In Brain News, Research News

A substantial article was recently published by Cureus which explores the role of liquid biopsy in diagnosis and prognosis of WHO grade 4 astrocytoma (Glioblastoma), and provides a comprehensive overview of the current state of play for the modality. Here we break down the key information, discuss the overall take-aways and what the future of care looks like for the brain cancer community.

What is a liquid biopsy?

A liquid biopsy is an alternative method of determining the diagnosis and/or prognosis of a condition. It uses biological fluid, or ‘biofluid’, obtained from the body. This may include blood, urine, or cerebrospinal fluid. The biofluid is then sequenced to detect cancer cells, revealing information that can inform, support, or determine diagnosis and prognosis.

Evaluating new methods for disease monitoring is an important area of research in which PRIME plays an active role. Our PRIME service has provided patient involvement support to multiple studies which are utilising liquid biopsies. Across these projects, researchers are determining how liquid biopsies can benefit the treatment pathway for patients as either a primary or secondary aim. Click here to find out more and get involved.

Progress with liquid biopsies

Research into liquid biopsies as a potential tool has been ongoing for decades. But more recently they have become a realistic option for detecting markers of tumours (typically in blood). Our understanding and utilisation of this modality has improved enough that researchers are now exploring how this option could compete with or support our standard practice of monitoring and diagnosing patients.

The latest World Health Organization (WHO) classifications of brain tumours allows for a greater comprehension of how tumours behave and respond to treatments. It is also aiding our ability to understand information collected through liquid biopsy. A useful table outlining the WHO classifications is featured here.

WHO grade 4 astrocytoma (more commonly referred to as glioblastoma) is the most common primary malignant brain tumour in adults. It accounts for 60% of all astrocytoma, and 50% of all primary malignant tumours.

Currently, the standard of care for WHO grade 4 astrocytoma is surgery, radiotherapy and chemotherapy. Molecular testing of tumour samples helps classify the tumour, but these techniques are not cost-effective and can be inconclusive.

It is integral to improving care for our community that we develop methods requiring less intervention. Liquid biopsies present a potential solution.

What are the advantages of liquid biopsies? Are there limitations?

Obtaining biomarkers in blood or cerebrospinal fluid is easy. Furthermore, the biofluid can be measured multiple times, making it a more effective way to monitor disease progression.

Traditionally in standard care, the tumour is removed during surgical resection or a surgical biopsy. These procedures are invasive and have limitations. Limitations include the challenge of preserving tumour samples for sequencing and issues arising when there is not enough sample for a definitive conclusion. Additionally, invasive biopsies can create risk of cognitive complications for the patient spanning from speech impairments, balance or memory to severe health risks or even death.

Liquid biopsies would significantly decrease many of these risks, as well as potentially provide a fuller picture of how the cancer cells are behaving.

Potential drawbacks to liquid biopsy however include the potential for information to be missing in the biofluid. There is also a lot of further research and development necessary to know how best we can utilise this modality, and rely on it for consistent insight on how to best manage and provide appropriate treatment and support to those living with a brain tumour. However, it remains an exciting field of exploration which provides a promising alternative for the outcome and comfort of someone facing a diagnosis.

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If you or someone you love is living with a brain tumour and have any questions around this latest news, or want to access support, give us a call on 01983 292 405 or email hello@brainstrust.org.uk. You can also visit our little brainstrust website which features support for children affected by brain tumour.

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Introduction

The Brain Tumour Data Dashboard lets you explore up -to-date, population level data about the brain tumours diagnosed in England between 2013 and 2015. Using the drop down menus on the left you can select different groups of patients to view in the charts below. In these charts the number of patients for every 100 diagnoses is displayed as images of people. Patients have been grouped by date of diagnosis, type of tumour, age, gender, and region in England.

For each group of patients you can explore the different routes to diagnosis, the proportion of those who received chemotherapy or radiotherapy, as well as the survival of the patients within each group. For more information about what these metrics mean please see the glossary.

How to use

  1. Select the year of diagnosis using the drop down menu.
  2. Select your patient group of interest from the four drop down menus in the following order:
    1. Tumour group
    2. Age at diagnosis
    3. Region of England
    4. Gender of patient
  3. To view a second chart to compare different groups of patients, click the ‘compare’ button.The second chart will appear below the first chart.

*Note that the tool is best used on a laptop or tablet rather than a mobile phone*

Unavailable data

Some of the data in these charts is not available.There are two main reasons for this:

  1. How the data has been grouped

If you cannot select a patient group from the drop down menus, the data is unavailable because of how the data has been organised.

Public Health England has grouped the data like a branching tree. The bottom of the tree contains all the patients with brain tumours, and then each branch divides the data by a certain characteristics, like age, or location of tumour. But the data is divided in an order, starting with location of the tumour (endocrine or brain), then by age, region, and gender. Age is at the start because it makes a bigger difference to survival rates and treatment rates than gender or region. Sometimes, after the data has been split by type of tumour and age, there is not enough data to be split again. This is because to protect patient confidentiality groups cannot contain less than 100 patients. Because some groups cannot be split further, you cannot create ‘totals’ for everyone by region or gender. For example, you cannot see results for all ages by region, or all brain tumours by gender. If these totals were calculated and released, it might be possible to identify patients, which is why Public Health England cannot release this data.

  1. Statistical reasons and data availability

If you can select a patient group from the chart menus, but the chart does not display, the data is unavailable for one of several reasons:

  1. Data is not yet available for the selected year from Public Health England.
  2. Data is not available because the data quality is too poor to release this statistic.
  3. Data is not available as the statistic is not appropriate for this group.
  4. Data is not available because the standard error of the estimate was greater than 20% and so the estimate has been supressed.

Up to date brain tumour data

Brain tumour data may influence the decisions you make about your care. Data also helps you understand the bigger picture, or landscape, in which you find yourself.

Brain tumour data and statistics influence the focus, and work of organisations like brainstrust. The information helps us to understand the scale and impact of the problems we are setting out to solve.

This tool helps you understand the landscape in which you find yourself having been diagnosed with a brain tumour. This landscape can be particularly tricky to navigate as there are many different types of brain tumour, all of which have a different impact.

The information you see represents the most up-to-date, official, population level brain tumour data available for England. Over time we will be adding to the brain tumour data available and publishing reports, with recommendations, as a result of what we learn from this data.

The data behind this content has come from Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and is a direct result of the ‘Get Data Out’ project.

This project provides anonymised population level brain tumour data for public use in the form of standard output tables, accessible here: http://cancerdata.nhs.uk/standardoutput

Incidence

The number or rate (per head of population) of new cases of a disease diagnosed in a given population during a specified time period (usually a calendar year). The crude rate is the total number of cases divided by the mid-year population, usually expressed per 100,000 population.

Malignant

Malignant tumours which grow by invasion into surrounding tissues and have the ability to metastasise to distant sites

Mortality

The number or rate (per head of population) of deaths in a given population during a specified time period (usually a calendar year). The crude rate is the total number of deaths divided by the mid-year population, usually expressed per 100,000 population.

Non-malignant

Not cancerous. Non-malignant tumours may grow larger but do not spread to other parts of the body.

Survival

The length of time from the date of diagnosis for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the survival is one way to see how well a new treatment works. Also called ‘overall survival’ or ‘OS’.

Routes to Diagnosis

Under the ‘Routes to Diagnosis’ tab in the Brain Tumour Data Dashboard, you can explore the ways patients have been diagnosed with brain tumours. There are many ways, or routes, for cancers to be diagnosed in the NHS. A ‘route to diagnosis’ is the series of events between a patient and the healthcare system that leads to a diagnosis of cancer. The routes include:

  1. Two Week Wait

Patients are urgently referred by their GP for suspected cancer via the Two Week Wait system and are seen by a specialist within 2 weeks where they are diagnosed.

  1. GP referral

Diagnosis via a GP referral includes routine and urgent referrals where the patient was not referred under the Two Week Wait system.

  1. Emergency Presentation

Cancers can be diagnosed via emergency situations such as via A&E, emergency GP referral, emergency transfer or emergency admission.

  1. Outpatient

Outpatient cancer diagnoses include diagnoses via an elective route which started with an outpatient appointment that is either a self-referral or consultant to consultant referral. (It does not include those under the Two Week Wait referral system).

  1. Inpatient elective

Diagnosis via an inpatient elective route is where diagnosis occurs after the patient has been admitted into secondary care from a waiting list, or where the admission is booked or planned.

  1. Death Certificate Only

Diagnoses made by Death Certificate Only are made where there is no more information about the cancer diagnosis other than the cancer related death notifications. The date of diagnosis is the same as that of the date of death.

  1. Unknown

For some patients with a cancer diagnosis, there is no relevant data available to understand the route to diagnosis.

 

More information

If any of the statistical terms in this section of the brainstrust website are hard to understand, we recommend looking them up here:

Cancer Research UK’s Cancer Statistics Explained

http://www.cancerresearchuk.org/health-professional/cancer-statistics/cancer-stats-explained/statistics-terminology-explained#heading-Seven

If you are looking for help understanding terms relating specifically to brain tumours, and treatment, then the brainstrust glossary is available here:

https://www.brainstrust.org.uk/advice-glossary.php