World Cancer Day is #ADayToUnite, when campaigners, carers, scientists, clinicians, patients, nurses, students and members of the public come together to get the world talking about cancer.
In commemoration of 4 February 2016, Centre for Statistics in Medicine (CSM) members reflect on their work conducting and supporting cancer research and how their work helps to reduce the global burden of cancer.
Death in old age is inevitable but death before old age is not.
- Sir Richard Doll 1994
Cancer kills 8.2 million people worldwide every year. Half of us born in the UK after 1960 will be diagnosed with some form of cancer in our lifetimes.
World Cancer Day reminds us that although cancer is a global disease that affects us all, we can also all have a positive impact on cancer. We can support loved ones, share information, make healthy choices and support access to good cancer care and research.
CSM staff have the privilege of standing with the global research community, working with the Cancer Research UK (CRUK)'s Oxford Centre, among others, to find better treatments for cancer. Some support cancer clinical trials and others work on improving how cancer research is conducted.
Applied statisticians support clinical trials
CSM statisticians are collaborating on more than 40 cancer clinical trials. They make sure that trials ask a sensible, answerable question and that a good, usable answer is reported to the research community. The CSM portfolio includes a broad range from proof-of-concept trials to trials giving a treatment a final test before it becomes standard practice. Some trials involve patients towards the end of their life, and others trial treatments to slow down the progression from a precancerous to a cancerous condition.
Good answers come from good questions.
- Schoolman et al 1968
A medical statistician will be involved with the whole lifecycle of a trial. A clinician with a research idea will work with a statistician to set the research question. The statistician then designs the trial to get the best answer to the question, inputs to the protocols, and writes the statistical analysis plans that will guide how the trial is run. The trial needs approval from ethics and the MHRA, following which recruitment can start. The statistician works to make sure high-quality data is collected, to increase recruitment, and to present the trial for review by independent committees. When the trial is finished, the statistician analyses the data and helps to write it up for publication and for presenting at a relevant conference. A statistician can spend years working on a trial, following the progress of its participants.
CSM statisticians are particularly focused on researching better trial designs. A new trial, CHARIOT, will showcase a little-used design that uses all of the data gathered from the participants already in the trial, regardless of how far along in the protocol they are, to decide the treatment of the next patient. Other careful design, as in the Bayesian design of the trial LINES, enable us to use a small sample to find out information for patients with a rare form of cancer. By improving trial efficiency and success rates, these innovations ensure that trial participants' efforts add to body of research knowledge.
Methodology statisticians help improve research
CSM's methodology research team works to improve the quality and reliability of the cancer research that underpins clinical practice.
The team leads initiatives to improve the quality of research publications, in particular by helping to develop reporting guidelines (such as TRIPOD) and by writing educational articles that clarify concepts and guide the design, analysis and interpretation of clinical research studies of many kinds. They work on many research projects with relevance to cancer prognosis, therapy, and diagnosis.
The team explores existing methods and develops new ones, clarifying which research methods should be accepted amongst statisticians as representing best practice, and so be widely adopted in clinical studies, and identifying approaches to avoid.
CSM statisticians also work on the development and validation of prognostic models, the evaluation of prognostic and predictive biomarkers, and the evaluation and improvement of clinical trial protocols. They also work to synthesise the existing body of evidence by conducting systematic reviews, which are regularly featured in the Cochrane Library.
As Doug Altman, founder of the CSM, says: "A core principle of all our applied statistical and methodological research is that it has the potential to benefit patients. It has to be of considerable practical benefit to cancer researchers, clinicians, policy makers, and patients."
Cancer research at Oxford
CSM statisticians work with teams across Oxford and the UK on cancer research. This year, the CRUK Oxford Centre is uniting with five local charities for World Cancer Day. They are joining forces with Macmillan, Sue Ryder, International Network for Cancer Treatment and Research, Cochrane and the Oxfordshire Prostate Cancer Support Group to represent the cancer patient journey, in Oxford and around the world.
To find out more about the events planned on and around 4 February, and about cancer research at Oxford, visit http://www.cancercentre.ox.ac.uk/engagement/.
This news item is part of a series on the cancer research conducted and supported by the Centre for Statistics in Medicine, in commemoration of World Cancer Day on 4 February 2016. Read about CSM's support of two Barrett's Oesophagus trials here, a little-used trial design that will improve the efficiency of phase I trials here, and a new trial on pancreatic cancer here.