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Work led by researchers at UCL has had a national and international impact on the way that patients with symptoms suggestive of colorectal cancer are investigated. Specifically, investigation of the role of CT colonography (a relatively novel and non-invasive method of investigating the large bowel using an X-ray scanner) has led to this examination replacing the standard alternative of barium enema in the UK National Bowel Cancer Screening Programme and for symptomatic patients in the NHS. The research has also led to easing of pressure on over-subscribed endoscopy services in the NHS because patients can be safely diverted towards CT colonography as an alternative.
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.
Fears of recurrence (FoR) are the major concern for cancer patients. The Adjustment of Fear, Threat or Expectation of a Recurrence (AFTER) was initiated in Liverpool and developed significantly at the University of St Andrews by the originator (Prof. Humphris) and colleague Dr Ozakinci for general cancer patients, including an innovative validated Fear of Recurrence measure. The measure identifies patients with high FoR in NHS oncology services to enable psychological therapeutic treatments to be targeted. AFTER is being widely employed with cancer survivors successfully in UK cancer services and international oncology centres to reduce their FoR and depression.
Colorectal cancer is a common disease, which frequently causes death or morbidity, either because of failure to control the primary tumour or failure to prevent distant metastases. Leeds researchers have devised new treatment approaches using chemotherapy and radiotherapy and tested them in large randomised controlled trials which have led to major changes in clinical practice in the management of rectal cancer and advanced colorectal cancer (aCRC), driving clinical decision-making and improving outcomes for patients. This includes better-evidenced treatment for elderly patients and patient stratification on the basis of molecular biomarkers.
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.
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.
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.
Collaborative research conducted by the Biological Sciences Research Group (BSRG) has brought considerable benefits for the treatment of cancer patients. Experimental research has shown that the shelf-life of the biological cancer drug Herceptin can be greatly extended thereby bringing significant economic benefit through cost savings. A clinical trial has demonstrated that yoga benefits the health and well-being of patients with gynaecological cancer leading to prospects of improved cancer survivorship. Sowter provides research-informed oncology training for NHS clinical trials staff throughout the National Institute of Cancer Research UK network (NCRN), and has supervised two senior registrars through their MD qualifications.
Computed tomography (CT) and Magnetic Resonance Imaging (MRI) have revolutionised the practice of medicine by providing improved diagnostic accuracy resulting in improved clinical management and outcome. The evidence-based medicine approach developed by Professor Dixon and his team contributed to the timely evaluation of these technologies. Several of his studies proved improved outcome measures, including reduced mortality, shorter in-patient stay and enhanced diagnostic confidence. Examples include: CT of patients with acute abdominal problems and possible large bowel disease; CT for suspected pulmonary embolism; MRI for lumbar spine disease; MRI for knee and shoulder problems. These informed radiological guidelines adopted across Europe.
Impact: UoE-developed techniques to determine liver volume and define, pre-operation, the minimum liver remnant required have transformed the viability and success of liver surgery and stimulated commercial development of imaging software/hardware.
Significance: Precise functional liver volume measurement prior to surgery is now the standard of care and, for example, renders 85% of patients previously deemed irresectable to be resectable with a perioperative mortality of 2-4%.
Beneficiaries: Patients with liver cancer; the NHS and healthcare delivery organisations; imaging software/hardware companies.
Attribution: Pivotal studies were led by Wigmore and Garden at UoE.
Reach: Worldwide; technique recommended in guidelines in Europe, N America, Asia, Australasia; deployed in the management of 3600 patients per annum in the UK alone; the use of open-source software increases accessibility in developing world.