The Virtual Cardio-Oncology Research Initiative (VICORI)

Cancer and cardiovascular disease are the two of the most common health conditions worldwide. With improved survival and an ageing population, more and more people are living longer with both conditions. There is a known relationship between cancer and cardiovascular disease with both cancer and treatments for cancer increasing the likelihood of developing cardiovascular disease. However, at the start of the VICORI programme, little was known about the variation in the care and treatment of cardiovascular disease for people who also had cancer – or vice versa. Similarly, the interactions between both conditions and how they influenced choices of treatment strategies.

Prior to VICORI, many of the existing cancer and cardiovascular cohorts had relatively small sample sizes. The VICORI programme was set up to create a large scale resource with long follow-up that covered all areas of England. Working in partnership, the cancer data from NHS England (NCRAS) [1] was combined with five national audits from the National Institute for Cardiovascular Outcome Research (NICOR), including myocardial infarction (MINAP), heart failure and percutaneous coronary interventions (PCI) [2,3].The VICORI provides a highly-assured data resource on individuals with cancer and/or cardiovascular disease and aims to further knowledge of cardio-oncology through research projects aligned with its programme.

The VICORI programme is jointly funded by Cancer Research UK (C53325/A21134) and the British Heart Foundation (SP/16/5/32415)

References:

1. Henson KE, Elliss-Brookes L, Coupland VH and others. Data Resource Profile: National Cancer Registration dataset in England. International Journal of Epidemiology. February 2020: volume 49:16–16h. 
2. Gale CP, Weston C, Denaxas S. and others on behalf of the NICOR Executive. Engaging with the clinical data transparency initiative: a view from the National Institute for Cardiovascular Outcomes Research (NICOR). Heart. July 2012: volume 98 pages 1040–1043.
3. The National Institute for Cardiovascular Outcomes Research 2021.

The Principal Investigators for VICORI are Dr David Adlam and Professor Mick Peake from the University of Leicester.

The partnership also comprises the Biostatistics Research Group at University of Leicester (Paul Lambert, Mark Rutherford, Cathy Welch, Freya Tyrer, Aiden Smith); University Hospitals of Leicester (Julian Ow); the NDRS team at NHS England (Lizz Paley, Sally Vernon, Jenni Lai); the NICOR team (John Deanfield, Mark de Belder); with additional key partners at University of Leeds (Chris Gale), Royal Brompton and Hareford Hospitals (Alexander Lyon), Barts Health NHS Trust (Charlotte Manisty), London School of Hygiene and Tropical Medicine (Krishnan Bhaskaran), University of Oxford (Sarah Darby), University of Birmingham (Mike Hawkins), the Royal Marsden NHS Foundation Trust (Alistair Ring) and University College London (Ami Banerjee).

We also have a committed public advisory group (Paul Charlton, Sally Jeans, Andy Deutsch, Alison Fielding and Derek Price) who help with prioritisation, dissemination and interpretation of findings.

The broad work programmes for VICORI are:

1. Management and treatment of cancer and cardiovascular disease.
2. Cardiovascular disease treatments and outcomes by cancer status.
3. Cancer treatments and cardiovascular disease outcomes.
4. Prevalence of cancers and cardiovascular diseases.

1. Coles B; Welch CA; Motiwale RS; Teece L; Oliver-Williams C; Weston C; de Belder MA; Lambert PC; Rutherford MJ; Paley L; Kadam UT; Lawson CA; Deanfield J; Peake MD; McDonagh T; Sweeting MJ; Adlam D. Acute heart failure presentation, management and outcomes in cancer patients: a national longitudinal study. European Heart Journal Acute Cardiovascular Care [online ahead of print]. March 2023.  
2. Teece L, Sweeting MJ, Hall M, Coles B, Oliver-Williams C, Welch CA, de Belder MA, Deanfield J, Weston C, Rutherford MJ, Paley L, Kadam UT, Lambert PC, Peake MD, Gale CP, Adlam D. Impact of a prior cancer diagnosis on quality of care and survival following acute myocardial infarction: retrospective population-based cohort study in England. Circulation: Cardiovascular Quality and Outcomes [in press]. 2023
3. Waterhouse JV, Welch CA, Battisti NML, Adlam D, Sweeting MJ, Paley L, Lambert P, Deanfield JE, de Belder M, Peake MD, Ring A. Geographical variation of social deprivation, cardiovascular and other comorbidities in 226,516 patients with early breast cancer in England: results from a National Registry Dataset Analysis. Cancer Research. March 2023: volume 83, issue 5 supplement, abstract number P6-08-04.
4. Battisti NML, Welch CA, Sweeting M, de Belder M, Deanfield J, Weston C, Peake MD, Adlam D, Ring A (2022). Prevalence of cardiovascular disease in patients with potentially curable malignancies: a national registry dataset analysis. Journal of the American College of Cardiology:CardioOncology. June 2022: volume 4, issue 2, pages:238-253.
5. Coles B, Teece L, Weston C, de Belder MA, Oliver-Williams C, Welch CA, Rutherford MJ, Lambert PC, Bidulka P, Paley L, Nitsch D, Deanfield J, Peake MD, Adlam D, Sweeting MJ. Case-ascertainment of acute myocardial infarction hospitalizations in cancer patients: a cohort study using English linked electronic health data. European Heart Journal Quality of Care and Clinical Outcomes. January 2022: volume 8, issue 1, pages:86-95. 
6. Sweeting MJ, Oliver-Williams C, Teece L, Welch CA, de Belder MA, Coles B, Lambert PC, Paley L, Rutherford MJ, Elliss-Brookes L, Deanfield J, Peake MD, Adlam D and the VICORI Collaborative. Data Resource Profile: The Virtual Cardio-Oncology Research Initiative (VICORI) linking national English cancer registration and cardiovascular audits. International Journal of Epidemiology. January 2022: volume 50, issue 6, pages:1768–1779.
7. Welch CA, Sweeting MJ, Lambert PC, Rutherford MJ, Jack RH, West D, Adlam D, Peake M (2020). Impact on survival of modelling increased surgical resection rates in patients with non-small-cell lung cancer and cardiovascular comorbidities: a VICORI study. British Journal of Cancer. August 2020: volume 123, issue 3, pages:471-479.

For more information about the VICORI, please contact [email protected]