In this blog Dr Mieke Van Hemelrijck, Reader (Associate Professor) in Cancer Epidemiology in the School of Cancer & Pharmaceutical Sciences at King’s College London tells us how she has adapted Guy’s Cancer Cohort to research the impact of COVID-19 on cancer patients outcomes.
Most of your work has revolved around the epidemiology of urological cancers, how did you sidestep into COVID-19 work?
I run Guy’s Cancer Real World Evidence Programme, which is a collaboration between Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. Together with Anne Rigg (the clinical lead from GSTT) we work with routinely collected anonymised data from cancer patients generating hypothesis and evidence important in both the clinical and the research settings.
When the pandemic hit, our oncology colleagues were lacking evidence on how best to treat their cancer patients, as a lot of them are on immune suppressants or immune stimulants. The first question the clinicians wanted to be answered evolved around the risks of using ibuprofen. This resulted in our systematic review of the effects of ibuprofen after we also did some further work around immune suppressants and stimulating drugs.
Once we realised that London was at the epicentre of the COVID-19 epidemic in the UK and that South East London was the epicentre of the epicentre it made sense to use our cancer dataset to explore outcomes on cancer patients who tested positive for COVID-19. My team manages Guy’s Cancer Cohort – which is our REC approved database to use routinely collected anonymised data on cancer patients in GSTT for research. Since ethics was already in place it was easier for us to amend the dataset to include data on COVID and cancer.
Currently, there are various initiatives to develop core outcomes, including those being developed for COVID. We looked at these initiatives and liaised with other colleagues at KCL and in Milan. Our colleagues in Milan are critical because they’re ahead of us in terms of the pandemic and had already begun to think about data items to collect and core outcomes. Together we designed a database of core data items to collect on our cancer patients.
What do you expect to be able to study once you have sufficient data? Are there any hypotheses you’re keen to explore?
The obvious one is “how is cancer impacting on COVID outcomes?”. That’s the easiest one to study because by looking at all our cancer patients who are COVID positive we can quickly say things about for example their demographic composition.
The question “how does COVID impact oncological outcomes?”, is very tricky to answer. We need to compare outcomes from cancer patients who do not have COVID but do have a similar type of cancer, a similar type of treatment, etc to patients with COVID. There are so many factors which play a role on oncological outcomes. On top of that, there is an even more important question once we go post-COVID, which is “what is the effect of the pandemic in itself on oncological outcomes and quality of life?”. There will be changes in treatment, delays in treatment, and then there will also be a number of people who due to delays in early diagnosis and screening are going to get a diagnosis of cancer which could have been preventable (or treatable). We’ll end up with many patients who present with a more advanced stage at the time of diagnosis.
Finally, the importance of collecting data on healthcare professionals cannot be overlooked: there’s a lot of work to be done around the quality of life, stress, fatigue and anxiety in the healthcare profession as well as our patients.
How will this impact on cancer treatment during the COVID outbreak?
I think the most important thing is to quantify the impact across various settings. The impact will be different across Europe, the UK and even just in South East London. It’s about working together to share data and share findings.
The next step is engaging policymakers. We can’t change the guidelines for cancer patients, we can share out data, we can publish our results. Afterwards, we’ll have to work with policymakers, patient and healthcare professional advocates to shape guidelines. Our contribution is making sure we provide good quality of data if we keep reporting and are sensible about the strengths and limitations of our analysis, we can inform those who eventually have the final decision on policy.
You mentioned the collaboration with Milan. What does that help you achieve?
We want to see that our data collection is aligned. Italy has a different healthcare system and is at a different stage of the pandemic. When investigating the question “how is cancer affecting COVID outcomes?” we would like to compare findings in our hospital with those in Milan.
What are your future plans for the data collection? How are you building on this new resource for the future?
We have shared our data collection template with various other groups both internationally and within our own academic health centres.
It’s great to see the close collaboration between academics and oncologists. With the support of our clinical colleagues, we’ve been able to identify ways in which to improve the quality of the database. By listing potential research questions, thinking about potential study designs and then carrying out preliminary analyses we can ensure at an early stage that we are collecting all the data we will need.
The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.
