Professor Babu Naidu

• 2006 C-Th, Intercollegiate Diploma Royal College of Surgeons
• 2004 MD, King's College (University of London)
• 1998 FRCSEd, Royal College of Surgeons Edinburgh
• 1998 FRCSEng, Royal College of Surgeons (RCS) England
• 1997 MMed Sci, Trauma Surgery (University of Birmingham)
• 1997 MBBS, King's College (University of London)

A native of Birmingham, Professor Naidu qualified and trained in the UK and undertook basic science research in lung injury at the University of Washington, Seattle, USA.  

His clinical and research interests include:

• Enhanced recovery/rehabilitation for surgery
• Digital app-based solutions for health care delivery - Fit4Surgery
• Lung cancer screening
• Volume reduction therapy for Emphysema

University of Birmingham

• Diagnosis and Management of Respiratory Disorders - Faculty member
• Surgical Oncology & Perioperative management - Faculty member
• Postgraduate lung cancer module - Faculty member
• Medical students - Chest anatomy
• Education and supervision of postgraduate students

External teaching

• Birmingham Cardiothoracic review course (international course)
• European Cardiothoracic Society Thoracic course
• Society of Cardiothoracic trainees courses
• Society of Cardiothoracic Allied health professional courses

Professor Naidu's team has delivered an impactful research profile in ‘Enhanced Recovery after surgery’ (ERAS), specifically identifying modifiable risk factors for poor outcomes and modifying them through targeted interventions including optimised pain relief, smoking cessation, exercise programmes and nutrition (PMID: 26769017, PMID: 20805178). Most recently this has extended to digital solutions with approaches to identify understand and minimize digital exclusion (EDI).

Their work has been acknowledged worldwide and led to leading the international group which published the worldwide ERAS Guidelines which is the most accessed article in recent times in Thoracic Surgery (PMID: 30304509). In addition this unique but extrapolatable theme of research has resulted in significant funding and stimulated a stream of publications and postgraduate students. This summary highlights key milestones in generating and managing the means required to deliver innovative and distinctive internationally recognised research.

Background

Around 6000 patients in the UK undergo curative lung cancer surgery. The number is set to double with the national roll out of lung cancer screening. This will transform the presentation of cancer from only 20 % that present early to 80% and is a paradigm survival shift for the cancer with the worst outcomes in the UK. However, 30 % of patients undergoing surgery will develop complications which are linked to increased risk of death, admission into intensive care and a poorer quality of life after surgery. Professor Naidu's team have published pivotal papers looking at modifiable risk factors which includes type of pain relief, nutritional state and smoking status and physical capacity.

Analgesia

In conjunction with Professor Fang Gao Smith, the team conducted a Cochrane review (PMC7151756), feasibility study (PMID: 31292172) and then secured funding for the largest multi-centre randomised controlled trial funded by the NIHR  HTA trial in thoracic surgery, TOPIC 2. The study is now closed to completion.

Nutritional Intervention

As part of the  Birmingham Health Partnership Masters to Doctorate Bridging Programme, the team conducted a successful nutritional intervention feasibility study which won the thoracic Gold medal at the Society Cardiothoracic surgery (SCTS)  research meeting (2017) and the findings of the study confirmed that a larger definitive RCT was feasible. (PMID: 35768119). The intervention has been combined with a digital exercise programme as outlined below and funding secured for a large multicentre study, Fit4Surgery 2.

Smoking Cessation

Utilising a novel co-design method, ’Double diamond’ ( British Design Council), the team developed a new smoking cessation intervention in collaboration with the Tobacco and Alcohol Research Group from University College London, specifically Professor Robert West, the ‘guru’ of smoking cessation in the UK. As part of this intervention, the team developed a digital tool to assist patients, Quit4Surgery, in conjunction with a local SME Evolyst. (PMID: 33158819). Currently the team are testing the feasibility across a multicentre trial. The project is funded by an investigator-led grant from Johnson and Johnson.

Exercise Programme

Designing the ‘Rehabilitation for Operated lung Cancer’ (ROC) programme, a multi-stranded prehabilitation programme optimising fitness for lung surgery, the team then conducted a successful feasibility study (PMID: 23959742) which showed taking part in the programme was associated with reduced complications and measurable cost savings. With his team, Professor Naidu developed the Fit 4 surgery App incorporating these themes and also completed a second feasibility study (PMID: 31277671) funded by The Health Foundation. It confirmed that digital app-based rehabilitation seemed to be as effective as conventional rehabilitation classes.

Working with Professor Joan Duda (School of Sport, Exericse and Rehabilitation Sciences), Professor Naidu has embedded behaviour change theory into the app and secured funding for the Fit 4 Surgery 2 trial which aims to find out if providing an app that delivers personalised exercise, nutrition and health information, in addition to any support that lung surgery patients would normally receive, improves physical recovery, reduce the chances of developing complications or the impact of them on quality of life, and save cost in the NHS.

This narrative illustrates the parallel progress of feasibility studies into a multistranded intervention to be tested in a single definitive study and as an example establishing and developing productive high level-relationships and research collaborations. But as these data have been presented and published, Professor Naidu and his team have been celebrated in case studies of excellence in national policies such as for NHS Improvement; ‘Fulfilling the Potential: A Better Journey for Patients and a Better Deal for the NHS (Enhanced Recovery)’ and Cancer Rehabilitation; ‘Making excellent cancer care possible’ National cancer action team - national cancer programme (March 2013).

Professor Naidu and his team have won externally awarded medals and prizes: Healthcare practice - National awards ‘Fit 4 Surgery’ Effective dissemination of information category for good practice the Healthcare Quality Improvement Partnership Quality Improvement Award (2014) and ‘ROC’ Enhanced recovery partnership prize – NHS improvement – DOH (2012).
Press coverage of the programme and app both on TV (ITV news) and written press has been widely supportive (Lung patients get rehab boost with mobile app - Birmingham Mail Online). 

Their studies, in conjunction with a growing body of international data, have resulted in clear recommendations for ERAS in international guidelines – ‘Enhanced recovery guidelines in thoracic surgery ERAS society’ (PMID: 30304509) and as one of 40 key national targets in cross disciplinary ‘Taskforce for lung health’ (2018). 

As a pioneer and early adopter of prehabilitation, Professor Naidu's work now appears as standard of care for all lung cancer patients (not just surgery) in the ‘National Optimal lung cancer pathway’ (2020) and the national survey shows widespread adoption (PMID: 32410658). Thus networking links with industry, government and professional bodies has had a positive and measurable impact.

Collaborative funding Lung TRACERx (TRAcking Cancer Evolution through therapy)

This study is a prospective observational cohort study that has transformed the understanding of non-small cell lung cancer (NSCLC) through translational research. It is a large flagship study for the main funder, Cancer Research UK, and Professor Naidu is co-investigator in the study.

Taking place over nine years, the study involves 842 patients who have been enrolled. The study aims to define how cancer clonal heterogeneity affects the risk of recurrence and survival, and how cancer subclones compete, adapt and evolve from diagnosis to relapse. In turn, this will define how analysis of intratumour heterogeneity can inform patient stratification and the development of novel targeted and immune based therapies.

Professor Naidu's clinical research team is the top recruiter into the study with over 300 patients entered into the study. TRACERx patients, whose cancer comes back, have the opportunity to enter clinical trials of novel therapies (depending on test results of their tissue samples) from which they could benefit, namely DARWIN 1 & 2 and CHIRON and they have recruited patients into these novel studies. Finally, the team also recruit patients into the CRUK-funded PEACE program which allows for the consent of patients at the end of life for post-mortem analysis of multiple metastatic sites so that high resolution evolutionary histories can be deciphered.

Professor Naidu sits on the PEACE governance board which has oversight of all the streams of research evaluating new research ideas presented by researchers and a ensuring smooth process of the study. Tracer X funding was attained for his fellow facilitated studies into B cell function with Professor Gary Middleton and this has resulted in significant home grown publications and funding (PMID: 35672305 & PMID: 34728792).

Widening participation - The thoracic surgery patient collborative group (RESOLVE)

This group was formed by Professor Naidu with the help of his clinical research team. This national patient group met for the first time at the Society of cardiothoracic surgery (SCTS) annual meeting in 2016 and subsequently every year (except during COVID). It’s a way in which people with Thoracic surgery conditions, their families, carers or members of the general public can influence and learn about the research carried out in the field.

The purpose of the group is also to help make clinicians research more relevant and acceptable to people with thoracic conditions, clinicians and researchers. Professor Naidu's team produce a newsletter, offer training to patients on how to take part, and have had several successful projects evolve after presentation to the group. This is a practical application of the University of Birmingham ideology of ‘delivering research that matters’ and shows Professor Naidu's drive to ‘engage with the users of our research locally, nationally, and internationally to make a difference.’ To date, 21 research projects have been presented and valuable feedback into the design and delivery and value of project has been gathered. Many of the group members have been involved beyond the meetings as co-investigators. Three of the projects have gone on to secure funding. This valuable resource has been cited in SCTS bulletin.

Chairing advisory committees

Due to Professor Naidu's clinical research reputation in the region, he was appointed as Chair of the Lung and Mesothelioma Expert Advisory Group (West Midlands Cancer Alliance). Their aim is to ensure that patients with lung and mesothelioma cancers receive high quality equitable cancer care throughout the West Midlands regardless of geography or socio-economic factors and will, wherever possible, endeavour to improve the standard of care provided.

Professor Naidu works with cancer clinical teams from all hospitals across the West Midlands. Together, they have devised and are delivering a simple set of actions which will have significant impact on care, while sharing good practice and providing support to each other. Their plans have mirrored the national drive to reduce variation in treatment rates in cancer.

One of the actions they have implemented is an online trial map for the region to facilitate identification of suitable patients at the multidisciplinary meeting, to allow patients the ability to access trials not being carried out across the region and to facilitate referral for consideration. This clinical tool is also paralleled with a patient information tool. In addition, Professor Naidu has conducted a nurse workforce review, helped implement new ways of working, (patient navigators) and run multiple workshops and educational events.

As Clinical Lead for the Targeted Lung Health Check Programme in Birmingham, Professor Naidu and his team have successfully set up this programme which is picking up lung cancer earlier ('Urgent health checks for Small Heath residents 'saves 11 lives' - why you need to get yours' - Birmingham Mail Online). 

Building successful academic services and partnerships

Professor Naidu is Surgical Lead of the Respiratory Research Group and the Birmingham Acute Care Research Group (BACR) within the Institute of Inflammation and Ageing and has been an active contributor to both. With regards to the research groups, in conjunction with Professor David Thickett, Professor Naidu set up and ran the lung tissue collection process, initially at the Heartlands Hospital and now at the Queen Elizabeth Hospital. 

His clinical research team have recruited and carried out a harvest of tissue for over 10 years. This valuable tissue has supported many PhD and Postdoctoral programmes over the years, making their studies viable and impactful, and will in the future support the NIHR Birmingham BRC programme for inflammation. Professor Naidu has also been asked to lead the wider surgical research and delivery of enhanced recovery across all surgical specialities at the University Hospital Birmingham. 

Regular involvement in positive promotion of higher education through relevant external activities and mentoring and coaching of others

The aim is to provide training and mentorship opportunities for the next generation of surgical trialists who will be supported to become leaders of an expanded surgical trials portfolio over the next 5-10 years. In addition to helping them establish themselves, Professor Naidu has helped them promote the ethos by running national research days.

Further information is available online via The SCST Bulletin - August 2022 issue.