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Research

Cancer Research UK Cancer Survival Programme

  • The CONCORD study: an international comparison of cancer survival - more details
  • Estimation of relative survival - the strel program - more details
  • Life tables for use in survival analyses - more details
  • Socio-economic inequalities cancer survival using MRC Clinical Trials: AXIS - more details
  • Trends in cancer incidence and mortality in South Asians in England and Wales, 1986-2004 - more details
  • Comparison of approaches for handling missing data in survival analysis - more details
  • Socio-economic gradients in cancer survival in France and the UK - more details
  • Does the implementation of treatment guidelines affect cancer survival? - more details
  • Methods for evaluating the proportion of cancer patients who are "cured" - more details
  • Inequalities in access to treatment for colorectal cancer patients - more details
  • Cancer survival in persons resident in "Spearhead" Primary Care Trusts in England - more details
  • Cancer survival indicators for the National Centre for Health Outcomes Development - more details
  • Avoidable deaths - more details

Other research:

  • Office for National Statistics collaboration - more details
  • Fighting Against Cancer Today (FACT) - Slovenian Presidency of the EU - more details
  • Impact of specialist treatment centres on cancer survival and 'cure' among young people in England and Wales - more details
  • Breast cancer incidence and mortality trends in relation to screening - more details
  • Acid suppressor drugs and the risk of developing gastro-oesophageal adenocarcinoma and gastric carcinoids - more details
  • Lung cancer in young women - more details

Completed research

  • Trends in overall cancer survival in the UK - more details
  • Breast cancer treatment and outcome in the Yorkshire Cancer Network area, 1982-2003 and the Panorama programme - more details
  • Cancer survival trends in England and Wales, 1975-1991: deprivation and NHS Region - more details

 

Socio-economic inequalities cancer survival using MRC Clinical Trials
Professor Michel P Coleman, Dr Bernard Rachet and Dr Ula Nur
Collaboration with Dr Max Parmar and Mr Matthew Sydes, MRC Clinical Trials Unit
Funded by Cancer Research UK

Insights from AXIS (Adjuvant X-ray and 5-Fluorouracil Infusion Study)
There is clear evidence that cancer survival differs between socio-economic groups. This socio-economic gradient has been demonstrated for most adult cancers diagnosed in England and Wales up to 1999, and for several major cancers in Scotland. National cancer registry data do not currently allow direct evaluation of the underlying causes of socio-economic differentials in survival, because they do not contain the necessary information on stage and treatment. The aim of this study was to quantify socio-economic differences in cancer survival among patients included in a randomised clinical trial of Adjuvant X-ray and 5-fluorouracil Infusion Study (AXIS). In this study colorectal cancer patients were randomized to PVI (postoperative portal vein infusion) or no PVI before or during surgery. Rectum cancer patients were randomly allocated to two possible treatment randomizations, PVI versus no PVI and radiotherapy versus no radiotherapy. If socio-economic gradients in survival similar to those seen in the general population are also observed within the trial, it is more likely that the survival differences in the general population are due to biological or environmental factors. If, on the other hand, socio-economic gradients in survival are not observed in the trial population, it is more probable that the survival gradients observed in the general population are due to health care system factors. In the trial population, relative survival up to five years was slightly better in more affluent than the more deprived groups, but there was no significant deprivation gap between rich and poor. These dissimilarities in survival gradient between the trial population and the general population of England and Wales, suggest that survival gradients observed in the general population could well be due to health care system factors.

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Trends in cancer incidence and mortality in South Asians in England and Wales, 1986-2004
Dr Punam Mangtani, Professor Michel P Coleman, Professor Isabel dos Santos Silva, Professor Dave Leon and Dr Bernard Rachet
Funded by Cancer Research UK

To take advantage of the experience of migration to Britain from India, Pakistan and Bangladesh where cancer risk is low, to seek clues for cancer prevention. Frequency, trends and socio-economic inequalities in cancer incidence and mortality in these populations will be examined.

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Comparison of approaches for handling missing data in survival analysis
Dr Bernard Rachet and Dr Ula Nur

Population-based cancer registries are often forced to create new tumour registrations with incomplete data for which it may be difficult or impossible to obtain the required complementary information. Incomplete data are unavoidable in most research surveys, even if great efforts are made in planning and data collection. This difficulty is more prevalent in population-based routine data such as those collected by cancer registries. Restriction of analysis to records that are complete may yield inferences that are substantially different from those that would have been obtained had no data been missing. Ad hoc approaches such as complete-case analysis, mean-substitution or the use of a separate category for records with 'missing' data can all introduce bias and reduce the precision of estimation. To our knowledge, little work has been done on the impact of missing data on survival estimates, and none at all on relative survival with cancer data. A common type of missing data in cancer survival analysis arises when the true date of diagnosis cannot be identified, because the only available source of information is the death certificate. Since these records cannot be included in conventional survival analysis, the missing data can give rise to bias in survival estimation. We propose to apply the method of multiple imputation to the EUROCARE data in order to evaluate the impact of the routine exclusion of DCO records from relative survival estimation. Sensitivity analyses will be carried out to check the robustness of the results.

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Socio-economic gradients in cancer survival in France and the UK
Dr Bernard Rachet
Collaboration with Professor David Forman, Northern and Yorkshire Cancer Registry and Information Service (NYCIRS) and Dr Guy Launoy, Registre des Tumeurs Digestives du Calvados

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Does the implementation of treatment guidelines affect cancer survival
Professor Michel P Coleman, Dr Bernard Rachet and Dr Artak Khachatryan
Funded by Cancer Research UK

To investigate whether compliance with national cancer treatment guidelines in NHS Trusts affects the survival of cancer patients treated in those Trusts. To assess the impact of factors such as the stage of disease at diagnosis, the patient's socio-economic status and organisation of cancer services in the Trust.

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Methods for evaluating the proportion of cancer patients who are "cured"
Dr Bernard Rachet and Dr Anjali Shah
Collaboration with Dr Paul Lambert, Centre for Biostatistics & Genetic Epidemiology, University of Leicester and Dr Paul Dickman, Therese Andersson and Sandra Eloranta, Karolinska Institute, Sweden

The aims of this project are to develop statistical methods for estimating and modelling the cure fraction in population-based cancer survival analysis and apply the methods to data from Sweden, Finland, England and the USA with the joint aim of evaluating the new methodology as well as studying temporal trends in cancer patient survival. Traditional approaches to studying temporal trends in cancer patient survival typically involve estimating 5-year relative survival for different periods of diagnosis and attempting to correlate the observed trends with changes in factors thought to affect survival. A common problem is that an observed trend may be consistent with several competing hypotheses. An alternative approach, which we believe provides greater insights, is to simultaneously estimate the proportion of patients cured along with the distribution of survival times of the 'uncured'. Studying trends in both the cure fraction and the average survival time of the uncured gives greater possibilities for distinguishing between competing explanations for an observed trend in patient survival.

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Inequalities in access to treatment for colorectal cancer patients
Dr Bernard Rachet and Libby Ellis
Collaboration with Dr Franco Sassi, Organisation for Economic Co-operation and Development (OECD) and Dr Catherine Lejeune, Faculté de Médecine, Dijon, France

Evidence has shown that individuals belonging to more affluent socio-economic groups have better survival from a wide range of cancers. Despite advances in diagnosis and treatment, colorectal cancer remains a serious disease with poor survival at five-years. A 3-5% difference in five-year survival between the most affluent and most deprived populations in the UK has been shown. Access to healthcare could be a possible explanation for the observed inequalities in survival, but evidence for a relationship between access to healthcare and survival is limited.

This study, in collaboration with Dr Franco Sassi at the Organisation for Economic Co-operation and Development (OECD) and Dr Catherine Lejeune at the Institut National de la Santé et de la Recherche Médicale (INSERM), aims to explore socio-economic inequalities in access to treatment of colorectal cancer and its effect on survival.

The study includes data on all patients diagnosed with colorectal cancer between 1997 and 2002 who were resident in the areas covered by three Regional Cancer Registries in England. The primary outcome measure is 1-year relative survival.

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Cancer survival in persons resident in "Spearhead" Primary Care Trusts in England
Dr Anjali Shah, Libby Ellis, Professor Michel P Coleman and Dr Bernard Rachet
Funded by the Office for National Statistics

The "Spearhead Group" of areas was announced on 19 November 2004 and consists of the Local Authority areas, and the PCTs which map to them, that are in the bottom fifth nationally for 3 or more of the following 5 factors: male and female life expectancy, cardiovascular disease and cancer mortality rates in under 75s, and Index of Multiple Deprivation 2004 (Local Authority Summary), average score.

The "Spearhead Group" is a fixed list of 70 Local Authorities, and 62 PCTs (formerly 88
PCTs) and forms the focus for Government action to tackle life expectancy, cancer and
cardiovascular disease inequalities.

In collaboration with the Office for National Statistics (ONS) and the Department of Health (DH), we produce estimates of cancer survival for ten of the most common cancers in adults among persons who, at the time of diagnosis, were resident in the territory of what are now Spearhead Primary Care Trusts in England, compared with those resident in the rest of England.

Please go here for a list of our joint publications with ONS.

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Cancer survival indicators for the National Centre for Health Outcomes Development
Professor Michel P Coleman, Dr Bernard Rachet, Libby Ellis and Dr Delia Alexe
Collaboration with the National Centre for Health Outcomes Development

The Cancer Survival Group collaborates with the National Centre for Health Outcomes Development (NCHOD) to provide cancer survival indicators for the resident populations of various health and administrative geographies in England. We have carried out the following analyses:

  • Cancer survival in patients diagnosed 1992-1994 followed-up to 1999, England, NHS Region and Health Authority. January 2002
  • Cancer survival in patients diagnosed 1993-1995 followed-up to 2000, England, NHS Region and Health Authority. January 2002
  • Cancer survival in patients diagnosed 1994-1996 followed-up to 2001, England, Government Office Region (GOR) and Strategic Health Authority (SHA). April 2004
  • Cancer survival in patients diagnosed 1995-1997 followed-up to 2002, England, GOR and SHA. April 2005
  • Cancer survival in patients diagnosed 1996-1998 followed-up to 2003, England, GOR and SHA. June 2006
  • Cancer survival in patients diagnosed 1997-1999 followed-up to 2004, England, GOR and SHA. June 2006

and generated the following reports:

  • Cancer Survival in the Health Authorities of England. May 2002
  • Improvements in methodology for NHS cancer survival indicators. December 2002
  • Cancer survival indicators for the National Health Service in England: exploration of alternative geographic units of analysis - Primary Care Organisations and Strategic Health Authorities. June 2004
  • Cancer survival indicators for the National Health Service in England : implications of using Cancer Networks as alternative geographic units of analysis. December 2006 [in press]
  • Implication of using cohort and period approached to estimate relative survival for cancer patients at national and regional level. February 2007 [in press]

More information about NCHOD is available on their website www.nchod.nhs.uk.

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Avoidable deaths
Professor Michel P Coleman, Dr Bernard Rachet
Collaboration with Dr Diane Stockton, Scottish Cancer Surveillance Team

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Fighting Against Cancer Today (FACT) - Slovenian Presidency of the EU
Professor Michel P Coleman and Dr Delia Alexe
Collaboration with Professor Martin McKee, Health Services Research Unit, LSHTM and Dr Tit Albrecht, Institute of Public Health of the Republic of Slovenia
Funded by the European Commission's Health & Consumer Protection Directorate and the Government of Slovenia

The decision by the Slovenian Presidency to the European Union (EU) in 2008 to focus on cancer has provided an important opportunity to explore how policy makers in Europe are responding to the huge public health challenge of cancer, and to develop new policy recommendations. Therefore, the European Commission's Health & Consumer Protection Directorate and the Government of Slovenia are supporting a collaboration between internationally recognised public health institutes in the EU, among them LSHTM, under the umbrella of the project FACT. The main objectives are to close the gap between cancer prevention, diagnosis, treatment and care between and within EU member states, and to send a strong political signal that immediate and concerted action is needed to reduce cancer incidence and mortality and to improve cancer outcomes across Europe. A series of activities have been planned, among these, the preparation of the publication 'Responding to the challenge of cancer in Europe: a proposal', addressing the situation on cancer in Europe as an important task that will ultimately facilitate setting out an agenda for action by policy-makers at all levels. This task is jointly coordinated by LSHTM and the Slovenian Institute of Public Health.

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The impact of specialist treatment centres on cancer survival and 'cure' among young people in England and Wales
Dr Anjali Shah and Professor Michel P Coleman
Collaboration with Professor Tim Eden, Professor of Teenage and Young Adult Medicine, Manchester, Professor Jillian Birch, Paediatric and Familial Cancer Research Unit, Manchester, Charles Stiller, Childhood Cancer Research Group, Oxford, Dr Mike Hawkins, Centre for Childhood Cancer Survivor Studies, Birmingham, Dr Lorna Fern, Teenagers and Young Adult Clinical Studies Group, London and Dr Margaret Rogers, Lecturer in Supportive and Palliative Care, Manchester
Funded by the Laura Crane Trust

More than 1,700 cases of cancer are diagnosed in people aged 10-24 years in England every year, and cancer is the most common natural cause of death in this age group. Several hospital units specifically for teenagers and young adults with cancer have been built or are in development around Great Britain to provide for the specific needs of people in this age group. For people aged 10-24 years who were diagnosed with a malignancy in England and Wales, this research will aim to: analyse trends in survival and 'cure' by type of treatment centre, treatment and co-morbidity for those diagnosed during 1989-2004; analyse trends in survival and 'cure' by age, sex, type of cancer and deprivation for patients diagnosed during 1971-2004; provide short-term predictions of survival and 'cure', using period analysis; assess the impact of prognostic factors on survival using multivariate models; evaluate the most suitable methodological approaches to estimating outcome when data are sparse.

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Breast cancer incidence and mortality trends in relation to screening
Dr Bernard Rachet and Dr Anjali Shah
Collaboration with Professor Jacques Estève, Service de Biostatistique, Hospices Civils de Lyon

The overall aim of the project is to produce a refined comparative assessment of the impact of breast cancer screening on trends in breast cancer incidence and mortality in England and Wales and in France. The availability of birth cohort data that we can analyse by single year of birth and single year of age will enable the impact of screening on incidence and mortality trends to be examined more comprehensively than would be possible with data in the usual quinary age groups. Approaches to breast screening have been very different in England and France. It is of substantial importance to evaluate the impact of breast screening in England and Wales because the Department of Health in 1992 set a target of reducing breast cancer mortality by 25% in women aged 55-69 years by 2000.

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Acid suppressor drugs and the risk of developing gastro-oesophageal adenocarcinoma and gastric carcinoids
Dr Delia Alexe, Libby Ellis, Professor Michel P Coleman and Dr Bernard Rachet
Funded by Hammersmith Medicines Research

The incidence and mortality of gastro-oesophageal adenocarcinoma have risen rapidly since the early seventies and a similar trend has been noticed for carcinoid tumours. The reasons for these changes are, however, still unknown. This study aims at providing a better understanding into the aetiology of gastro-oesophageal adenocarcinoma, and gastric carcinoids, with a view to ascertain the reasons behind the observed trends. The main hypothesis is that therapy with acid suppressor drugs increases the risk of developing gastro-oesophageal adenocarcionoma, as well as gastric carcinoids; thus, the wide availability and use of these drugs during the last three decades may explain some of the increase in the incidence and mortality of these cancers. This association will be documented through a large epidemiologic study based on the information obtained by linking the Cancer Registry data for England with the General Practice Research Database (GPRD), which will also facilitate follow-up and diagnostic validation processes as well as the investigation of other risk factors.

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Lung cancer incidence trends in young women
Libby Ellis
Collaboration with Dr Jesme Baird, Director, The Roy Castle Lung Foundation

This study was to investigate whether there has been an upward trend in lung cancer incidence in young women. We examined the rates (per 100,000 population) of newly diagnosed cases of lung cancer in females for the period 1995-2003, by age and morphology.

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Trends in overall cancer survival in the UK
Professor Michel P Coleman, Dr Bernard Rachet and Manuela Quaresma
Funded by Cancer Research UK
Outcome of project can be found at http://www.cancerresearchuk.org/aboutus/whoweare/ourgoals/goal10/

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Breast cancer treatment and outcome in the Yorkshire Cancer Network area, 1982-2003
Professor Michel P Coleman, Dr Bernard Rachet, Dr Côme Lepage and Manuela Quaresma
Publications: Lancet April 2006;367:1139, Panaroma "The hospital that failed women", 2 April 2006, Lancet August 2006;368:370
Full set of reports and commentaries can be found here

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