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BEYOND Cancer

Using Big Data to Identify Opportunities for Disease Prevention after Cancer.

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About

BEYOND Cancer 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.

About
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BEYOND Cancer About
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BEYOND Cancer is a five-year project that began in 2015 focusing on 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 heart, and a number of newer cancer treatments have been linked to an increased risk of adverse cardiovascular effects. Cancer treatment typically involves various combinations of chemotherapy drugs, radiotherapy, and surgery, and how individual treatment-specific cardiotoxicities translate into cardiovascular risk 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 two main areas of research are:

  • how cancer treatment related cardiotoxicities translate into cardiovascular risk in the population of cancer survivors
  • how the diagnosis and treatment of breast cancer affect the long term mental health and quality of life of survivors

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.

Research
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BEYOND Cancer research
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Our two main areas of research are:

How cancer treatment related cardiotoxicities translate into cardiovascular risk in the population of cancer survivors

This project is funded by a Wellcome/Royal Society Sir Henry Dale Fellowship, and uses data routinely collected in anonymised electronic health records to study cardiovascular disease risk among survivors of cancer in the UK.

It has three aims:

To estimate the risks of key cardiovascular diseases in survivors of certain cancers, and to investigate determinants of increased risk.

This 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.

A description of work underway can be found on the CPRD website.

To evaluate the predictive accuracy of existing risk stratification tools in cancer survivors.

Cardiovascular risk scoring is widely used to guide disease prevention in the general population, but none of the widely used cardiovascular risk stratification tools have been validated in, or optimised for, cancer survivor populations. The results of this study will inform whether existing or modified scoring algorithms can adequately identify cancer survivors in greatest need of preventive interventions.

To investigate whether recommended pharmacological interventions to prevent cardiovascular disease are optimally implemented among cancer survivors.

Pharmacological management of lipid levels and blood pressure remains a key strategy for general long-term cardiovascular disease prevention but it is unclear whether this is being implemented optimally in cancer survivors. The evidence generated from this study will assess the extent to which current cardiovascular risk prevention guidelines are being implemented in this population, and whether patients adhere to preventive therapies; this information is essential to inform prevention initiatives among cancer survivors.

These studies are currently ongoing.

How the diagnosis and treatment of breast cancer affect the long term mental health and quality of life of survivors

Women with a history of breast cancer are the largest group of cancer survivors in the UK.

This project uses both patient reported outcomes and data routinely collected in anonymised electronic health records to study mental health and quality of life of breast cancer survivors in the UK.

It has two aims:

To quantify the risk of adverse mental health outcomes in women diagnosed with breast cancer, compared to women who did not have cancer.

This study will use data routinely collected in primary care practices and hospitals in the UK to assess whether breast cancer survivors have a different risk of anxiety and depression in the years after the diagnosis, compared to women who did not have a cancer diagnosis. Information on the long-term risk of these conditions is currently scarce. The results of this study can be used to inform evidence-based strategies to tackle the burden of mental health disorders in cancer survivors.

To investigate the health-related quality of life of women with a history of breast cancer for a year or longer, compared to women who did not have cancer.

We currently know little about how a previous diagnosis of breast cancer might affect a woman’s quality of life and mental health in the long term. In this study, we are inviting women with a previous diagnosis of breast cancer, and women who never had cancer, to answer some questions about their feelings and experiences. The results of this study will allow clinicians and policy makers to better understand the long-term needs of the largest group of cancer survivors in the population.

Please visit study page here.

Quality of life study
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BEYOND Cancer Quality of life in breast cancer survivors
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Quality of life, depression and anxiety in breast cancer survivors compared to women who did not have cancer

This a study in which we are inviting women with a history of breast cancer for one year or longer, and women who did not have cancer, to answer short questionnaires about their quality of life and mental health.

The aim is to understand if women who have had a diagnosis of breast cancer in the past have more anxiety, depression or a poorer quality of life compared to women who have not had cancer.

Participants in this study were randomly selected from primary care practices in the UK which contributed data to the Clinical Practice Research Datalink, at the Medicines and Healthcare products Regulatory Agency.

We are currently recruiting patients for this study. The results will be made available on this page in due course.

If you wish to be notified of the study results, please leave your email below.

Acknowledgments

We would like to thank all study participants and primary care practices for their collaboration.

We would also like to thank the Independent Cancer Patients' Voice for their help in the development of the study materials.

This study is a collaboration between researchers at the London School of Hygiene & Tropical Medicine and the Clinical Practice Research Datalink (CPRD), which is part of the Medicines and Healthcare products Regulatory Agency (MHRA).

Who we are
Profiles

Helena
Carreira

Research Degree Student

Helen
Strongman

Research Fellow
Publications
Publications List Block
Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases.
Helen Strongman, H, Gadd S, Matthews A, Mansfield KE, Stanway S, Lyon AR, dos-Santos-Silva I, Smeeth L, Bhaskaran K.
2019
Lancet. DOI: 10.1016/S0140-6736(19)31674-5
Risk of dementia among postmenopausal breast cancer survivors treated with aromatase inhibitors versus tamoxifen: a cohort study using primary care data from the UK.
Bromley SE, Matthews A, Smeeth L, Stanway S, Bhaskaran K.
2019
J Cancer Survivorship 2019 13: 632. DOI: 10.1007/s11764-019-00782-w
Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review
Carreira, H; Williams, R; Müller, M; Harewood, R; Stanway, S; Bhaskaran, K
2018
Journal of the National Cancer Institute. ISSN 0027-8874 DOI: https://doi.org/10.1093/jnci/djy177
Acute Pericarditis and Cancer Risk: A Matched Cohort Study Using Linked UK Primary and Secondary Care Data
Søgaard, KK; Sørensen, HT; Smeeth, L; Bhaskaran, K
2018
Journal of the American Heart Association, 7 (16). e009428. ISSN 2047-9980 DOI: https://doi.org/10.1161/JAHA.118.009428
Statin use in cancer survivors versus the general population: cohort study using primary care data from the UK clinical practice research datalink
Chidwick, K; Strongman, H; Matthews, A; Stanway, S; Lyon, AR; Smeeth, L; Bhaskaran, K
2018
BMC cancer, 18 (1). p. 1018. ISSN 1471-2407 DOI: https://doi.org/10.1186/s12885-018-4947-8
Long term adjuvant endocrine therapy and risk of cardiovascular disease in female breast cancer survivors: systematic review
Matthews, A; Stanway, S; Farmer, RE; Strongman, H; Thomas, S; Lyon, AR; Smeeth, L; Bhaskaran, K
2018
BMJ (Clinical research ed), 363. k3845. ISSN 0959-8138 DOI: https://doi.org/10.1136/bmj.k3845
Adverse mental health outcomes in breast cancer survivors compared to women who did not have cancer: systematic review protocol
Carreira, H; Williams, R; Müller, M; Harewood, R; Bhaskaran, K
2017
Systematic reviews, 6 (1). p. 162. ISSN 2046-4053 DOI: https://doi.org/10.1186/s13643-017-0551-2
Herpes zoster risk after 21 specific cancers: population-based case-control study
Hansson, E; Forbes, HJ; Langan, SM; Smeeth, L; Bhaskaran, K
2017
British journal of cancer, 116 (12). pp. 1643-1651. ISSN 0007-0920 DOI: https://doi.org/10.1038/bjc.2017.124
Breast cancer recurrence after reoperation for surgical bleeding
Pedersen, RN; Bhaskaran, K; Heide-Jørgensen, U; Nørgaard, M; Christiansen, PM; Kroman, N; Sørensen, HT; Cronin-Fenton, DP
2017
The British journal of surgery. ISSN 0007-1323 DOI: https://doi.org/10.1002/bjs.10592
Pericarditis as a Marker of Occult Cancer and a Prognostic Factor for Cancer Mortality
Søgaard, KK; Farkas, DK; Ehrenstein, V; Bhaskaran, K; Bøtker, HE; Sørensen, HT
2017
Circulation. ISSN 0009-7322 DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.024041