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Linkage of the CHHiP randomised controlled trial with primary care data. A study investigating ways of supplementing cancer trials and improving evidence-based practice.

Lemanska, Agnieszka, Byford, Rachel C., Cruickshank, Clare, Deamaley, David P., Ferreira, Filipa, Griffin, Clare, Hall, Emma, Hinton, William, Lusignan, Simon de, Sherlock, Julian and Faithfull, Sara (2020) Linkage of the CHHiP randomised controlled trial with primary care data. A study investigating ways of supplementing cancer trials and improving evidence-based practice. BMC Medical Research Methodology.

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Background: Randomised controlled trials (RCTs) are the gold standard for evidence-based practice. However, RCTs can have limitations. For example, translation of findings into practice can be limited by design features, such as inclusion criteria, not accurately reflecting clinical populations. In addition, it is expensive to recruit and follow-up participants in RCTs. Linkage with routinely collected data could offer a cost-effective way to enhance the conduct and generalisability of RCTs. The aim of this study is to investigate how primary care data can support RCTs. Methods: Secondary analysis following linkage of two datasets: 1) multicentre CHHiP radiotherapy trial (ISRCTN97182923) and 2) primary care database from the Royal College of General Practitioners Research and Surveillance Centre. Comorbidities and medications recorded in CHHiP at baseline, and radiotherapy-related toxicity recorded in CHHiP over time were compared with primary care records. The association of comorbidities and medications with toxicity was analysed with mixed-effects logistic regression. Results: Primary care records were extracted for 106 out of 2811 CHHiP participants recruited from sites in England (median age 70, range 44 to 82). Complementary information included longitudinal body mass index, blood pressure and cholesterol, as well as baseline smoking and alcohol usage but was limited by the considerable missing data. In the linked sample, 9 (8%) participants were recorded in CHHiP as having a history of diabetes and 38 (36%) hypertension, whereas primary care records indicated incidence prior to trial entry of 11 (10%) and 40 (38%) respectively. Concomitant medications were not collected in CHHiP but available in primary care records. This indicated that 44 (41.5%) men took aspirin, 65 (61.3%) statins, 14 (13.2%) metformin and 46 (43.4%) phosphodiesterase-5-inhibitors at some point before or after trial entry. Conclusions: People develop new comorbidities and commence medications after enrolment to trials. Data recorded in primary care are a rich resource and linkage could provide near real-time information to supplement trials and an efficient and cost-effective mechanism for long-term follow-up. In addition, standardised primary care data extracts could form part of RCT recruitment and conduct. However, this is at present limited by the variable quality and fragmentation of primary care data.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
Byford, Rachel C.
Cruickshank, Clare
Deamaley, David P.
Ferreira, Filipa
Griffin, Clare
Hall, Emma
Lusignan, Simon de
Sherlock, Julian
Date : 25 July 2020
Funders : NHS, NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust, Institute of Cancer Research
Additional Information : Embargo OK Metadata Pending
Depositing User : James Marshall
Date Deposited : 13 Aug 2020 10:54
Last Modified : 13 Aug 2020 10:54

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