Generating impact to prevent cancer in people with Lynch syndrome

Lead Research Organisation: University of Leeds
Department Name: School of Medicine

Abstract

The National Institute for Health and Care Excellence (NICE) is a government organisation that produces guidelines for the National Health Service (NHS). NICE recommends that healthcare professionals should consider prescribing daily aspirin to prevent bowel cancer in people with a genetic condition called Lynch syndrome. Lynch syndrome increases the risk of developing a spectrum of cancers, including bowel. Future national guidance may recommend aspirin for cancer prevention in the general population, similar to Australian recommendations. In my PhD, I investigated the barriers to implementing aspirin for cancer prevention into the NHS. I studied the views of people with Lynch syndrome, the general population, and healthcare professionals. I concluded that coordinated strategies, which address the needs of patients and healthcare professionals, are required to implement aspirin for cancer prevention into the NHS. I identified individuals with Lynch syndrome for whom aspirin was not appropriate, highlighting a need for new cancer prevention initiatives for these people. In the ESRC Fellowship, I will enhance my PhD impact, and further develop my training and publication track record. I will develop a competitive funding proposal, which will secure my position as a future leader in behavioural research.

PhD research event engaging with different audiences
I will host an online event showcasing my PhD findings, focusing on the findings related to people with Lynch syndrome. I will moderate a session for attendees to discuss how to implement the findings into policy and clinical practice. I will invite key stakeholders, including people with Lynch syndrome, research scientists, and representatives from relevant organisations (e.g., Cancer Research UK, NICE). I will share a summary of the event and agreed recommendations for policy and practice through the charity Lynch Syndrome UK, and the British Journal of General Practice.

Publication of final PhD study
I have published three of my four PhD studies in leading health journals. My third study explored the views of the general population on aspirin for bowel cancer prevention. I will submit the study for publication in Preventive Medicine Reports.

Limited new research
In my PhD, I interviewed 15 people with Lynch syndrome to discuss their views on aspirin for bowel cancer prevention. In these interviews, other key preventive approaches were discussed, such as diet and exercise to prevent obesity-related cancers. Weight management could be an important complementary or alternative strategy to aspirin for cancer prevention. I will allocate 20% of the Fellowship to re-analysing these interviews, and conducting 10 new interviews to explore participants' views on weight management to prevent cancer. I will submit the study for publication in Familial Cancer, and present at the International Behavioural Trials Network Conference.

Funding proposal
I will develop a funding proposal to adapt a weight management intervention to prevent cancer in people with Lynch syndrome with overweight or obesity. During the design of the proposal, I will seek out the views of patient representatives, and expert researchers. I will consider several funding schemes, including the ESRC New Investigator Grant. I will submit the proposal by the end of the ESRC Postdoctoral Fellowship.

Training
I will undertake training to enhance my research skills, and network with leading international behavioural researchers. I will apply to attend:
- International Agency for Research on Cancer summer school 2024 programme in Lyon, France.
- International Behavioural Trials Network 2024 summer school and conference in Montréal, Canada.
- University of Oxford course: 'Randomised Control Trials Course: A Guide to Design, Conduct, Analysis, Interpretation and Reporting'.

This Fellowship is aligned with the Wellbeing, Health and Communities pathway, which aims to address challenges such as obesity.
 
Description In the ESRC WRDTP Postdoctoral Fellowship, I aimed to further consolidate my PhD, which examined decision-making on aspirin for colorectal cancer prevention, enhance my academic training, and submit a funding proposal in a new research area of weight management. In my ESRC Fellowship, I published my final PhD study in BMJ Open: 'Acceptability of aspirin for cancer preventive therapy: a survey and qualitative study exploring the views of the UK general population'. I also had the opportunity to work on a study with my mentor, Professor Rebecca Beeken, and several new collaborators. The study explored the views of people with experience of obesity and living with and beyond colorectal, breast or prostate cancer on weight management.
In the Fellowship, I developed a large project proposal as the principal investigator (PI), and with my mentor Professor Sam Smith as co-PI to Yorkshire Cancer Research (YCR). While I was unsuccessful, I learnt invaluable skills in grant development, and working with a diverse expert team. To develop the YCR funding proposal, I conducted patient and public involvement (PPI) work with people with Lynch syndrome and higher weight. To support further meetings, I was successfully awarded a NIHR RDS-YH Public Involvement Fund. I also recruited 12 experts in behavioural science, weight management, or Lynch syndrome to an interdisciplinary steering group, who I collaborated with on the YCR proposal.
In the Fellowship, I undertook multiple training opportunities. In May 2024, I attended the International Behavioural Trials Network (IBTN) 2024 Summer School in Montréal, Canada. In September 2024, I attended the University of Oxford Randomised Control Trials Course. I also attended the European Health Psychology Society 2024 conference, where I presented the qualitative study on weight management.
Exploitation Route In the publication, 'Acceptability of aspirin for cancer preventive therapy: a survey and qualitative study exploring the views of the UK general population', I observed higher acceptability towards taking daily aspirin for colorectal cancer prevention among people in the general population who perceive themselves at increased risk, from factors such as a personal or family history of cancer. In the future, the UK may recommend aspirin for colorectal cancer prevention for people in the general population aged 50 to 70, similar to Australia. It may also be possible that future UK guidance instead recommends aspirin for those at higher risk of cancer outside of the Lynch syndrome population, such as people who have previously had cancer. For aspirin to be effective for preventing cancer, there needs to be sufficient acceptability and uptake of the medication. The findings from this publication provide important early evidence on acceptability towards taking aspirin for cancer prevention among those with a personal or family history of cancer, outside of the Lynch syndrome population.
Sectors Healthcare

 
Description 'Using behaviour change theory to address the grand challenges in wellbeing, health and communities', White Rose DTP
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description The Yorkshire Cancer Research Bowel Cancer Improvement Programme resources to support the prescribing of aspirin
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Contribution to new or improved professional practice
URL https://ycrbcip.leeds.ac.uk/ycrbcip-resources/
 
Description NIHR RDS-YH Public Involvement in Grant Applications Funding Award
Amount £590 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 09/2023 
End 12/2023
 
Title Short survey on aspirin use for cancer prevention among the UK general public 
Description Australian guidance recommends aspirin for colorectal cancer prevention among people aged 50-70 at population risk. The medication could be offered more widely in the future in the UK and other countries. We conducted an online survey to investigate aspirin use, and awareness of aspirin for cancer prevention among the UK general population. We recruited 400 UK respondents aged 50-70 through a market research company to an online survey. 
Type Of Material Database/Collection of data 
Year Produced 2023 
Provided To Others? Yes  
Impact The dataset was used in my publication, 'Acceptability of aspirin for cancer preventive therapy: a survey and qualitative study exploring the views of the UK general population', https://bmjopen.bmj.com/content/13/12/e078703 
URL https://archive.researchdata.leeds.ac.uk/1134/
 
Description Invited speaker at West Yorkshire & Harrogate Cancer Alliance Team Colorectal Optimal Pathway Group Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact I attended the West Yorkshire & Harrogate Cancer Alliance Team Colorectal Optimal Pathway Group Meeting, where I discussed my PhD research on the barriers and facilitators towards aspirin for colorectal cancer prevention. I discussed the barriers among people with Lynch syndrome, and GPs. The group included clinical practitioners working in colorectal cancer. From this talk, I am hoping to work closely with a colorectal cancer nurse to reduce the barriers to GPs prescribing aspirin.
Year(s) Of Engagement Activity 2024
 
Description Lynch Syndrome UK Patient Conference 2024. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact I presented my potential future work on weight management and physical activity at the Lynch Syndrome UK 2024 patient conference. The event was well attended with over 50 people, and I took questions from the audience which enabled me to understand reactions to this work.
Year(s) Of Engagement Activity 2024