How can we help cancer patients weigh up their treatment options?

When someone is diagnosed with cancer, they start on a treatment journey that has a number of decision points along the way. At each point, the clinician needs to provide the patient with reliable information about the various treatment options available, and which are likely to maximise their chance of survival while minimising their risk of side effects.

Researchers at Oxford Population Health provide patients and clinicians with precisely this kind of information through a research programme called Benefits and Risks of Cancer Treatments.  

Carolyn Taylor, a clinical oncologist with expertise in breast cancer, and fellow oncologist David Cutter, whose expertise is lymphoma, recognised the need for such research while working in busy clinical settings treating cancer patients. They realised there were points in a patient’s treatment journey where reliable information was not available, or not in a form that clinicians and patients could easily understand. For example, results from past clinical trials of cancer treatments do not always apply to today’s patients because treatments improve over time. In addition, people who enter clinical trials are usually fitter than people in the general population.  

With funding from Cancer Research UK, Carolyn and David work with a team of other clinicians and statisticians. They bring together large datasets and apply the best statistical methods to answer patients’ treatment questions with clear and reliable information.  

The team have collated and organised 30 years of nationwide data on cancer patients in England and linked them to other data sources, such as hospital admissions and treatment records. These have generated several million data records with details on the type of cancer and treatments given for each patient. The team combine these data with findings from randomised trials showing treatment effects to produce personalised estimates of the benefits and risks of various cancer treatments used today.   

WHAT ARE THE BENEFITS AND RISKS OF RADIOTHERAPY? 

A common choice faced by cancer patients is whether to have radiotherapy, a treatment that uses high-energy X-rays to destroy cancer cells. Around half of cancer patients receive radiotherapy.

But when targeting parts of the chest area, such as the breasts, the nearby heart and lungs may receive some radiation dose from the radiotherapy beams. In the past, clinicians knew that radiotherapy could cause heart disease or lung cancer later in life, but the size of the risk for individuals was unknown. This meant that clinicians could not compare the known benefits of radiotherapy with its risks.

In response to this need, the ‘Benefits and Risks of Cancer Treatments’ team performed several studies. In one study, they gathered data on women who had received breast cancer radiotherapy in the past, estimated doses of radiation received by the heart, and collected information on which women later developed heart disease. This enabled clinicians, for the first time, to predict the magnitude of the risk for each patient using their estimated heart radiation dose and other risk factors for heart disease. Similar studies have been done in patients treated for lymphoma.

In the UK, these studies have led to the widespread introduction of heart-sparing techniques in radiotherapy. These reduce the heart’s exposure to radiation by, for example, asking the patient to take a deep breath and hold it during radiotherapy. This expands the lungs, pushing the heart away from the radiation beams. As a result, most women with breast cancer who have radiotherapy in the UK have a less than 1% risk of developing radiation related heart disease during the next 30 years. This means that for most women, the benefits in terms of avoiding cancer recurrence or death are much larger than the risks.

In lymphoma, the risks for most patients are similarly small. These and other findings have reassured many patients considering radiotherapy. They have also influenced national and international guidelines with more patients now recommended for radiotherapy, and more lives saved. Other research over the past 20 years has resulted in shorter treatment times and more targeted radiotherapy.

Another study carried out by the research team estimated the long-term risks of lung cancer from breast cancer radiotherapy, in both smokers and non-smokers. The findings revealed that non-smokers had a less than 1% chance of dying from lung cancer linked to their radiotherapy, meaning that for most of them the benefits of radiotherapy for breast cancer far outweighed the risks from this future side effect. For long-term continuing smokers, however, the risk was estimated to be much greater – between 2% and 6%. As a result, clinicians may consider not recommending radiotherapy as a treatment for smokers if they are unable to stop smoking. Similar work in lymphoma has shown corresponding results for smokers and non-smokers. 

WHAT ARE THE BENEFITS AND RISKS OF CHEMOTHERAPY? 

The ‘Benefits and Risks of Cancer Treatments’ team are also studying the main risks from common chemotherapy drugs, so they can be compared with the benefits.  

For example, patients with lymphoma, breast cancer, sarcoma and bladder cancer can all be treated with a type of chemotherapy called ‘anthracycline’ which is very effective, but can cause heart disease and leukaemia. At present, the sizes of the risks for a given treatment dose are unknown, so it is not possible to compare the benefits with the risks. The team are conducting studies using large-scale data to quantify those risks and over the next five years they will present them in web application tools that can be used by clinicians in consultation with their patients. When the tools show that the risks are similar to or greater than the benefits, alternative treatments can be considered.

HOW ARE PATIENTS SHAPING RESEARCH PRIORITIES? 

The research programme draws on the experience of clinicians in the team (in oncology, surgery, radiotherapy physics and psychological medicine), and on the needs of patients. Studies come about following requests by patient advocates, patient organisations, and clinical groups. They involve patient advocates with lived experience of the cancer concerned, who work with the team to identify key information needs. Their ideas and perspectives help to ensure that the information produced is relevant and accessible to patients. 

Carolyn says ‘Patients provide really good, thoughtful ideas; things we wouldn’t have thought of ourselves as researchers.’ For example, patient advocates highlighted the need for web tools so that clinicians can input data for individual patients and see the risks for different treatment strategies. 

Hilary Stobart is a breast cancer survivor and patient advocate who has partnered with the research team for more than 10 years, providing a patient voice in breast cancer studies.   

‘Many of us with lower risk breast cancer think that our prognosis is much worse than it actually is. We then spend the first year or two in a lot of panic about what's happening when actually the likelihood is that we'll be fine for many years at least,’ she says. ‘Good, clear communication about prognosis can make a vast difference to a patient’s quality of life, and how they cope with things.’ 

Clinicians now have reliable information to help them, and the patients they care for, to weigh up different options, but there is a long way to go. As Hilary says ‘More studies will be needed in the future. Cancer is still with us. There’s a lot more to do.’

Updated 6 Aug 2026.