Over the past decades, earlier detection of cancer through screening programmes and better cancer treatments have improved survival for many people with cancer. However, there are concerns that some cancer treatments may have long-term effects on bone health, leading to more broken bones and consequent diminished quality of life, increased risk of death and costs to healthcare services.
We will use information that is routinely collected in general practices and hospitals. We will identify people who have had cancer and a group of people of a similar age and sex who have never had cancer. We will then compare how often people with cancer experience broken bones compared to people without cancer.
We want to investigate whether some, or all, cancer survivors are at risk of developing bone problems. Understanding cancer survivors’ risk of broken bones will help health services target interventions to prevent fractures, and prioritise areas for more research on how specific cancers can lead to poor bone health.
Over the past decades, advances in cancer detection and treatment have resulted in improved survival, whilst raising concerns about long-term adverse consequences. It has been suggested that people receiving cancer therapy may experience higher rates of bone loss, osteoporosis and bone fracture. However, there is currently little population-based evidence on this. The relationship between cancer survival and bone health is important to understand considering the high burden of morbidity and mortality associated with fracture and consequent reduced quality of life, in addition to the substantial financial costs to the health service.
Our matched cohort study will use data from CPRD GOLD and Aurum primary care databases and linked Hospital Episodes Statistics (HES) admitted patient care data to identify cancer survivors and age/sex/GP-matched controls. Linked ONS mortality data will be used to censor deaths. We will describe the incidence of fracture and osteoporosis in cancer survivors (ascertained using primary care and linked HES data). We will use Cox regression analysis to compare the risk of bone fracture in individuals with a history of cancer (stratified by cancer site) to matched controls with no history of cancer. Linked patient-level deprivation data will allow adjustment for socioeconomic deprivation. We will also assess whether the association between having a history of cancer and developing adverse bone health outcomes changes with key individual-level factors.
The study will help to identify whether some, or all, cancer survivors are at higher risk of developing bone problems, will help health services target interventions to prevent fractures, and will help identify priority areas for more detailed research on how specific cancers can lead to poor bone health.
The primary outcome is bone fracture. Secondary/exploratory outcomes are major osteoporotic fractures, and diagnosed osteoporosis.
Krishnan Bhaskaran - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Krishnan Bhaskaran - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Eva Buzasi - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Garth Funston - Collaborator - University of Cambridge
Helen Strongman - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Helena Carreira - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation