Living with and beyond cancer – National Cancer Survivors Day 2023

Earlier detection and better treatments mean more than three million people in the UK are now living with and beyond cancer, a figure estimated to rise to 5.3 million by 2040 (Macmillan, October 2022). This is good news, but we know that some cancer treatments increase the risk of other health problems which can have a significant impact on the quality and length of life after cancer.

Research at The Christie NHS Foundation Trust, together with The University of Manchester is focused on how we can reduce these risks. We have recently been awarded £2.47 million for 2022-27 by the National Institute for Health and Care Research (NIHR) for our new Living with and Beyond Cancer (LWBC) research theme, part of the NIHR Manchester Biomedical Research Centre (BRC).

To coincide with National Cancer Survivors Day, we want to highlight some of our recent work. Our aim is to understand how certain cancer treatments have long term physical and mental effects. We are also working on screening programmes aimed at early detection of second, treatment related cancers in people cured of a first cancer.

We are additionally interested in using digital health applications to inform and support patients and clinicians. Most importantly we work closely with cancer patients to understand their perspectives and help guide our work.

Current research

Several LWBC researchers are working on improvements in the way we screen at-risk patients for cancer. For example, we know that women treated with radiotherapy to breast tissue when they are aged 10-35 years are at increased risk of developing breast cancer. Our research showed that the reach of screening into the at-risk population was low, so Prof John Radford (Professor of Medical Oncology, The Christie NHS Foundation Trust and Manchester BRC LWBC Co-Theme Lead) and team have set up a national dataset of at-risk women across England (BARD).

This makes sure all eligible women are automatically offered screening at the right time. This project was presented with a University of Manchester Outstanding Benefit to Society through Research Making a Difference award in May. You can find out more about this on the YouTube video Outstanding benefit to society through research: Professor John Radford and team and the team are pictured receiving their award below.

Dr Marianne Aznar (Senior Lecturer Adaptive Radiotherapy, University of Manchester) and colleagues are working on increasing our understanding of those most at risk of developing breast cancer in the BARD patient group. They aim to improve screening for individual cancer survivors by developing new methods to measure and report accurately the radiotherapy dose received by breast tissue during treatment.

Dr Kim Linton (Clinical Senior Lecturer, Medical Oncology, University of Manchester and Manchester BRC LWBC Programme lead) and Dr Rachel Broadbent (Specialist Registrar, Medical Oncology, The Christie NHS Foundation Trust) are interested in promoting screening for lung cancer in patients who have survived Hodgkin’s lymphoma (HL). Most survivors may not be aware that they are at a higher risk of developing lung cancer due to the treatment they received, sometimes many years previously.

In a recent study, two of 102 HL survivors reviewed, who had no symptoms, were diagnosed with lung cancer and went on to have potentially curative treatment. Manchester BRC funding will continue this work, developing a national lung cancer screening programme in HL survivors.

Dr Rohan Shotton (Clinical Research Fellow, The Christie NHS Foundation Trust) is looking at a group of chemotherapy drugs called anthracyclines and their effect on the heart. These drugs are very successful against several types of cancer including lymphoma, sarcoma and breast cancer but they can sometimes lead to heart damage. This can cause symptoms like breathlessness, tiredness and ankle swelling. Dr Shotton aims to develop new blood tests to detect heart damage at its earliest stage, so that affected patients can be better identified and managed.

Two new projects are using large databases, covering approximately 20% of the population of England and containing anonymised GP record information, to review the late effects of cancer treatments. The first study, led by Prof Darren Ashcroft (Professor of Pharmacoepidemiology, University of Manchester) and Dr Claire Higham (Consultant Endocrinologist, The Christie NHS Foundation Trust and Manchester BRC LWBC Programme Lead) has shown for the first time that the risk of bone fractures is increased in cancer survivors compared to the general population. This means that cancer survivors can be warned of this risk and given information on preventing fractures when their treatment is complete.

In a second study, due to start in autumn 2023, a Manchester BRC PhD funded student will use the same databases to investigate the increased risk of developing psychiatric illness in childhood, teenage and young adult (TYA) cancer survivors, later in life. We hope this will drive better clinical care for TYA patients, showing the need for earlier assessments and treatment from mental health specialists.

The long-term management of cancer survivors has been significantly improved by the ADAPT programme, developed by Professor Radford and team at The Christie NHS Foundation Trust. Here, routine hospital follow-up ceases at five years, and patients and their GP are provided with individualised information about possible late consequences of treatment, screening and management. Patients are not discharged and have immediate access to advice if needed. Patients have told us they have confidence in this approach and know who to contact for help. The next step is development of a digital e-ADAPT platform in collaboration with The University of Manchester.

Working with patients

All the work discussed so far has been informed by speaking to our patients about what is important to them. For example, Dr Claire Higham and Dr Sally Taylor (Senior Research Fellow, The Christie NHS Foundation Trust) recently asked patients about the impact of treatment-related bone fractures on their quality of life. Patients reported substantial challenges in their daily lives including a majority who experience severe to moderate pain, stiffness and mobility issues. They reported problems with getting a diagnosis, information and support. This will be used to help develop regular patient questionnaires and personalise support for patients.

Claire and Sally, working with Vocal’s Cancer Network, have also asked cancer survivors whether they thought it was important to collect information on the long-term side effects of cancer treatments. One person commented that ‘Even your family, don’t really understand what you are going through so if you are involved and having regular contact so you feel you were still part of things, it would be good.’

When thinking about the best information to collect, another said we should always ask about ‘the most important things which can affect the quality of daily life’. We will now use these valuable insights to shape our clinical data collection in the future.