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Improvements in therapy have increased the 5-year survival rate for a number of cancers, leading to a new focus on promoting the health and wellbeing of cancer survivors. In the UK alone, over 500,000 people have physical or psychological consequences associated with cancer or its treatment.
Research at the University of Surrey has led to the development of self-management interventions for cancer survivors, demonstrating that active patient involvement leads to significant health and wellbeing benefits. These studies have driven national and international practice policy in the management of the consequences of cancer and its treatment.
There are currently 2 million cancer survivors in the UK. This is predicted to become 6 million by 2050 — by which time more than 50% of the UK population are expected to have experienced a cancer diagnosis. Our research and expertise have been central to the creation of the Department of Health's National Cancer Survivorship Initiative (NCSI), and framing policy more widely to respond to this challenge. It has provided evidence of the wide-ranging impact of the disease following cancer treatment, and has led to new models of cancer aftercare being implemented across the UK and internationally. Our research has linked directly to policy and practice through Professor Jessica Corner's membership of the NCSI Steering Group, as co-chair of the Department of Health's Cancer Patient Experience Advisory Group, and through our partnership with Macmillan Cancer Support.
Research at the University of Bristol (UoB) led to the Department of Health (DH) decision in 1997 that screening for prostate cancer would not be introduced in the UK until there was evidence that benefits outweighed harms. UoB-led and collaborative research subsequently provided evidence to support informed decision-making in the NHS. A formal review by the DH in 2010 endorsed the policy and confirmed that any change would be based on evidence from the team's randomised trials. This research has ensured UK men have avoided known harms of prostate cancer screening in the context of uncertain benefits, and saved the UK economy £ billions.
ProtecT (Neal, Cambridge; Donovan, Bristol; Hamdy, Oxford), funded by NIHR in 1999, is the largest randomised controlled trial in localised prostate cancer; and compares a deferred conservative approach (Active Monitoring — developed by the Trial PIs) with surgery and radiotherapy. Avoiding "over-treatment" in low risk cancer is important and Active Monitoring (AM) and Surveillance (AS) have now had a major impact on patients and on national health policy through NICE guidance, which recommends such management approaches. The linked bio-repository was critical to characterising the genetic pre-disposition alleles (SNPs) in prostate cancer, which are now being used to identify high risk populations.
Research carried out at King's College London (KCL) has raised awareness of the potential risks associated with certain hormone therapies used to treat prostate cancer. The group found that such hormone therapy can raise the risk of heart attack by 24% and the risk of dying from heart disease by 21%. However, for men receiving anti-androgen hormone therapy, the risk of dying from heart disease was lower compared to other hormone therapies such as gonadotropin-releasing hormone agonists. With anti-androgen hormone therapy there was a chance of heart failure but the risk was 5% compared to 34% for other hormone therapies which reduce testosterone production.
The research has had very considerable impact in terms of reach, as over 600 articles have been published in newspapers and other media which refer to the KCL finding that men with prostate cancer treated with certain hormone therapies have a higher risk of heart disease and strokes.
The findings had a very significant impact on US Food and Drug Administration (FDA) advice to healthcare professionals on the benefits and risks of hormone therapy. The FDA also required manufacturers of certain hormone therapy drugs to add safety information to labels.
The work of White has led to a re-appraisal of men's risk of premature death, both in the UK and abroad. His analysis of morbidity and mortality data has helped stimulate a worldwide debate on the health of men and the risks they face with their health. In the UK, analysis of cancer data has led the leading cancer charities to have a rethink on men's risk of cancer. The EC State of Men's Health in Europe report has helped create a new insight into the equality needs of men and stimulated the production of similar reports globally.
Researchers at the University of Leeds have designed and developed new approaches and technologies for cancer patients to self-assess their symptoms and quality of life. The work focused on electronic methods for collecting patient-reported outcome measures (PROMs), developing PROMs for neglected areas of patient care, and running trials of these techniques. These approaches produced sizeable patient benefits including improved symptom control and better quality-of-life. These findings have influenced clinical guidelines in the UK and Canada, NHS policy and the endorsement of PROMs in the Health and Social Care Act (2012). Electronic PROMs systems based on the Leeds research have been implemented locally, nationally and internationally, making measurable improvements to patient welfare and health, such as a reported significant increase in completion of chemotherapy treatment.
Research in Leeds showed, conclusively for the first time, improved outcomes for cancer patients managed in multidisciplinary specialised cancer care teams. Our research and systemic overview provided the evidence for a new government policy to reconfigure cancer care services into Cancer Networks, Centres and Units. This required radical evidence-based changes including centralisation of many cancer surgical services. A rigorous implementation plan based on research evidence, was initiated under Leeds leadership and sustained in subsequent government policies. It changed clinical guidelines and professional standards, altered practice for all UK cancer patients and contributed to improved cancer survival.
Research within the Northern Ireland Barrett's oesophagus Register demonstrated that cancer risk in this disease was substantially lower than previously thought. It identified clinico-pathological characteristics and potential biomarkers that allow Barrett's patients to be stratified into those with higher and lower cancer risk. This research has influenced recommendations from Gastroenterological Associations in the UK and USA and resulted in altered clinical practice nationally and internationally, in which costly routine endoscopic surveillance is now targeted to Barrett's oesophagus patients with the highest cancer risk.
Bangor University staff (Neal & Wilkinson) are core members of a collaboration whose research since 2003 has had significant policy relevance and impact in the field of primary care oncology. Impact has been made in three areas: