Transforming Cancer Services Team for London (TCST) has been working with the National Cancer Registration and Analysis Service (NCRAS) to analyse the extent to which Londoners diagnosed with cancer are affected by more than one primary cancer.
In our latest blog, Sophie Jose, Jason Petit and Liz Price describe their research and how the findings will inform support services for people living with cancer in London.
People with more than one primary cancer diagnosis are likely to experience significant consequences of multiple rounds of treatment and therefore have more complex care needs. After a first cancer diagnosis the chances of a new primary tumour are higher than for the general population. However, it has not been well understood just how many people in London are actually affected by subsequent primary cancers.
As part of our partnership between the National Cancer Registration and Analysis Service at Public Health England and the Transforming Cancer Services Team for London, we looked at how many people in London were living with subsequent primary cancers.
What we did
Because of the partnership that exists between TCST and NCRAS, we were able to access data on all cancer diagnoses in London in the National Cancer Registration dataset. Using this data we could identify the number of people in England who had received a cancer diagnosis between 1995-2016 and were still alive at the end of 2016. We then looked to see how many of these people had been diagnosed with more than one primary cancer at a different body site in this time. Because we are a London-based partnership, we then focused our analysis on London. As well as looking at the numbers of patients affected in London, we investigated which tumour sites the first and subsequent cancers occurred at, and how much time had passed between first and subsequent cancer diagnoses. As this analysis used prevalence data, we didn’t look at subsequent cancers of people who didn’t survive to 2016.
What we found
By the end of 2016, 218,177 people were living with and beyond a cancer diagnosis in London. 9,072 people, equivalent to 4% of those living with and beyond cancer, had received a subsequent primary cancer diagnosis. When we looked for differences in different population groups, we saw that nearly 7% of people with a cancer diagnosis aged over 85 had received subsequent cancer diagnoses compared to less than 1% of people aged below 44 years of age. We didn’t see large differences in subsequent cancer prevalence between men and women or when we compared different ethnic groups.
Contrary to what we had expected, we didn’t see any obvious patterns in the site of subsequent tumours in relation to the first tumour site. Tumour sites that were common amongst first cancers were also common for subsequent cancers. Amongst people living with subsequent primary cancers, 20% had received their diagnoses less than a year apart.
Why it’s important
To the best of our knowledge, this is the first work done to show the prevalence of subsequent primary cancers amongst people living with a cancer diagnosis in London. There are many consequences of cancer that require ongoing care and support. These consequences may include treatment and its side-effects, recurrence and metastases, comorbidities, and psychological and mental ill-health; all of which may be experienced anew with each new cancer diagnosis. Understanding how many people are affected will help with planning of care and services to support those living with and beyond cancer. We’ve highlighted that people are diagnosed with subsequent primary cancers more than six months after their first diagnosis, the time in which a cancer care review will be performed in primary care1. This analysis adds to the case for a structured, long term management approach to cancer by primary care teams. This work also reminds us of the importance of educating patients to remain vigilant of cancer signs and symptoms after the ‘all clear’ from a cancer diagnosis.
Where to find out more
The full slide-deck describing subsequent primary cancers in London can be found on the NCRAS-TCST partnership page. A workbook showing the prevalence of subsequent primary cancers across England can also be found here.
Sophie Jose, Senior Cancer Information Analyst
Jason Petit, Senior Cancer Intelligence Lead
Liz Price, Associate Director (living with and beyond cancer)
Transforming Cancer Services Team for London Healthy London Partnership
Data for this study is based on patient-level information collected by the NHS. The data is collated, maintained and quality assured by Public Health England’s National Cancer Registration and Analysis Service. We would like to thank Dr Kanika Rai for her input into this work.