Queen's University Belfast

Academic Institute

Department of Education and Learning Northern Ireland (DELNI)

Yes

113

Cancer is amongst the leading causes of morbidity and mortality worldwide and is the most common cause of death (29%) in Northern Ireland [1]. The number of people over 65 is projected to increase by 40% in NI, between 2010 and 2025. Older adults are less likely to receive optimal curative cancer therapies and have poorer survival outcomes [2,3]. Investigation into sub-optimal treatment in elderly cancer patients has not adjusted for the combined-effects of key variables such as stage, comorbidity and frailty. In particular, self-reported morbidities and frailty markers derived from the Census data have not been used. In addition, few studies have assessed under-treatment’s effected on net survival, and none have adopted a causal-inference methodological approach. This research aims to determine: a) whether there is curative surgical under-treatment in older adult breast, colorectal, and lung cancer patients. b) whether under-treatment reduces net survival for breast, colorectal and lung cancers. c) a causal inference methodology to address aims a) and b). From the Northern Ireland Cancer Registry (NICR), a population-based cancer registry, 1,700 breast, 1,500 lung, and 1,500 bowel cancer patients will be linked to the Northern Ireland Longitudinal Study (NILS). The NICR will bring patients’ tumour (e.g. stage), treatment modality, and comorbidity information. The NILS dataset health information on frailty (e.g. Q22, 2011 Census) and comorbidity (Q23, 2011 Census), ethnicity, and socio-economic factors. The combining of key variables from both NICR and NILS will provide an unprecedented opportunity to adjust for relevant sources of confounding at an individual level. Using causal-inference methods, the results will be comparable to the gold-standard randomized trial, which reduces the risk of confounding through randomization of the experimental units, allowing stronger conclusions, in relation to causality, to be made from an observational study.

Research into the elderly is very relevant for public policy since the number of people over 65 is projected to increase by 40% in NI, between 2010 and 2025, and the older adults’ size (i.e. those over 85) is expected to almost double [1]. With this growing proportion of elderly patients making up the NI population, better treatment outcome for these patients will significantly enhance the public health in Northern Ireland. This research is of great interest to the Health and Social Care NI (HSCNI), HSC Public Health Agency and Department of Health NI since they are directly involved in working to improve the health of the population. The study will stimulate a change in clinical decision-making perhaps requiring extra resource to adequately and objectively assess elderly cancer patients whose overall health issues may be more complex than younger patients. Better forms of comprehensive geriatric assessment [2] will be required to sufficiently distinguish within the much wider spectrum of health status in elderly patients [than younger]. This study should also be of interest to general practitioners, cancer charity organizations and anybody working in the care of the elderly, as it would raise awareness, increase knowledge of the possible consequences of under-treatment, and directly affect the way in which care is provided to the elderly with cancer.

20/12/2017

TRE