Most cancers are diagnosed after a visit to primary care. Cancers that are diagnosed earlier are likely to have better outcomes and so rapid referral of patients presenting with suspected cancer symptoms for further investigation in secondary care is important. However, GPs are faced with many patients that present with symptoms that could be cancer. Given that the majority of patients will not have cancer, it is not practical or feasible to refer all patients urgently and a cancer referral in someone at very low risk of having cancer could cause unnecessary anxiety. New tests or combinations of existing tests that can be used in primary care to identify patients at most risk of having cancer would help guide GPs in their clinical decision-making and reduce diagnostic delays in primary care.
Cancer Research UK, the Medical Research Council and the Engineering and Physical Sciences Research Council convened a workshop in November 2021 to bring together multidisciplinary researchers to develop ideas for new tests/tools in primary care that aim to enhance cancer risk stratification. The attendees worked together to generate innovative research proposals and, at the end of the workshop, the new teams pitched their ideas to receive seed funding for feasibility testing from a Cancer Research UK Early Detection Innovation Award. One of the successful teams involved Oxford researchers.
Team MAARS: Multimodal Active Adaptive Risk Stratification for Gastrointestinal Cancer
Professor Julia Hippisley-Cox (Nuffield Department of Primary Care Health Sciences, Oxford) is leading a team that aims to develop an adaptive risk stratification tool to estimate the risk of developing gastrointestinal cancer. Current risk scoring systems, such as QCancer, only provide static risk estimates based on a patient’s clinical characteristics and symptoms and do not incorporate the results of blood tests or scans that patients may receive as they progress further along a clinical investigative pathway.
Julia will work with Dr Jun Wang (Queen Mary’s London), Professor Konstantin Nikolic (University of West London), Dr Tingting Zhu (Institute of Biomedical Engineering, Department of Engineering, Oxford), Dr Robert Kerrison (University of Surrey) and Dr Joe Geraghty (Manchester Royal Infirmary) to analyse patient electronic GP records linked to secondary care outcomes in the QResearch database. Using advanced data analytics, the team will identify the tests/diagnoses that are most useful for clinical decision-making. Using this information, they will develop and validate an active adaptive risk assessment tool to generate a personalised risk score that can be updated as a patient progresses along a clinical pathway. This tool will help to target resources to those at highest risk of having cancer, enabling earlier diagnosis, and to identify patients at lowest risk who can be safely reassured.