster, Chief Executive, Cancer Focus Northern Ireland, said: “Cancer Focus is delighted to fund this ground-breaking research into breast cancer, which has the potential in the forseeable future to benefit women all over the world. We are only able to support this vital work because of the generosity of our local community.”

The researchers are currently seeking funding to launch clinical trials and hope to do so within 12 months. It is envisaged that, in the first instance, a small control trial will be carried out using a combination of two drugs on 12 women for a period of three months, using biopsy, blood and urine samples to track DNA damage.

For further information, contact the Communications Office on Tel. +44 (0)28 9097 3087 or email

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Queen’s Leads the Way in UK fight against Prostate Cancer

Pictured L to R: Patient Allister Murphy with Professer David Waugh and Professor Joe O'Sullivan

Queen’s University Belfast has announced it is to partner with the University of Manchester to form the first regional Movember Centre of Excellence in the fight against prostate cancer.

The radical development is in partnership with Prostate Cancer UK and the Movember Foundation and will see an investment of £5 million over a five-year period across Belfast and Manchester.

Prostate cancer is the most common cancer among males in the UK with 40,000 new diagnoses every year. Comprising an outstanding team of internationally recognised scientists from across different disciplines, the key focus of the Belfast-Manchester hub will be improving outcomes for men with advanced disease. The funding will ensure that lab breakthroughs are translated into clinical benefits as quickly as possible. The Belfast-Manchester nexus will also include the Manchester-based Christie NHS Foundation Trust, the largest single-site cancer centre in Europe. A second Centre of Excellence will be located in London and will also receive £5 million over five years.

The two Centres were selected after a rigorous, international peer-review process. To qualify for funding, lead scientists had to prove strong, international track records and their teams needed to demonstrate existing or planned cross-discipline collaborations between basic and clinical scientists.

Over the five-year programme, researchers in Belfast and Manchester will identify men at high risk of aggressive disease, and find which patients respond best to various treatment options – an approach often referred to as ‘personalised medicine’. Cancer specialists will also work on refining new and existing treatments such as radiotherapy to improve how well they work for advanced prostate cancer, including cancer that has spread to the bones. The Belfast-Manchester Centre will bring in expertise from outside of prostate cancer, using insights from the latest research into other cancers including melanoma, breast and lung.

Professor David Waugh, Director of the Centre for Cancer Research and Cell Biology at Queen’s, is one of two Scientific Co-Directors of the Centre, alongside Professor Richard Marais, Director of the CRUK Manchester Institute.

Prof Waugh said: “The Belfast-Manchester Centre of Excellence provides a rare opportunity to bring together an international team of experts in radiation, biomarker discovery, genetic modelling and tumour biology who will use their individual talents in a collective and focused manner to make significant discoveries to benefit and extend the lives of men with prostate cancer.

“The scale and duration of funding available through the programme enables clinicians and scientists to tackle major clinical problems and more importantly, the longer timeframe also enables the team to ensure that our scientific progress has a clear clinical line-of-sight, and that we can begin to apply this new knowledge into clinical practice – resulting in more immediate benefits for those affected.

“I am extremely excited about what we can achieve.”

Professor Joe O’Sullivan, chair of radiotherapy development and clinical lead for radiotherapy at the Northern Ireland Cancer Centre and Chair of the Uro-Oncology Multidisciplinary Team at the Belfast Trust will be one of two Clinical Co-Directors of the Centre.

Prof O’Sullivan said: “I am extremely excited about the prospect of working with a team of world class researchers and those who are bringing their expertise from outside prostate cancer research in to the field for the first time.

“Through this research programme we have the opportunity to increase the speed of clinical advances by taking a fresh approach to prostate cancer research involving state of the art technology and a genuine collaborative approach.”

Movember UK Country Manager Sarah Coghlan said the Centres of Excellence scheme was “one of the most significant and exciting milestones for the Movember Foundation and prostate cancer research in the UK”.

She continued: “We’re bringing the best in the research world together for a sustained period to have a real impact and to develop real understanding of how to fight this disease.

“These Movember Centres of Excellence are the first of their kind in the UK focussed on prostate cancer and they represent the Movember Foundation’s commitment to having an everlasting impact on the face of men’s health. We salute every one of the Mo Bros and Mo Sistas in the UK. This wouldn’t be possible without them.”

In addition to the funding from Movember, the HSC R&D Division of the Public Health Agency has contributed an additional £500,000 to the Centre. It will be used to fund two key posts within the Northern Ireland Cancer Centre – a research radiographer and a post-doctoral research scientist.

Dr Janice Bailie, Assistant Director of the HSC R&D Division at the Public Health Agency said: “I am delighted that we will partner with Movember/Prostate Cancer UK to support the Belfast arm of this new Centre of Excellence in translational prostate cancer research.

“I believe this project has the potential to bring significant benefits to those living with prostate cancer in Northern Ireland and beyond. The Movember award recognises the strong track record in prostate cancer research in Belfast and Manchester, and this investment from HSC R&D Division will further enhance the already close working relationship between the Northern Ireland Cancer Centre in Belfast Health and Social Care Trust and the Centre for Cancer Research and Cell Biology at Queen’s University Belfast.” Professor Richard Marais of the CRUK Manchester Institute, part of the University of Manchester, said: “We have established a unique collaboration that will bring together knowledge and insights from across different cancers and disciplines, which will enable us to tackle some of the complexities still surrounding this disease from a new perspective.

“Crucially, by working in partnership we also hope to increase the speed at which lab breakthroughs reach the man in the clinic and have a direct impact on patient outcomes.”

 For media inquiries please contact the Queen’s Communications Office on or Tel. 028 9097 3091.

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Local Charity Announces Research Funding for Leukaemia and Lymphoma at Queen’s

Research charity, Leukaemia & Lymphoma NI, has announced a £1.5 million investment to support research into leukaemia, lymphoma and other related disorders. The organisation will make this investment over a three year period.

As part of the £1.5 million package, the organisation has launched a £500,000 Golden Anniversary research programme, one of the major scientific and awareness initiatives that the charity has planned for its 50th anniversary year.  The investment and research programme will enable researchers and clinicians in Queen’s University Belfast and across Northern Ireland to expand their internationally recognised research.

Leukaemia & Lymphoma NI is the only charity in Northern Ireland solely dedicated to funding research into leukaemia, lymphoma, myeloma and other related conditions. All of the funds raised by the organisation remain in Northern Ireland to promote research into the causes and cure of these conditions.

New cases of leukaemia, lymphoma and myeloma account for over 9% of all types of cancer.  This makes this group of blood cancers the 5th most common type of cancer, with more males (55% of cases) affected than females.   Around 94% of all leukaemia and 99% of all lymphoma cases occur in adults.

Figures from Northern Ireland, which are very similar to those across the United Kingdom, show that around 7 out of 10 acute myeloid leukaemia patients under 60 years will be alive after 24 months.  This decreases to only 2 out 10 if the patients are aged over 60 years old. The reported incidence of one type of lymphoma, non-Hodgkin’s lymphoma, has increased nearly three-fold in the past 20 years.

The Golden Anniversary research programme will enable research into aspects of leukaemia, lymphoma and other related blood cancers to improve our understanding of these diseases, leading to better therapies and patient outcomes.  One of the projects will be the ‘Victoria Montgomery/Leukaemia & Lymphoma NI studentship’ which will focus on research into acute myeloid leukaemia (AML) and is named after a young mother from Portadown who lost her life to an aggressive form of leukaemia in November 2012.    

Mr Bill Pollock, Chair of Leukaemia & Lymphoma NI, said: “Over the past 50 years, the charity has supported leukaemia research and I am very pleased that we are in a position to make this major investment to support the valuable and innovative research into blood cancers being undertaken in Northern Ireland.”  

Professor Ken Mills, Chair of Experimental Haematology in Queen’s University Belfast, said: "Our scientists are highly respected experts in their field and their research aims to understand how leukaemia and other related diseases develop. From this we can discover better ways of treating all of these diseases and ultimately improve the outcome and quality of life for patients.   This exciting announcement by Leukaemia & Lymphoma NI of a £1.5M commitment to research will greatly enhance the ability of our researchers in Northern Ireland to undertake globally significant research."

Professor David Waugh, Director of the Centre for Cancer Research and Cell Biology (CCRCB) at Queen’s, said "The funding of this research programme by Leukaemia & Lymphoma NI demonstrates their continued confidence in the high quality research being undertaken in Belfast to identify novel therapies and improve patient outcomes. It is crucial funding such as this that allows researchers at Queen’s, along with our partners, to change and improve lives."  

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Investment of nearly £1 Million set to Boost Local Cancer Research

Cancer patients in Northern Ireland are set to benefit from a landmark investment of nearly £1 million in cancer research from the Friends of the Cancer Centre Charity.

The Charity, based at the Cancer Centre at Belfast City Hospital, has partnered with Queen’s Centre for Cancer Research and Cell Biology (CCRCB) to provide a £900,000 funding injection for research into clinical trials – medical research trials involving patients - over the next three years.  The investment, which will be delivered through an annual grant of £300,000 over a three year period, will allow the CCRCB to increase the clinical capacity of the specialist team that plans and delivers clinical trials, through a number of critical new staff posts.  This increased capacity of the clinical trials research team will allow for further research and development of world leading cancer trials, an increase in patient recruitment numbers by consultants and clinical academics within the Cancer Centre at Belfast City Hospital and ultimately improved outcomes for cancer patients.

Colleen Shaw, chief executive of Friends of the Cancer Centre, said: “This is not a donation in our eyes; this is a financial investment in the future of local cancer research and in the future of cancer care in Northern Ireland. Northern Ireland has become a world leader in cancer care and the Cancer Centre at Belfast City Hospital provides the highest level of treatment available.

“Northern Ireland, through the team at CCRCB, has been at the forefront of the drive to find the latest and best ways to treat all kinds of cancer and clinical trials have become a vital weapon in this.   As a charity whose focus is on supporting those affected by cancer, we recognise the potential that lies in clinical trials and the direct benefits they can have on a patient’s life. For us, this investment is also hugely important as this is not money that will disappear into the often unseen world of cancer research, as it will directly impact people affected by cancer, here and now.”

The investment will fund a number of vital posts within the clinical trials team, including a clinical research nurse, research radiographer, senior data manager as well as dedicated pharmacy support.  These posts are vital in the development and implementation of clinical trials, as they provide the essential infrastructure to offer a more comprehensive and innovative trial portfolio, as well as more readily available access to trials.

David Waugh, Director of the Centre for Cancer Research and Cell Biology (CCRCB) at Queen’s University, said: “We cannot emphasis enough how important this funding is.  It permits us to increase the capacity of specialist staff we need to implement these world leading and life changing clinical trials.  Thanks to the support of Friends of the Cancer Centre, the next three years are set to be a very exciting time for us as we now have a dedicated resource in the Cancer Centre to conduct these trials that take forward innovative discovery from our research and strive for better outcomes for patients.

“We have been at the forefront of some of the most ambitious and ground breaking research in recent years and some of our own trials have been adopted by leading cancer centres across the UK and Europe.  We can now continue to drive this transition from being a follower to an internationally recognised leader in individualised cancer treatment with research born in Belfast, led by Belfast.”

Professor Joe O’Sullivan, consultant clinical oncologist at the Cancer Centre and head of the clinical research programme in radiotherapy and prostate cancer at the CCRCB, said: “As a clinical researcher, I am very keen to have a large number of trials available to my patients and it would not be possible to achieve this without the support of Friends of the Cancer Centre.

“From the patients’ perspective, this investment is also hugely significant.  I see people every day who are faced with a life changing diagnosis and whilst for many the outlook is good with treatment, others need major improvements in our currently available treatment options. This is where clinical trials come in.  I have seen first-hand how a trial can impact and often improve a patient’s outlook.  This is very exciting for me as a consultant, especially when the trial is home grown and developed in Belfast, but most importantly this can be life changing and indeed lifesaving for the patient.”

Friends of the Cancer Centre is one of the leading cancer charities in Northern Ireland working to support cancer patients, their families and carers through key projects in the areas of research, patient comfort and care, clinical care and equipment.  In addition to the investment in clinical trials, Friends of the Cancer Centre also supports cancer research through funding a number of other projects, including the Northern Ireland Cancer trials Centre and the Northern Ireland Biobank.  Over the next three years, Friends of the Cancer centre has committed over £2 million to local research alone.  

For further information please contact Nuala Bannon at Friends of the Cancer Centre on 028 9069 9393 or

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Professor Richard Kennedy named winner of Vice-Chancellor's Impact Prize

Professor Richard Kennedy

Congratulations to Professor Richard Kennedy from the Centre for Cancer Research and Cell Biology, who was named the winner of the Vice-Chancellor's Impact Prize at an awards ceremony on Friday 15 November 2013. 

Professor Kennedy and his team have developed tests to personalise cancer treatment worldwide. His leading-edge translational research on prostate, colon and breast cancer is informing the options for patients, giving them a better chance for recovery and survival.

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A Girls' Night In for Cancer Focus

Cancer Focus Northern Ireland Research Fellow Dr Kienan Savage, who is conducting pioneering research work focusing on the prevention and treatment of breast cancer at CCRCB, lends his support to 'Girls’ Night In'.

As part of breast cancer awareness month, Cancer Focus Northern Ireland is asking local women to host a Girls’ Night In during October to raise funds for pioneering breast cancer research at Queen’s University Belfast.

Cancer Focus, the new name for Ulster Cancer Foundation, promotes and supports internationally competitive, high quality research into the causes, treatment and prevention of cancer. Currently the charity is funding a research fellowship at Queen’s that is focusing on the prevention and treatment of breast cancer.

Roisin Foster, Cancer Focus Chief Executive, said: “Research is an extremely important element of what we do. Each year we invest £300,000 - £400,000 in cancer research to help identify the causes of cancer and discover improved methods of diagnosis and treatment. Many cancers previously thought to be incurable are now being treated successfully as a result of scientific research. 

“The research Cancer Focus is funding has the potential to make an enormous difference to the lives of many women, but we can’t do it without you. We’re asking women across Northern Ireland to show their support by hosting a Girls’ Night In for a few friends to raise money for our research work. You can organise a pink themed afternoon tea, a movie marathon, a pamper party – whatever you and your friends enjoy doing – and ask for a donation to Cancer Focus. It’s a great reason to have a good time with the girls.”

Leading researcher Dr Kienan Savage has been appointed as Research Fellow for Cancer Focus and leads the research team at the university. Dr Savage has recently identified a number of new cancer genes that appear to be involved in the development of breast and ovarian cancers, and some forms of leukaemia.

“These cancers often arise due to damage to genes within our DNA, known as ‘gatekeeper’ genes. The genes control how often cells divide, allowing cells to grow out of control forming a tumour,” Dr Savage said.

“The new cancer genes which have been discovered appear to play a role in repairing damage to DNA and thereby aid the repair of damaged ‘gatekeeper’ genes, helping to prevent cancer.

“My research will add significantly to our understanding of how these genes work to prevent the development of cancer. It may also lead to the development of new quick and effective tests to help decide which treatments specific cancer patients will benefit from, and may help to identify new proteins that could be targeted for future therapies.

“It’s fantastic to get this opportunity to develop my own independent research which has the potential to be hugely significant for cancer patients everywhere,” he said. 

To find out more information about  the Girls’ Night In or to request your fundraising pack call the Pink Party Gals at Cancer Focus on 028 9066 3682, email or visit

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Almac Discovery and Queen’s Launch £13M Cancer Drug Discovery Partnership

A new £13 million partnership to accelerate cancer-focused drug discovery in Northern Ireland has been launched by Enterprise Minister Arlene Foster MLA.

As part of the project, Queen’s and Almac Discovery have announced the scheduling of a phase one clinical trial for ovarian cancer, involving the first novel cancer drug fully developed in Northern Ireland.

Involving up to 60 ovarian cancer patients, the drug being trialled has been created as a result of an earlier collaboration between Almac Discovery and Professor Tracy Robson from the School of Pharmacy at Queen’s.

Explaining about the trial, Professor Robson said: “This latest trial involves a new treatment for cancer known as ALM201, which rather than attacking tumours directly, prevents the growth of new blood vessels in tumours, starving them of oxygen and nutrients and thereby preventing their growth. It targets tumours by an entirely different pathway to those treatments currently approved.”

Alan Armstrong, CEO of Almac added: “Bringing new treatments to patients is a complex process. The announcement today of a new clinical trial, which is the result of a previous partnership between Almac and Queen’s School of Pharmacy, is a timely illustration of how collaboration between the University and industry is already creating novel approaches to cancer therapy which have a very real chance of helping patients.”

At today’s event, Enterprise Minister Arlene Foster, said: “This significant investment in research and development will enhance collaboration between academia and industry. This will ensure the investment is maximised, that research is effectively commercialised and that ultimately, enhanced treatment solutions are made available to cancer patients.

“The fact that Almac and Queen’s are engaged in such ground-breaking research here in Northern Ireland is something that we should be extremely proud of. It will reinforce our position as a leader in research and development for the health and life sciences sector.”

It was also announced today that a new CCRCB/Almac Discovery joint programme in Cancer Drug Discovery will bring researchers from Queen’s University Belfast’s Centre for Cancer Research and Cell Biology (CCRCB) and scientists from Almac Discovery together to translate research discoveries into treatments for patients.

The two projects represent a total investment of £13M, with £7 million of support offered by Invest Northern Ireland, which includes part funding from the European Regional Development Fund.

As a result of the joint programme, 17 scientists from Almac Discovery have been seconded to Queen’s CCRCB in an industry led venture. The discovery team will work to identify parts of tumours which are susceptible to treatment by cancer drugs and to then develop the new drugs to target them.

The partnership will also enable new approaches to selecting those patients who will be most likely to respond to the new drugs, and to create the technologies needed to deliver the drugs directly to the tumour site in the patient.

The new discovery programme is being led by Professor Tim Harrison, Vice President of Discovery Chemistry with Almac Discovery. As part of this partnership, Professor Harrison has been appointed McClay Chair of Medicinal Chemistry at Queen’s for the next three years.

Commenting on the new partnership, he said: “While Almac Discovery and Queen’s have already been successfully collaborating for a number of years, this exciting new programme is bringing together for the first time, under one roof, some of our most talented scientists. As a result we expect to see an increase in both the breadth of drug targets we are able to identify and a subsequent increase in the development of potential therapeutics for patients.”

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