Research Research awards Doris Godfrey BTF Research Award 2016 Differentiated thyroid cancer survival, recurrence rates by disease stage and quality of life in the Northern Cancer Network This award funded a research study in North East England into thyroid cancer survival among their patients. We caught up with one of the lead researchers, Dr Rob Chandler, who reports some encouraging results. What was the aim of the research? Mortality from thyroid cancer is reported to be higher in the UK compared with several other European countries, though UK data on mortality by disease stage has not been published. The aim of this study was to establish the disease-specific mortality rates by stage in thyroid cancer patients treated at the Institute of Genetic Medicine, International Centre for Life, Newcastle upon Tyne. What did the study involve? The study looked at the medical records and, where applicable, causes of death of four hundred and twenty patients treated at the centre in Newcastle between 2000-2010. What were the findings? Overall disease-specific mortality was 1.4% at 5 years after diagnosis and 5.8% at 10 years after diagnosis. The observed mortality was 58. This was lower than the expected 66.3 deaths. There were no deaths due to thyroid cancer in patients with stage I disease at 5 or 10 years. The 10-year disease-specific mortality rose according to the cancer’s stage (stage II 3.1%, stage III 28.6%, stage IV 30%). What does this mean? These results are very encouraging. They show very high survival figures from thyroid cancer at 5 and 10 years after diagnosis. This is equivalent to the best published figures from other countries. The likely explanation behind previous press reports of poor UK survival rates is that the UK is not as good as some other countries at registering the small incidental cancers that have excellent prognoses. As expected, this makes our national cancer statistics on thyroid cancer look worse. When the mortality rates are examined by disease stage, the data becomes far more informative. Unfortunately, our national cancer database does not provide figures for mortality by disease stage. How has funding for the BTF Doris Godfrey award helped? Without the financial support we received from the BTF, this research could not have taken place. We would like to thank the BTF and its members for supporting our work. Further reading ‘Differentiated Thyroid Cancer Mortality by Disease Stage in Northern England’ by P Perros, D Mason, M Pearce, SHS Pearce, R Chandler, U K Mallick. Read the full report This interview appeared in our member newsletter, BTF News, June 2020 Simon Pearce, Professor of Endocrinology and Honorary Consultant Endocrinologist, Institute of Genetic Medicine, Newcastle upon Tyne and Chief Investigator Dr Petros Perros Preliminary Report (21 Feb 2018) The purpose of this study is to ascertain thyroid cancer 5 and 10-year disease specific survival and recurrence rates by cancer stage at diagnosis, to assess QOL of long-term survivors of thyroid cancer, and to ascertain whether reforms in the NHS and the introduction of national guidelines were associated with thyroid cancer outcomes, by exploring trends in 5-year survival and recurrence rates over the past 10 years. Data from Public Health England Office for Data Release (PHEODR), which were requested on 10 March 2016, were received in December 2017. These included 420 patients who had a new diagnosis of thyroid cancer made between 1 January 2000- 31 December 2005 who were treated in the Newcastle upon Tyne Hospitals NHS Foundation Trust. The censor date for the purpose of establishing vital status was 31 December 2017. The data supplied by PHEODR were cross-checked with electronic patient records of the Newcastle upon Tyne Hospitals NHS Foundation Trust and with the Integrated Clinical Environment (ICE) platform which accesses laboratory and radiology results and reports from other hospitals in the region. This report summarises progress thus far. Results Data on 420 patients were received. The demographics are shown in Table 1. Overall 7-18 year survival was 86.2%. Data on tumour histology and vital status are shown in Table 2. Multifocal tumours were reported in 99 cases (23.6%). TNM staging data were very scantly in the files provided by PHEODR (only available for 58/420, 13% of cases). Review of hospital electronic records has so far yielded staging data for 196 (46.7%) of patients. The data on staging and overall survival are shown in Table 3. This work is ongoing and we estimate that we will be able to derive staging data for over 80% of the 420 patients. Discussion We had estimated that retrieval of data from the Northern region would yield approximately 800 patients. We have so far looked at data derived from one of the two main centres in the Northern region that provides services for patients with thyroid cancer (Newcastle upon Tyne Hospitals NHS Foundation Trust) and were able to access 420 cases. We anticipate that extension of the study to the other main centre (James Cook University Hospital, Middlesbrough) will provide the expected number of 800 cases. Preliminary data show an overall 7-18 year survival which is similar to national 10 year survival figures (86.2% vs 85%) , However, the North East has the highest age-adjusted mortality rates from all causes in the UK  and therefore cancer specific mortality is expected to be lower. In the EUROCARE-4 study  5 year age-adjusted relative survival for thyroid cancer in England was recorded as 80.5%, which was lower than the EUROCARE-4 mean (83.2%) and much lower than the best figures (Slovenia, 93.3%). The EUROCARE-4 study used data censored in 2001-2002, ie approximately 5 years earlier than our study. However mortality from thyroid cancer in the UK has been stable over many years. We can therefore speculate that given that our sample yielded an overall survival at 7-18 years of 86.2% and given that the data are not adjusted for age and geographical background of overall mortality, they support our hypothesis that the EUROCARE-4 data may have overestimated mortality from thyroid cancer in the UK, most likely due to under-recording of small papillary thyroid cancers, which have the best prognosis. Our plan is to derive staging data from electronic records for all of the the 420 patients and update the parameters we have already alluded to in this report. We will also expand to interrogate the database for the impact of age, gender and histological type on 5 and 10 year survival and recurrences. This data will be compared to published series. We are awaiting to receive further data from PHEODR on causes of death and this will help derive cancer specific mortality. Once we have completed this phase, we will roll it out to the James Cook University Hospital, and we will apply to ethics for the questionnaire component of the study assessing quality of life. We initially intended to start the data collection in March 2016 and complete data collection in March 2017. We are therefore behind approximately by two years. The delay has been unfortunate and imposed by the time it has taken for PHEODR to filter and supply the data. A series of security checks to safeguard confidentiality had to be adhered to, which contributed to the delay. Since receiving the data (December 2017) we have made good progress and we anticipate to have completed the study by March 2019. References 1. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/thyroid-cancer/survival 2. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathsregisteredbyareaofusualresidenceenglandandwales 3. Verdecchia A, Francisci S, Brenner H, Gatta G, Micheli A, Mangone L, Kunkler I; EUROCARE-4 Working Group. Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data. Lancet Oncol. 2007;8:784-96. Final report to follow.