Jennifer Lees

Among people diagnosed with cancer, chronic kidney disease (CKD) is extremely common and a strong predictor of premature death, particularly in women. In people with cancer and CKD, premature death is not explained by presentation with cancer at more invasive stage. I hypothesise that CKD drives premature death through cautious selection, reduced efficacy, and increased harms from cancer treatments, that these effects are exacerbated by flawed creatinine- based estimation of kidney function and are more pronounced in women. This project harnesses the power of existing patient data to define the current landscape of cancer treatment in men and women with CKD. I will extend my skills and collaborative networks to understand how cancer diagnoses, treatment pathways, benefits and harms change according to kidney function, and how new tools for estimating kidney function could improve outcomes in people with cancer. Trial data are unrepresentative

observational data are liable to confounding by indication: maximum impact will be achieved by using state-of-the-art data science methodologies in a unique tapestry of datasets to attenuate and overcome these limitations. Successful completion will offer diverse opportunities for further study, and create transferable tools to understand decision-making, benefits and harms across a range of disease processes and treatment interventions.

Cancer and cardiovascular disease are the two commonest causes of morbidity and mortality worldwide. Approximately 5-10% of population have chronic kidney disease (CKD). Both cancer and cardiovascular disease are present in excess in patients with CKD, and associated with significant morbidity and early mortality. With an ageing population, the burden of CKD, cancer and cardiovascular disease is ever-increasing. Onco-nephrology, the study of the interface between oncology and nephrology, aims to understand the interplay between cancer and kidney disease. CKD is associated with increased incidence and possibly worse outcome from cancer. Cancer treatments, especially newer systemic anti-cancer treatments, are associated with nephro- and cardio-toxic side effects, presenting clinically as acute kidney injury, hypertension, proteinuria or exacerbating existing CKD. We will address a number of important issues where kidney disease, cancer and cardiovascular disease either co-exist or are mutually exacerbated using large, readily available datasets and data linkage from general population, cancer and CKD cohorts in Scotland and the UK. We anticipate that this will increase understanding of the interplay between cancer and CKD, and will lead to improvements in care for patients with co-existent cancer and kidney disease.