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BEYOND Cancer

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

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About

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.

About
BEYOND Cancer About 2 columns
BEYOND Cancer About
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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.

Research
BEYOND Cancer 2 columns research
BEYOND Cancer research
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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:

  1. Shared risk factors for cancer and cardiovascular disease (e.g. excess body weight)
  2. Anti-cancer treatments (e.g. type of chemotherapy regiment, radiotherapy to the heart and major vessels
  3. 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.

Who we are
Profiles

Helena
Carreira

Research Fellow

Helen
Strongman

Assistant Professor
Publications
Scientific Papers
Factors associated with COVID-19-related death using OpenSAFELY
Williamson EJ, Walker A, Bhaskaran K, Bacon S, Bates C, Morton CE, Curtis HJ, Mehrkar A, Evans D, Inglesby P, Cockburn J, McDonald HI, MacKenna B, Tomlinson L, Douglas IJ, Rentsch CT, Mathur R, Wong AYS, Grieve R, Harrison D, Forbes H, Schultze A, Croker R, Parry J, Hester F, Harper S, Perera R, Evans SJW, Smeeth L, Goldacre B.
2020
Nature. 2020. doi: 10.1038/s41586-020-2521-4
Endocrine therapy use and cardiovascular risk in postmenopausal breast cancer survivors
Matthews A, Hinton SP, Stanway S, Lyon A, Smeeth L, Lund JL, Bhaskaran K
2020
Heart. 2020 Nov 11;heartjnl-2020-317510. doi: 10.1136/heartjnl-2020-317510.
Quality of life and mental health in breast cancer survivors compared with non-cancer controls: a study of patient-reported outcomes in the United Kingdom
Carreira H, Williams R, Dempsey H, Stanway S, Smeeth L, Bhaskaran K
2020
J Cancer Surviv. 2020 Oct 21. doi: 10.1007/s11764-020-00950-3
Risk of 16 cancers across the full glycemic spectrum: a population-based cohort study using the UK Biobank
Rentsch CT, Farmer RE, Eastwood SV, Mathur R, Garfield V, Farmaki A, Bhaskaran K, Chaturvedi N, Smeeth L
2020
BMJ Open Diabetes Res Care. 2020 Aug;8(1):e001600. doi: 10.1136/bmjdrc-2020-001600
Association Between Atopic Eczema and Cancer in England and Denmark
Kathryn E Mansfield, Sigrún A J Schmidt, Bianka Darvalics, Amy Mulick, Katrina Abuabara, Angel Y S Wong, Henrik Toft Sørensen, Liam Smeeth, Krishnan Bhaskaran, Isabel Dos Santos Silva, Richard J Silverwood, Sinéad M Langan
2020
JAMA Dermatol. 2020 Jun 24;e201948. doi: 10.1001/jamadermatol.2020.1948
Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review
Helena Carreira, Rachael Williams, Helen Strongman, Krishnan Bhaskaran
2019
BMJ Open. 2019 Jul 2;9(7):e029227. doi: 10.1136/bmjopen-2019-029227
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