Primary Objective
To determine how frequently cough occurs in patients with kidney cancer and whether this is related to the subtype, how advanced the cancer is, or to their treatment?
Secondary Objectives
If it is shown that the cough is caused by a substance produced by the kidney cancer, this knowledge could lead to new screening tests in patients having a chronic cough, so kidney cancer is diagnosed at an earlier stage improving prognosis and develop an effective treatment of this troublesome cough.
Background and rationale
Renal cell carcinoma (RCC) is now the 7th most common cancer in the UK with an estimated lifetime risk (in those born after 1960) of developing this of 3% males and 2% for females. [Cancer Research UK] A third are stage 4 at presentation with spread to lungs, brain, bone, and liver and so can present with persistent cough, haemoptysis, abnormal liver function tests, bone pain etc. [Kidney Cancer UK] Chronic cough affects 10% of the adult population and is a common reason why patients visit their general practitioner (GP). In half the patients a cause (such as asthma, bronchiectasis, gastro-oesophageal reflux, medication) is identified, but in the remainder no cause is found.
The recognition of cough occurring in patients with RCC was first described in 1935 by Creevy and in 2005 Walsh suggested in an unpublished paper, the presence of an associated cough in 31% of patients with RCC referred to by Estfan and Walsh. Even now, clinicians treating patients with cough or RCC remain unaware of this association although it is widely discussed within kidney cancer patient forums. This results in a in delay in diagnosis of the RCC, potentially resulting in poorer quality of life and worse outcomes.
PhD
- A systematic review of the literature to determine: “What is the prevalence and persistence of cough in patients with renal cell carcinoma with reference to subtype, staging and treatment?”
- Identify the prevalence of cough in patients attending the SCKCC, at the Royal Free London NHS Trust (UCL partner) and identify those diagnosed with RCC with a representative cohort enrolled into a longitudinal study with reference to the effect of treatment and disease progression on their symptoms of cough using EQ-5D and the validated Leicester Cough Questionnaires.
- To understand why a cough develops, a feasibility study using cough hypersensitivity testing will be performed in consented patients with kidney cancer with and without a cough. The cough hypersensitivity test will be validated on a number of “control” subjects. Citric acid (stimulates c and A delta fibres) will be initially used and in those found to be responsive, capsaicin (stimulates only c fibres) will be used to determine the cough hypersensitivity pathway
Impact of ENT UK Foundation funding
UCL Doctoral Skills Training Programme
Pertinent to the PhD was the need to attend a course on the process of carrying out a systematic review. The online course ‘Systematic reviews in health and disease’ from UCL was completed with the ENT UK Foundation Grant.
“This was a self-paced but challenging course with lots of statistics! I completed the course in January 2022 obtaining 89% in the assessment.”
Current Status
The protocol is published on PROSPERO. Working with urology registrar as second reviewer and anticipate completion of systematic review by September 2022.
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