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GTD is a group of pre-malignant and cancerous conditions that affect pregnancy occurring in 1800 women annually in the UK. The Charing Cross GTD centre at Imperial College is a world leader in this disease area and since 2008our impacts include the health and welfare benefits associated with the development of new combination chemotherapy regimens which have been recognised in national and international guidelines and the refinement of patient stratification to a particular treatment. Imperial researchers have taken a leading educational role both nationally and internationally on the disease and its management to help others to develop new centres in their own countries.
The Million Women Study of 1.3 million UK women over the age of 50, coordinated by the Cancer Epidemiology Unit at Oxford, has established the relationship between hormone replacement therapy (HRT) and breast, endometrial, and ovarian cancer, and has had a dramatic effect on HRT prescription patterns and prescription guidelines worldwide. This has had a major impact on women's health. Prior to the study, one third of UK women aged 50-64 were using HRT. The marked decline in HRT use following publication of the study's findings has led to a reduction in the incidence of breast cancer among menopausal women.
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.
Approximately 80% of all breast cancer is hormone receptor positive localised cancer in postmenopausal women. For 30 years the universal standard adjuvant endocrine treatment for these women was five years of tamoxifen, but side effects and recurrences limited its usefulness. Results from the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial led to a major worldwide change in the standard recommended treatment, from tamoxifen to anastrozole (an aromatase inhibitor). From 2009 this treatment became UK national policy (recommended by NICE), and guidance in other countries (eg Australia, USA) has also been revised. Anastrozole is now routinely offered to women with hormone receptor positive breast cancer in UK and (extrapolating from trial data) we estimate over a thousand are spared a recurrence in UK annually.
Researchers at the University of Manchester (UoM) have made a significant impact internationally on improving outcomes for women diagnosed with breast cancer (>49,000 pa in the UK) and on preventing the disease. The changes in clinical practice based on our research are now national guidelines and have helped set international treatment standards. These new approaches have: increased the duration of survival of women with advanced breast cancer; reduced relapse rates and improved survival after surgery for early breast cancer; and prevented disease in women at high risk. The revised treatment has benefited >1.5m women worldwide annually who develop breast cancer and sales of anastrozole, which has replaced tamoxifen as the major endocrine therapy, have grossed over $1bn p.a.
International obstetric practice has been changed by two large randomised controlled trials led from the University of Oxford's National Perinatal Epidemiology Unit, which demonstrated the efficacy of magnesium sulphate for both treatment and prevention of eclampsia during pregnancy, a condition characterised by fits in association with hypertension, and an important cause of maternal morbidity and mortality. Until the 1990s there was widespread geographical variation in the management of the condition, with magnesium sulphate used almost exclusively in North America. Following the publication of the results of these two trials magnesium sulphate is now in routine use globally, widely recommended in guidelines, and has been placed on the WHO Model List of Essential Medicines.
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.
Two large multicentre clinical trials designed and led by researchers and clinicians in Leeds have resulted in major changes to treatment for patients with multiple myeloma. Myeloma VII clearly established the use of high-dose melphalan supported by autologous stem cell transplant (ASCT) following chemotherapy. Myeloma IX, the largest randomised controlled trial ever in myeloma, showed that zoledronic acid, in addition to reducing skeletal damage, showed an overall survival benefit and introduced the use of thalidomide as an effective yet less toxic therapy. Adoption of these treatment regimens has produced significantly improved outcomes throughout the developed world.
Research by Dr Garikipati identifies that microfinance is most beneficial to women when it enables them to enhance their livelihoods and participate in the local enterprise economy. It also shows that over 80% of the microfinance loans in Andhra Pradesh, India, did not meet these conditions. Using these research findings, Dr Garikipati directly lobbied the Government of Andhra Pradesh (GoAP). This has had an impact on governmental organisations and other stakeholders within the microfinance industry and lead to the introduction of the Livelihood Enhancement Plan (LEP), which is used at the time of loan application. Dr Garikipati collaborated with the GoAP in designing and implementing the LEP. It impacts 500,000 women per year who join the microfinance program and enables them to enhance livelihoods in keeping with the demands of the local economy.
The ultimate goal of in-vitro fertilisation (IVF) therapy is the live birth of a single, healthy child. However, issues of treatment failure, complications and multiple births (twins or triplets) continue to persist and have a major impact on patient quality of life. Pioneering research at the University of Glasgow has driven the concept of personalised IVF therapy and outcome prediction, reforming clinical guidelines and defining criteria for access to funded IVF therapy. This research has stimulated revision of UK regulatory policy on the number of embryos transferred during IVF. These strategies underpin the recommended practice for the 48,000 women undergoing IVF in the UK each year. In addition, the Glasgow team's online, personalised `IVFpredict' calculator, which women can use to predict their success of a live birth, has been completed by more than 5 million users worldwide.