Ethnicity and the tumour characteristics of invasive breast cancer

Ethnicity and the tumour characteristics of invasive breast cancer in over 116,500 women in England.
Br J Cancer (2021). https://doi.org/10.1038/s41416-021-01409-7

• Analysis of data from the National Cancer Registration and Analysis Service on women diagnosed with invasive breast cancer during 2013–2018 found that ethnic minority women are at greater risk of breast cancers with less favourable characteristics, even after allowing for age and other potential confounders. These differences are greater in older than younger women, and in the Black rather than South Asian ethnic groups.

Using the Cambridge Prognostic Groups in the NPCA

Using the Cambridge Prognostic Groups in the NPCA
HQIP 11 February 2021
This National Prostate Cancer Audit Short Report presents a new stratification tool (the Cambridge Prognostic Grouping, CPG) which classifies men into five categories based on more detailed information about the clinical features of their disease.

National Cancer Registration and Analysis Service: data users and partners

National Cancer Registration and Analysis Service: data users and partners
PHE 15 December 2020

• Guidance for all users of National Cancer Registration data on how to appropriately acknowledge use of the data on all outputs

Cancer diagnostic tools to aid decision-making in primary care:

Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis
Health Technol Assess 2020;24(66) November 2020

• Systematic reviews to examine the clinical effectiveness and the development, validation and accuracy of diagnostic prediction models for aiding general practitioners in cancer diagnosis identified little good-quality evidence. Many diagnostic prediction models are limited by a lack of external validation. 
• A survey of general practitioners/ practice level staff found that cancer decision support tools were available in 83 out of 227 practices, and were likely to be used in 38 out of 227 practices.

Cancer diagnostic tools to aid decision-making in primary care

Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis.
Health Technol Assess November 2020;24(66)

• Two systematic reviews have been published which examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. 
• Results: Systematic review 1 – five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 – 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools.

GatewayC Cancer Maps

GatewayC Cancer Maps

• The Cancer Maps is an interactive reference tool for GPs based on the NICE NG12 cancer guidelines. Primarily, the tool is designed to enable GPs to take symptoms that patients present with during a consultation and map them on possible suspected cancer pathways.
• There are 4 main ways to use The Cancer Maps :
• As a quick reference to NICE guidance
• As a decision support tool
• As an educational tool
• With patients to reassure or safety net

Cancer in the UK 2020: Socio-economic deprivation

Cancer in the UK 2020: Socio-economic deprivation
Cancer Research UK September 2020

• This report examines the link between socio-economic deprivation and cancer. 
• “People from more deprived areas are not only more likely to get cancer, they’re more likely to be diagnosed at a late stage for certain cancer types, and have trouble accessing cancer services.“
• Full report here.

Association of Type 2 Diabetes With Cancer: A Meta-analysis

Association of Type 2 Diabetes With Cancer: A Meta-analysis With Bias Analysis for Unmeasured Confounding in 151 Cohorts Comprising 32 Million People
Diabetes Care 2020 Sep; 43(9): 2313-2322.https://doi.org/10.2337/dc20-0204

• A total of 151 cohorts (over 32 million people, 1.1 million cancer cases, and 150,000 cancer deaths) were identified. In meta-analyses, type 2 diabetes (T2D) was associated with incidence of several cancers, from prostate (RR 0.83; 95% CI 0.79, 0.88) to liver (2.23; 1.99, 2.49), and with mortality from pancreatic cancer (1.67; 1.30, 2.14). In bias analyses, assuming an unmeasured confounding associated with both T2D and cancer with a RR of 1.5, the proportion of studies with a true effect size larger than a RR of 1.1 (i.e., 10% increased risk in individuals with T2D) was nearly 100% for liver, pancreatic, and endometrial, 86% for gallbladder, 67% for kidney, 64% for colon, 62% for colorectal, and <50% for other cancer incidences, and 92% for pancreatic cancer mortality.

CRUK Open Lab Initiative

CRUK Open Lab Initiative
CRUK

• The CRUK Open Lab Initiative is a digital tool which connects research groups with shared interests to generate new collaborations and spark discussions. The pilot phase, which launched in April 2020, successfully paired over 50 research groups.
• The tool is now available to researchers across the UK, enabling virtual meetings during the COVID-19 pandemic and beyond. 

A clinician's guide for developing a prediction model

A clinician's guide for developing a prediction model: a case study using real-world data of patients with castration-resistant prostate cancer
J Cancer Res Clin Oncol . 2020 Aug;146(8):2067-2075. doi: 10.1007/s00432-020-03286-8.

• A retrospective registry of 20 Dutch hospitals with data on patients treated for castration-resistant prostate cancer was used to develop a comprehensive guide for clinicians through the steps of developing a risk prediction model. 

Abstract

Understanding the link between health systems and cancer survival

Understanding the link between health systems and cancer survival: A novel methodological approach using a system-level conceptual model
Journal of Cancer Policy v25, September 2020, 100233

• Health system contribution to variation in cancer outcomes remains largely unexplained. This paper presents a conceptual model which depicts the complex interactions along the cancer care pathway. Possible ‘breakpoints’ are highlighted which may have adverse impacts on outcomes. The model provides a novel way to identify where health services could be adapted.

Routes to Cancer Diagnosis 2010-2017

Routes to Cancer Diagnosis 2010-2017
National Cancer Registration and Analysis Service (NCRAS) 14 July 2020

• Routes to Diagnosis categorises the pathways that lead to a patient’s diagnosis of cancer. These results provide an overview of the results for 2006 to 2017, showing the trends over time for all malignant neoplasms (excluding non-melanoma skin cancer) and a snapshot of results in 2017 for female breast, colorectal, lung and prostate cancers.
• One of the aspects highlighted by Routes to Diagnosis is the inequality in how people are diagnosed. A study by Herbert and others found that age and deprivation affect the route to diagnosis. Older people continue to make up the bulk of those diagnosed as an emergency presentation, and those who are more deprived are also more likely to be diagnosed through this route.

Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency [Preprint]

Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency [Preprint]
ResearchGate accessed 29 April 2020 DOI: 10.13140/RG.2.2.34254.82242

• "The model estimated 6,270 excess deaths at 1 year in England."
• "In England, the proportion of patients with incident cancer with≥1 comorbidity was 65.2%. The number of comorbidities was strongly associated with can-cer mortality risk. "

Read a commentary on this research here:

Deaths in people with cancer could rise by at least 20%
Imperial College Health Data Research Hub for Cancer 29 April 2020

Cancer patients in England: diagnostic intervals

Cancer patients in England: diagnostic intervals
PHE 21 April 2020

• Population-based statistics on diagnostic intervals for cancer patients for 24 cancer types diagnosed in 2014 and 2015 in England.
• This commentary accompanies an interactive tool that presents these diagnostic intervals and frequencies by age at diagnosis, stage at diagnosis, broad ethnic group, Charlson comorbidity index, income deprivation, sex and Cancer Alliance.
• It includes new insights by ethnicity, stage and comorbidity.

Chemotherapy, Radiotherapy and Surgical Tumour Resections in England

Chemotherapy, Radiotherapy and Surgical Tumour Resections in England
PHE 8 April 2020

• Population-based statistics on cancers treated with chemotherapy, radiotherapy and surgical tumour resection which were diagnosed between 2013 and 2016 in England. 
• This commentary accompanies an interactive tool that breaks down treatment by age at diagnosis, stage at diagnosis, broad ethnic group, Charlson comorbidity index, income deprivation, sex, year of diagnosis and Cancer Alliance.

Impact of maternal reproductive factors on cancer risks of offspring: A systematic review and meta-analysis of cohort studies

Impact of maternal reproductive factors on cancer risks of offspring: A systematic review and meta-analysis of cohort studies
PLOS One 30 March 2020 bdoi.org/10.1371/journal.pone.0230721

• This systematic review examined the association between maternal reproductive factors of age at birth, birth order, number of births, delivery methods, and breastfeeding duration and cancer in children. 
• For most exposures and most cancers, no suggestion of a causal relation was found. Meta analysis concludes that very small impacts existed between a number of reproductive factors and cancer incidence and mortality in children and the certainty of evidence was low to very low primarily due to observational design.

The Effect of Assessing Genetic Risk of Prostate Cancer on the Use of PSA Tests in Primary Care: A Cluster Randomized Controlled Trial
PLoS Med, 17 (2), e1003033 7 February 2020 DOI: 10.1371/journal.pmed.1003033

• A small RCT (73 in each arm) carried out in USA concludes that providing GPs with access to a genetic test to assess lifetime risk of prostate cancer did not reduce the overall number of future PSA tests. However, among men who had a genetic test, knowledge of genetic risk significantly influenced future PSA testing.

Abstract

Cancer Inequalities Toolkit

Cancer Inequalities Toolkit
Health London Partnership

• The Transforming Cancer Services Team (TCST) has produced a toolkit to reduce inequalities in cancer care and outcomes in London and West Essex in terms of; marginalised groups, early diagnosis, access and treatment, personalised care, and a summary of recommendations.

OWise mobile app and website for supporting women with breast cancer

OWise mobile app and website for supporting women with breast cancer
Scottish health technologies Group Innovative Medical Technology Overview 10 January 2020

• OWise Breast Cancer is a patient support tool developed by Px HealthCare, which can be accessed as an app on smartphones and tablets, or through a website (http://www.owise.uk/). The OWise app is CE marked as a ‘medical device class 1’ (low-risk device). 
• A summary of the evidence submitted for assessment by the manufacture

Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review
British Journal of General Practice 2019; 69 (689): e809-e818. DOI: https://doi.org/10.3399/bjgp19X706745

• A systematic review of literature around electronic clinical decision support tools (eCDSTs) to support cancer diagnosis in primary care indicates that eCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. The authors conclude that "Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods."

Abstract