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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:
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.
Men with penile cancer often feel very isolated as they are reluctant to talk to others about their condition, and as it is so rare, they do not encounter others who have experienced it. Branney and colleagues' work has produced a resource, available through the Health Talk Online website, for men and their families: http://www.healthtalkonline.org/Cancer/Penile_Cancer.
Men with penile cancer are routinely signposted to this resource. An exhibition of the project's findings has helped to raise awareness of the condition in the general public. By increasing patient information support, clinician insight and men's awareness of the condition, this research has improved the quality of life of men with penile cancer.
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.
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.
Thyrotoxicosis (over-activity of the thyroid) affects up to 5% of the UK population and causes excess mortality, especially from vascular diseases, even in its mildest form. Thyroid cancer is the commonest endocrine cancer, its treatment being associated with adverse consequences which need to be minimised. A large programme of thyroid research in Birmingham led by Prof Jayne Franklyn has made major contributions to improving the management of thyrotoxicosis, specifically through optimal use of radioiodine treatment. Her group has developed and delivered a national training scheme to allow endocrinologists (hormone specialists) to give this treatment safely and effectively. Radioiodine is also a crucial part of treatment of thyroid cancer; Franklyn helped deliver a major trial showing that lower doses are as effective as higher doses in most cases but with fewer days in hospital and side effects. This research has changed clinical practice regarding more effective and safe use of radioiodine in thyrotoxicosis and thyroid cancer. It has been incorporated in national and international clinical guidance, patient information sources, and has directly affected clinician training and patient care pathways.
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 by our group at the University of Manchester has impacted directly on policy addressing inequities in access to treatment for older women with breast cancer, affecting treatment for 10,060 older breast cancer sufferers in England each year. Our research has led to improvements in pre-operative nutrition and screening for malnutrition for nearly 100,000 patients in Greater Manchester. We have contributed directly to international guidelines on post-treatment follow up for breast cancer and management of cough in lung cancer. We have also contributed to development of national vocational rehabilitation, employer support and benefits advisors for cancer survivors, affecting 700,000 survivors across the UK. Our work has led to implementation of family carer support needs assessment in UK hospice services, to date supporting some 4,500 carers per year with wider roll out imminent.
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.
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.