Cancer diagnosis is common, especially in older populations and it is estimated that there are 2.5 million people living with cancer in UK at any one time. Many people who experience cancer are also living longer. A key factor in cancer treatment and outcomes, especially in adults, is the cardiovascular risk status before and after cancer treatment. The importance of this risk is that it will determine the type and intensity of cancer chemotherapy treatment a patient receives and this risk may increase after the treatments have been given. Both these issues in turn will determine cardiovascular or cancer-related outcomes.
Using the CPRD, in the first stage we will investigate cardiovascular risk and disease in the adult population aged 40 years and over with any new cancer diagnosis, for four common cancers (breast, prostate, gastro-intestinal and lung). In the second stage, we will work out the cardiovascular risk for the different cancer populations. In the third stage, we will compare the cancer populations by cardiovascular status to comparable non-cancer samples with similar cardiovascular status, to investigate longer-term cardiovascular outcomes and identify factors that can be changed to prevent long term complications.
Background: In ageing populations who are living longer and with effective treatment of adult cancers means cancer survivors, means there are increasing numbers who have both cardiovascular disease and cancer. However, there is little evidence on the population level cardiovascular risk or disease status at the point of adult cancer diagnosis and how cancer treatment affects longer-term outcomes in common cancer specific populations.
Design: Retrospective cohort design.
Methods: The CPRD Gold and Aurum datasets linked to National Cancer Registration and Analysis Service, Hospital Episode Statistics (HES) and ONS death data will be used to identify adults aged 40 years and over with four common cancers (breast, prostate, gastrointestinal tract and lung) and compared to matched non-cancer cohorts. In four phases, there will be assessment of: (i) baseline cardiovascular risk factors at cancer diagnosis and change in risk factors following cancer diagnosis using longitudinal mixed models, (ii) risk of cardiovascular and related outcomes at 1, 3 and 5 years using flexible parametric survival models, (iii) cardiovascular risk score at baseline and development of a cancer-specific CVD risk score and (iv) estimation of population attributable fractions for modifiable risk factors.
Outcomes: This investigation will (i) determine cardiovascular risk factors, disease status and outcomes in populations with four common cancers, (ii) develop prognostic risk scores for assessing CVD risk in cancer populations and (iii) identify modifiable CVD risk factors at and after cancer treatment. Such evidence will be crucial in devising public health policies which incorporate routine CVD risk monitoring to develop new tailored risk assessments for an increasing adult population of cancer survivors.
Hospital admissions; Mortality; Cardio-metabolic diseases; Cardiovascular diseases; Cerebrovascular diseases; Cancer; Cardiovascular-related outcomes
Umesh Kadam - Chief Investigator - University of Leicester
Umesh Kadam - Corresponding Applicant - University of Leicester
Claire Lawson - Collaborator - University of Leicester
David Adlam - Collaborator - University of Leicester
Helen Strongman - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Kamlesh Khunti - Collaborator - University of Leicester
Krishnan Bhaskaran - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Lucy Teece - Collaborator - University of Leicester
Michael Sweeting - Collaborator - University of Leicester
Paul Lambert - Collaborator - University of Leicester
Richard Holland - Collaborator - University of Leicester
HES Admitted Patient Care;NCRAS Cancer Registration Data;NCRAS National Radiotherapy Dataset (RTDS) data;NCRAS Systemic Anti-Cancer Treatment (SACT) data;ONS Death Registration Data;Patient Level Index of Multiple Deprivation