The BEYOND Cancer research group aims to understand the impact of the cancer diagnosis and treatments on the long-term physical and mental health of the growing numbers of cancer survivors in the population.
The BEYOND Cancer group was formed in 2015 and focuses on research into the long-term physical and mental health of the growing number of cancer survivors in the UK.
There are over 2 million cancer survivors living in the UK and tens of millions worldwide, and with continuing improvements in cancer survival these numbers are likely to increase.
A cancer diagnosis is a distressing event and may affect patients’ lives in many ways. In addition to the risk of recurrent or second cancers, the long-term non-cancer health of these individuals is of increasing concern. Certain cancer therapies have known toxic side effects in the body, and several newer cancer treatments have been linked to an increased long-term risk of adverse outcomes such as heart failure. Cancer treatment typically involves various combinations of chemotherapy drugs, radiotherapy, and surgery, and how individual treatment-specific toxicities translate into cardiovascular and other risks in the population of cancer survivors is unclear. In addition, we currently know little about how a cancer diagnosis might affect the long-term quality of life and mental health of survivors in the UK.
Our main areas of research are:
- how cancer treatment-related cardiotoxicities translate into cardiovascular risk in the population of cancer survivors
- how cancer and respective treatments impact on other vascular morbidities such as dementia and kidney disease
- how having a history of cancer affects long-term mental health and other quality of life-related outcomes such as fatigue and pain.
There may be significant opportunities to prevent morbidity and mortality among cancer survivors by improving the identification of those at high risk, and the implementation of risk reduction strategies.
We aim to generate evidence that can be used to underpin such strategies.
We have received funding from Wellcome, the Royal Society, and the Medical Research Council to support our work.
Our main areas of research are:
- How cancer treatment-related cardiotoxicities translate into cardiovascular risk in the population of cancer survivors
We recently showed that survivors of almost all types of adult cancer have higher risks of one or more cardiovascular diseases compared with people who have never had cancer (Strongman et al, Lancet 2019), including venous thromboembolism, heart failure, and coronary heart disease.
The clear research priority now is to understand the precise drivers of these increased risks, and thus how and when one can most effectively intervene to reduce risk. We do this by investigating three aspects that may explain the increased risk of cardiovascular outcomes in cancer survivors:
- Shared risk factors for cancer and cardiovascular disease (e.g. excess body weight)
- Anti-cancer treatments (e.g. type of chemotherapy regiment, radiotherapy to the heart and major vessels
- Post-cancer changes in vascular risk factors and risk factor management (e.g. diabetes after cancer)
This research is needed to inform monitoring and prevention strategies, because despite some known and suspected links between cancer therapies and cardiovascular diseases, the overall risk and burden of specific cardiovascular diseases among cancer survivors have not been well-characterised across a range of cancers types.
- How cancer and respective treatments impact on other vascular morbidities such as dementia and kidney disease
We have established that cancer survivors have raised risks for a range of cardiovascular diseases (Strongman et al, Lancet 2019) and it is possible that other important vascular morbidities may also be increased in cancer survivors, but evidence so far is unclear.
We are investigating whether cancer survivors from different cancers have increased risks of dementia and kidney disease, as both conditions may result from vascular pathology, and we showed that breast cancer survivors have more cognitive complains compared to similar women who did not have cancer (Carreira et al, J Natl Cancer Inst. 2018).
For both vascular dementia and renal diseases, we will also explore the role of shared risk factors, direct toxicities of cancer treatments, mediation through cardiovascular disease, or cardio-protective medication use.
This research is needed to inform preventive strategies that aim to reduce the burden of these conditions in cancer survivors.
- How having a history of cancer affects long-term mental health and other quality of life-related outcomes such as fatigue and pain
We studied the medical records of more than 70,000 female breast cancer survivors in the UK, and found that breast cancer survivorship was associated with raised risks of anxiety, depression, fatigue, sleep disorders, pain and sexual dysfunction, persisting for several years after the cancer diagnosis.
We are now expanding this work to better understand the risk of adverse mental health outcomes in survivors from other cancers, as evidence on this is scarce. The results of these studies can be used to inform evidence-based strategies to tackle the burden of mental health disorders in cancer survivors.
Quality of life study
We recently invited women with a previous diagnosis of breast cancer, and women who never had cancer, to answer some questions about their feelings and experiences.
A total of 356 breast cancer survivors (8.1 years post diagnosis) and 252 women with no prior cancer kindly participated in the study.
We found that compared with women with no history of cancer, breast cancer survivors report more problems with cognition, sexual function, fatigue, and anxiety, particularly where their cancer was advanced and/or treated with chemotherapy.
Read more on this study.