QResearch

QCancer Risk Assessment Tools

Title

Derivation and validation of the QCancer algorithm scores

What is the aim of the study and why is it important?

QCancer is an evolving family of risk prediction algorithm which calculates (a) an individual’s risk of having a current cancer and (b) risk of developing cancer in the next 10 years and (c) survival for patients with a diagnosis of cancer. Each risk score takes account of their individual risk factors such as age, sex, ethnicity, clinical values and diagnoses and, where appropriate, a patients recorded symptoms. Overall there are 13 different types of cancer are identified according to clinical codes recorded on the primary care record or the linked mortality, cancer or hospital record. Papers describing the derivation and validation of the various algorithms have been published in the BJGP and BMJ Open. QCancer is used to quantify an individual’s risk in order to prioritise and inform decisions regarding investigations to diagnose cancer or interventions to lower risk. It is used by Macmillan, Cancer Research UK, NHS England and the ACE programme to support work to improve the early diagnosis of cancer. It is updated regularly to ensure the algorithms remain calibrated to the current population since the incidence of disease and the prevalence of risk factors changes over time. The updates also enable the algorithm to take account of improvements to data quality (for example increases in the completeness of recording of risk factors sch as ethnicity or laboratory values). It also allows adaptations to any changes which might be required to improve the predictive power of the tool or the population to which is applied.

Chief Investigator

Julia Hippisley-Cox

Location of research

Oxford

Date on which research approved

01-Nov-2011

Project reference ID

Q102

Are all data accessed are in anonymised form?

Yes

Brief summary of the dataset to be released (including any sensitive data)

Risk factors and symptoms which might suggest indicate an existing diagnosis of cancer or an increased risk of developing it over the next 10 years or factors which affect the survival for people who have a diagnosis of cancer. This is linked to diagnoses of cancer from GP, hospital, mortality and cancer records.

What were the main findings?

The QCancer early diagnosis tool is recommended by Cancer Research UK and NHS London. It is also recommended by the EMIS national user group (representing GPs using the most commonly used IT system, EMIS). The QCancer early diagnosis tool has been piloted and evaluated in the UK by Macmillan. It was used in London as part of the Accelerate, Co-ordinate, Evaluate (ACE) programmed initiative supported by NHS England, Cancer Research UK and Macmillanp. It has been highlighted by the 2017 enquiry by the All Party Parliamentary Group on Pancreatic cancer. An article from Australia about use of QCancer in clinical practice concluded that it have potentially greater clinical relevance than other tools and it could prove useful in supporting cancer diagnosis in general practice and also reducing investigation of patients at very low risk of cancer. It has also been evaluated by academics in Australia.

Implications and Impact

The QCancer tools are used to identify high risk individuals for treatment to reduce risk or referral to aid early diagnosis. The tools are publicly accessible and the majority have been integrated into several NHS computer systems including the major UK GP clinical system (EMIS) which supplies computer systems to over 55% of GP practices nationally covering a population in excess of 35 million. Several tools are included in national and international guidelines. QCancer is designed to prompt GPs to think about diagnosis of cancer and refer high risk patients to hospital sooner with the aim of patients being diagnosed at an earlier stage when there are more treatment options likely to improve survival. So the potential impact is earlier diagnosis of cancer and improved survival following a cancer diagnosis. The integration of the tool into EMIS systems was completed in 2016 and its use is being facilitated by a network of Macmillan GPs who are “training the trainers” in how to use the tool in clinical practice across the country.

Funding Source

No external funding

Research Team

Professor Julia Hippisley-Cox, Professor Carol Coupland

Publications

  • Development and validation of risk prediction algorithms to estimate future risk of common cancers in primary care: prospective cohort study
    Authors: Hippisley-Cox J Coupland CA.
    Ref: BMJ Open 2015; doi 10.1136/bmjopen-2015-007825
    http://bmjopen.bmj.com/cgi/content/full/bmjopen-2015-007825?ijkey=c3gvpJ5FUf7lx7i&keytype=ref
  • Symptoms and risk factors to identify men with suspected cancer in primary care: derivation and validation of an algorithm
    Authors: Hippisley-Cox J, Coupland C.
    Ref: British Journal of General Practice 2013; e1-e10
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529287/
  • Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm
    Authors: Hippisley-Cox J, Coupland C.
    Ref: British Journal of General Practice 2013; e11-e21
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529288/
  • Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm
    Authors: Hippisley-Cox J, Coupland C
    Ref: BMJ 2012;344:d8009
    http://www.bmj.com/content/344/bmj.d8009
  • Independent external validation of QCancer (Ovarian)
    Authors: Hippisley-Cox J, Coupland C
    Ref: European Journal of Cancer Care 2013;22(4):559-560
    https://doi.org/10.1111/ecc.12071
  • Identifying patients with suspected renal tract cancer in primary care: derivation and validation of an algorithm
    Authors: Hippisley-Cox J, Coupland C
    Ref: British Journal of General Practice 2012;62(597):e251-e260
    http://bjgp.org/content/62/597/e251
  • Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm
    Authors: Hippisley-Cox J, Coupland C
    Ref: British Journal of General Practice 2012;62(594):e38-e45
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252538/
  • Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm
    Authors: Hippisley-Cox J, Coupland C
    Ref: British Journal of General Practice 2012;62(594):e29-e37(9)
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252537/
  • Incorporating cancer risk information into general practice: a qualitative study using focus groups with health professionals
    Authors: Hippisley-Cox J
    Ref: British Journal of General Practice 2017;67(657):158
    http://bjgp.org/content/67/657/158.2
  • Development and validation of risk prediction equations to estimate survival in patients with colorectal cancer: cohort study
    Authors: Hippisley-Cox J, Coupland C.
    Ref: BMJ 2017;357 doi: 10.1136/bmj.j2497
    http://www.bmj.com/content/bmj/357/bmj.j2497.full.pdf

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