It is estimated that there are 2.5 million people living with cancer in United Kingdom at any one time. In adults with a new diagnosis of cancer, they will often also have a range of vascular diseases. Since cancer treatment itself creates new vascular risks, understanding the relationship between the two conditions (‘interaction’) becomes important, both in terms of how risk changes and how the outcomes of the two conditions are affected.
‘Vascular disease’ encompasses the range from problems of the heart, sugar, brain, peripheral areas such as legs to problems of the eyes and kidneys. In the adult population aged 40 years and over with a new diagnosis of breast, prostate, gastro-intestinal or lung cancer will be matched to populations without cancer, we will investigate: (i) the risk factors, vascular disease, and drug treatment status prior to diagnosis of new cancer; (ii) risk measurements before or at the point of new cancer diagnosis, (iii) how cancer and vascular diseases combine to impact on vascular, cancer-related and frailty outcomes, and highlight the factors that can be changed to prevent long term complications. Understanding how the treatment of cancer changes vascular risk and outcomes of both is key to devising new approaches to current public health prevention programmes that are in place nationally and internationally.
Background: Newly diagnosed adult patients with cancer often have other common chronic conditions, such as a range of vascular disease. It is known that cancer treatment increases vascular risks. However, there is little evidence on the population level vascular status at the point of adult cancer diagnosis and how this combination interacts to affect longer-term outcomes in populations.
Design: Descriptive and Cohort studies.
Methods: In linkage datasets, comprising CPRD Gold, Aurum, National Cancer Registration, Analysis Service, Hospital Episode Statistics (HES) and ONS death data, we will construct four cohort groups of breast, prostate, gastrointestinal tract and lung cancer and four matched non-cancer cohorts. There will be assessment of: (i) baseline vascular risk factors at cancer diagnosis and change in risk factors following cancer diagnosis using longitudinal mixed models, (ii) risk modelling scores at baseline (iii) risk of cancer, vascular and frailty outcomes at 1, 3 and 5 years using flexible parametric survival models for competing risks, and (iv) estimation of population attributable fractions for potentially modifiable risk factors.
Outcomes: This investigation will determine vascular status and outcomes in adult populations with cancers and such evidence will be crucial in devising public health policies which incorporate routine risk monitoring and assessments for an increasing adult population of cancer survivors.
Hospital admissions; mortality; cardio-metabolic diseases; cardiovascular diseases; thromboembolism; cerebrovascular diseases; cancer-related outcomes; frailty
Umesh Kadam - Chief Investigator - University of Exeter
Umesh Kadam - Corresponding Applicant - University of Exeter
Ke Li - Collaborator - University of Exeter
Krasimira Tsaneva-Atanasova - Collaborator - University of Exeter
Sarah Bailey - Collaborator - University of Exeter
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