Exploring long-term mental health, quality of life, cognitive health and cardiovascular disease outcomes among cancer survivors
Lead Research Organisation:
London School of Hygiene and Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
Concerns have been raised about the health of cancer survivors regarding the longer-term harmful consequences of cancer and its often aggressive and invasive treatment. Electronic Health Record (EHR) data sources, such as the UK Clinical Practice Research Datalink (CPRD) linked to cancer registration and treatment data, provide a unique opportunity to further our understanding of the relationship between cancer treatments and adverse health outcomes.
MH, quality of life (QoL), cognitive outcomes and cardiovascular disease (CVD) are key concerns for cancer survivors. Cancer is believed to worsen these outcomes through the adverse effects of treatments including fatigue, brain fog and cardiotoxicity, fear for the future, the stigma surrounding certain cancers and physical symptoms including chronic pain. Previous studies using CPRD data found the twenty most common cancers to be associated to a variety of negative MH and CVD outcomes. Additionally, MH problems may hinder cancer treatment and recovery. Despite this, little research has investigated the effects of different cancer treatments on MH, QoL, cognitive and CVD outcomes, nor the effects of treatment duration.
Breast cancer and prostate cancer are the most common cancers in the UK for women and men, respectively. These cancers are both hormone-mediated with more than 75% of those diagnosed living for at least ten years. Breast and prostate cancers are often treated with long-term hormonal therapy, as well as surgery, radiotherapy, chemotherapy and immune therapies. Survivors of these cancers have an increased risk of MH and CVD problems compared to the general population. Therefore, it is of interest to investigate the effects of anti-cancer treatments for survivors of breast and prostate cancers.
There are many issues in the capture of incident episodes of MH conditions in EHRs. These include a lack of clarity over how long an episode lasts (for example, two records of depression one year apart could be interpreted as one long episode or two short episodes), how to determine an individuals' severity of disease and whether managed (treated) or unmanaged illness can be identified. Prior MH research has utilised various case definitions based on codes for diagnosis, symptoms and prescriptions to define incident MH conditions, of which few were validated. Therefore, methodological issues in the ascertainment of MH make interpretations of the current literature challenging.
It is important to understand the effects of cancer treatment on MH, QoL, cognitive and CVD outcomes among the large and growing population of breast and prostate cancer survivors. However, it appears that little research has utilised detailed treatment data to compare the rate of these outcomes in those undergoing different treatment strategies for breast and prostate cancer with the general population. There are also important uncertainties in how best to define MH episodes in UK EHRs which need to be addressed by validating measures against a high-quality external source of information. Research on treatment specific effects will inform relevant stakeholders to guide clinical practice and aid in the development of MH, QoL, cognitive decline and CVD prevention strategies for those most vulnerable due to their cancer treatment.
Aims & Objectives
To exploit the opportunities offered by large scale linked EHR data to explore the effects of cancer treatments on the long-term MH, QoL, cognitive, and CVD outcomes among breast and prostate cancer survivors.
1. Determine how cancer treatment affects MH, QoL, cognitive and CVD outcomes in breast and prostate cancer survivors through a systematic review.
2. Evaluate and best define episodes and severity of mental illness in UK primary care data.
3. Investigate how anti-cancer treatments are related to MH, QoL, cognitive health and CVD outcomes for survivors of breast and prostate cancer in UK EHR data, and how these risks vary with treatment length.
MH, quality of life (QoL), cognitive outcomes and cardiovascular disease (CVD) are key concerns for cancer survivors. Cancer is believed to worsen these outcomes through the adverse effects of treatments including fatigue, brain fog and cardiotoxicity, fear for the future, the stigma surrounding certain cancers and physical symptoms including chronic pain. Previous studies using CPRD data found the twenty most common cancers to be associated to a variety of negative MH and CVD outcomes. Additionally, MH problems may hinder cancer treatment and recovery. Despite this, little research has investigated the effects of different cancer treatments on MH, QoL, cognitive and CVD outcomes, nor the effects of treatment duration.
Breast cancer and prostate cancer are the most common cancers in the UK for women and men, respectively. These cancers are both hormone-mediated with more than 75% of those diagnosed living for at least ten years. Breast and prostate cancers are often treated with long-term hormonal therapy, as well as surgery, radiotherapy, chemotherapy and immune therapies. Survivors of these cancers have an increased risk of MH and CVD problems compared to the general population. Therefore, it is of interest to investigate the effects of anti-cancer treatments for survivors of breast and prostate cancers.
There are many issues in the capture of incident episodes of MH conditions in EHRs. These include a lack of clarity over how long an episode lasts (for example, two records of depression one year apart could be interpreted as one long episode or two short episodes), how to determine an individuals' severity of disease and whether managed (treated) or unmanaged illness can be identified. Prior MH research has utilised various case definitions based on codes for diagnosis, symptoms and prescriptions to define incident MH conditions, of which few were validated. Therefore, methodological issues in the ascertainment of MH make interpretations of the current literature challenging.
It is important to understand the effects of cancer treatment on MH, QoL, cognitive and CVD outcomes among the large and growing population of breast and prostate cancer survivors. However, it appears that little research has utilised detailed treatment data to compare the rate of these outcomes in those undergoing different treatment strategies for breast and prostate cancer with the general population. There are also important uncertainties in how best to define MH episodes in UK EHRs which need to be addressed by validating measures against a high-quality external source of information. Research on treatment specific effects will inform relevant stakeholders to guide clinical practice and aid in the development of MH, QoL, cognitive decline and CVD prevention strategies for those most vulnerable due to their cancer treatment.
Aims & Objectives
To exploit the opportunities offered by large scale linked EHR data to explore the effects of cancer treatments on the long-term MH, QoL, cognitive, and CVD outcomes among breast and prostate cancer survivors.
1. Determine how cancer treatment affects MH, QoL, cognitive and CVD outcomes in breast and prostate cancer survivors through a systematic review.
2. Evaluate and best define episodes and severity of mental illness in UK primary care data.
3. Investigate how anti-cancer treatments are related to MH, QoL, cognitive health and CVD outcomes for survivors of breast and prostate cancer in UK EHR data, and how these risks vary with treatment length.
People |
ORCID iD |
| Matthew Hazell (Student) |
Studentship Projects
| Project Reference | Relationship | Related To | Start | End | Student Name |
|---|---|---|---|---|---|
| MR/W006677/1 | 30/09/2022 | 29/09/2030 | |||
| 2924932 | Studentship | MR/W006677/1 | 30/09/2024 | 29/09/2028 | Matthew Hazell |