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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.
University of Glasgow research has led to the adoption of first-line chemotherapy for ovarian cancer, which has improved patient survival by 11% and has been used to treat 66% of women with ovarian cancer since January 2011 in the West of Scotland Cancer Care Network alone. These therapies are recommended by guidelines for ovarian cancer treatment in the USA, Europe and the UK. The USA guidelines are disseminated to 4.3 million people worldwide and the European guidelines reach 15,000 health professionals. The UK guidelines are used to identify those drugs that are funded by the NHS and used in NHS hospitals.
Bowel cancer is the third most frequently diagnosed cancer worldwide. University of Glasgow researchers have established Xeloda (an oral 5-fluorouracil precursor) and XELOX (a chemotherapeutic regimen combining Xeloda with oxaliplatin) as highly effective, targeted therapies for patients with bowel cancer. Since 2008, European regulatory approval of these therapies has been incorporated into major international clinical guidelines. The research has transformed patient care by improving the treatment experience, with more convenient dosing schedules and fewer side effects compared with previous chemotherapy procedures. Xeloda and XELOX have transformed chemotherapy for bowel cancer and decreased therapeutic costs, potentially saving around £4,762 (Xeloda) and £947 (XELOX) per patient for the NHS.
UCL has conducted a series of national lung cancer trials, which have led to wide-scale changes in clinical practice. Two trials compared different platinum based therapies, which led to centres switching from using chemotherapy with cisplatin to carboplatin-based chemotherapy instead. Carboplatin can be given as an outpatient, and has fewer side effects, and has been (and still is) recommended as an alternative to cisplatin in the UK and US.
The HiLo trial has changed management for patients with well-differentiated thyroid cancer. Patients undergoing radioiodine ablation therapy are now given a low dose of radioactive iodine, which has fewer side effects, compared to the previous (standard) high dose. Also, to prepare patients for ablation they now have recombinant human TSH (thyrotropin alfa), which is associated with a better quality of life before and during ablation. The combination of low dose radioiodine and thyrotropin alfa means that patients can be treated as outpatients rather than inpatients. This is a more convenient treatment package, reducing health service and societal costs.
Impact: Improved depression care for people with cancer.
Significance: Assessment of emotional distress and evidence-based intervention to manage depression has a direct effect on quality of life of cancer patients. It may also reduce suicide attempts among them.
Beneficiaries: Cancer patients, NHS and healthcare delivery organisations.
Attribution: The work was led by Sharpe (UoE), with UoE Cancer Research Centre colleagues and collaborators in Manchester and London.
Reach: International; this work directly affected NHS practices and clinical guidelines in Europe and North America. It also stimulated international debate and new research into psychological aspects of living with cancer.
Before 2010, there was no accepted standard treatment for patients with advanced biliary tract cancer. The ABC02 trial showed that the combination of two drugs (gemcitabine and cisplatin) significantly improves survival, with acceptable side effects. Consequently, national and international guidelines have been revised to recommend this regimen as a standard of care. Furthermore, in ongoing trials of novel therapies, gemcitabine/cisplatin has become the comparator group, and the aim is to improve survival above what this can already achieve.
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.
Impact: Health and welfare; additional effective therapy for women with advanced, HER2+ breast cancer.
Significance: Allows approximately 10,000 patients a year, whose disease is no longer being controlled by trastuzumab, to receive a more effective therapy than chemotherapy with capecitabine alone.
Beneficiaries: Patients with incurable metastatic HER2+ subtype breast cancer; policy-makers; commerce.
Attribution: Cameron (UoE) was joint chief-investigator on the global pivotal registration trial that led to the marketing authorisation of the drug lapatinib in combination with capecitabine.
Reach: World-wide: the drug is approved in >100 countries and generated >£650M in sales for manufacturer GlaxoSmithKline.
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.