How patient data is being used to study the link between cancer and cardiovascular disease

Introduction

Researchers at the University of Leicester have been studying the link between cancer and cardiovascular disease. The research uses patient data collected by the National Disease Registration Service (NDRS). The team have created the world’s first national cardio-oncology research platform for England and published many research studies.

What is the Virtual Cardio-Oncology Research Initiative?

The Virtual Cardio-Oncology Research Initiative (VICORI) uses patient data to study differences in risk factors, treatments and outcomes between people with cancer, cardiovascular disease, or both. Cardiovascular disease covers all conditions affecting the heart or blood vessels.

VICORI is a 5-year research programme led by the University of Leicester. The VICORI team work with the National Cancer Registration and Analysis Service (NCRAS) and the National Institute for Cardiovascular Outcome Research (NICOR). The programme is funded by Cancer Research UK and the British Heart Foundation.

What have they found?

Using data from the whole of England, the VICORI team found out how many people had cancer and a cardiovascular disease.

They found that 390,000 patients were listed in both the cancer registry and one or more of the cardiac audits between 1995 and 2018.

Of these, over 160,000 patients had cancer and a hospital admission for acute coronary syndrome. Acute coronary syndrome is a term for conditions linked with sudden, reduced blood flow to the heart. There were also:

  • 61,000 patients with cancer and heart failure
  • 85,000 patients with cancer and an implanted cardiac device (a pacemaker or defibrillator)

An implanted cardiac device is placed in your chest to monitor your heart.

VICORI have used this information to explore the link between cancer and cardiovascular disease. They recently studied the treatment and outcome of patients with lung cancer. The study found that patients with cardiovascular disease and early-stage non-small-cell lung cancer were less likely to have a resection. A resection is surgery to remove cancerous tissue or part or all of an organ. A resection can cure patients with early stage cancer.

The study also found that patients with both diseases are more likely to die.

What are the next steps?

VICORI are looking at more ways to understand the link between cancer and cardiovascular disease. They plan to explore:

  • common risk factors such as lifestyle and economic factors that might increase the risk of both diseases
  • the impact of care delivery on cancer and cardiovascular disease diagnoses and treatment, for example the management and treatment of cancer patients who are diagnosed with acute cardiovascular disease in hospital
  • factors that may increase the risk of death

Why is this work needed?

Cancer and cardiovascular disease are the most common causes of death across the world. However, as treatment has got better, more people are living with both conditions.

It is well known that cancer and its treatment can increase the risk of cardiovascular disease, but we are unsure why this happens.

If you visit a hospital in England, you will probably find a cardiology department and a cancer centre. Yet these are separate departments, sometimes in different buildings. This is also the case in research, where cardiovascular disease and cancer are rarely studied together. This means we do not know much about how these two conditions and their treatments interact.

What are the benefits of this work?

VICORI hope to improve outcomes for people with cardiovascular disease and cancer by:

  • developing guidelines for patient care
  • informing care for patients with more than one disease

VICORI’s whole-country cardio-oncology research platform can also be used as a helpful data source for other researchers. This will lead to improved outcomes for people with cardiovascular disease and cancer.

VICORI also plan to create a guide for linking separate national health databases. The first stage of this was producing a Data Resource Profile, published in June 2021. The Data Resource Profile outlines all of the data that VICORI use.

What data is used for this work?

NDRS and NICOR have legal permission to collect patient-level data and to use it to protect the health of the population. This permission is given under Section 251 of the NHS Act 2006. Everyone working with patient data is trained in information governance and follows strict rules to make sure patient information stays safe.

VICORI uses national, routinely collected healthcare datasets to look at the link between cardiovascular disease and cancer. The NCRAS datasets include:

  • Cancer Outcomes and Services Dataset (COSD)
  • Systemic Anti-Cancer Therapy (SACT) dataset
  • Radiotherapy Dataset (RTDS)
  • Hospital Episode Statistics (HES) dataset

The COSD dataset is used to see the nature and stage of the cancer and the age, sex, socio-economic and ethnic make-up of the population.

The SACT dataset is used to see how many people with cardiovascular disease and cancer received chemotherapy or other drugs as part of their treatment.

The RTDS dataset is used to see how many people with cardiovascular disease and cancer received radiotherapy as part of their treatment.

Hospital Episode Statistics (HES) show when and where a patient went to hospital. VICORI uses the HES dataset to get more information about the patient before and after diagnosis. It is also used to complete some data records and check data quality.

The NICOR datasets include:

  • Myocardial Infarction (MINAP) dataset
  • Adult Cardiovascular Interventions (ACI) dataset
  • Adult Cardiovascular Surgical (NACSA) dataset
  • Heart Failure (NHFA) dataset
  • Heart Rhythms and Devices (CRM) dataset
  • The Congenital Heart Disease dataset

You can read more about NICOR’s datasets here.

The VICORI team also uses mortality data from the Office for National Statistics (ONS). This shows when patients died and the cause of death.

How have patients been involved?

NDRS have worked with ‘use MY data’ to produce this data story. ‘use MY data’ is an independent patient movement focused on promoting the benefits of using patient data to save lives and improve outcomes.

We worked with ‘use MY data’ member Paul Charlton on the story. Paul has helped to shape the VICORI research as a member of the Programme Board. He also sits on the Internal Project Review panel which reviews research proposals.

Paul recently gave a short presentation on VICORI’s research to the Consumer Forum of the National Cancer Research Institute. One of the follow up comments shows the importance of VICORI’s work for patients and their families:

‘By way of background I was diagnosed with Chronic Myeloid Leukaemia (CML) in August 2011. I’ve been lucky and the drug treatments have controlled the CML very well, however I have had some side effects, one of which maybe mild pericardial constrictive physiology. No one though can decide if this is a result of the drugs I’m taking, due to a viral infection or would just have happened. Hence my interest in the VICORI research and whether my medical history and experiences are relevant.

CML is a type of cancer that affects the white blood cells.

Where can I go for more information?

Read more about VICORI on their website here.

Find out more about the data that VICORI uses in their Data Resource Profile.

Read their article on the treatment and outcome of patients with lung cancer here.

Find out more about use MY data.

This work uses data provided by patients and collected by the NHS as part of their care and support.