In recent decades, treatment of many cancers has improved dramatically, so that many people now survive for a long time after cancer diagnosis. But going through cancer and receiving powerful anti-cancer treatments might have long term effects on both physical and mental health. This study will use routinely collected data from GPs and national registries to investigate whether cancer survivors have more (i) diseases related to their heart, circulation, and lungs; or (ii) mental health problems, compared with those who have never had cancer. Then, using data on which anti-cancer treatments patients received, we will investigate whether certain treatments are linked to more health problems in later life. The results of this study will help cancer survivors and their doctors to better understand the problems that can arise after cancer, and who is likely to be most at risk, so that extra monitoring and prevention can be put in place to try and minimise the impacts on patients.
In recent decades, treatment of many cancers has improved dramatically, so that there are increasing numbers of people surviving long-term after cancer. But cancer and its treatment may have long term effects on both physical and mental health. This study aims to investigate whether cancer survivors have more (i) vascular and respiratory-related diseases, or (ii) mental health problems, compared with people who have never had cancer. We will employ a matched cohort design, with cancer and non-cancer cohorts selected from routinely collected data from GPs, linked to Hospital Episodes Statistics (HES) Admitted Patient Care, cancer registration, and ONS death registration data. Cancers will be identified using GP, HES and cancer registry data; outcomes will be identified in GP, HES, and ONS mortality data. Relative risks of vascular-, respiratory-, and mental health-related outcomes will be estimated with Cox proportional hazards models. To investigate whether cancer survivors exposed to specific treatments (e.g. chemotherapy) are at greater non-cancer morbidity, we will conduct a cohort study among cancer survivors only. Exposure to treatment will be ascertained using the recently established linkages to the RadioTherapy DataSet (RTDS) and Systemic Anti-Cancer Therapies dataset (SACT). Vascular-, respiratory-, and mental health-related outcomes will be defined as in the matched cohort study. Hazard ratios will be computed using Cox regression models. The results of this work will help cancer survivors and their doctors to better understand the problems that can arise after cancer, who is likely to be most at risk, and can inform mitigation strategies.
The outcomes for comparisons between cancer survivors and cancer-free controls will be vascular-related diseases (in particular kidney disease [primary renal outcome acute kidney injury], vascular/overall dementia), respiratory-related diseases (primary: COPD, asthma, upper and lower respiratory infections, pneumonia), and mental health-related outcomes (depression, anxiety, cognitive impairment, fatigue, pain (including opioid prescription), sleep disturbance, sexual dysfunction, reproductive outcomes [primary: live births, pre-term births], and fatal and non-fatal self-harm). The outcomes for comparisons between patients receiving different anti-cancer treatments are venous thromboembolism, heart failure, arrhythmia, coronary artery disease, stroke.
Krishnan Bhaskaran - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Krishnan Bhaskaran - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Charlotte Warren-Gash - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Garth Funston - Collaborator - University of Cambridge
Harriet Forbes - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Helen Strongman - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Helena Carreira - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Jennifer Campbell - Collaborator - CPRD
Jennifer Quint - Collaborator - Imperial College London
Kirsty Andresen - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Lai Chun Jamie Wong - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Laurie Tomlinson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Li-Ju Chen - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Matthew Hazell - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Yuezheng Xiong - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
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;CPRD Aurum Pregnancy Register;CPRD GOLD Pregnancy Register;Practice Level Rural-Urban Classification