Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
10 December 2024
Andrew, Celia, Neomi and Ayodele (left to right)
The project: Clinical utility of neutrophil-to-lymphocyte ratio (NLR) in identifying patients at risk of cancer diagnosis in primary care: a cohort study using routine electronic health records
Research group: Sarah Bailey, Richard Neal, Sarah Price, Luke Mounce, Liz Down, Tanimola Martins, Elizabeth Shepherd, David Shotter, Celia Butler, Ayodele Awi, Neomi Alam, and Andrew Parsons
This study aims to build on the researchers’ existing work by exploring a link between different types of cancers and the “neutrophil to lymphocyte ratio”. Neutrophils and lymphocytes are different types of white blood cells; the body produces them when fighting infections. When a blood sample is taken the number of each type is counted and one is compared to another. When this ratio is recorded as high, it can indicate inflammation in the body which could be caused by an undetected cancerous tumour.
Previous studies have indicated that the “neutrophil to lymphocyte ratio” could be of particular importance when reviewing survival for patients already diagnosed with lung cancer, and kidney cancer, however it has never been considered as a tool to aid diagnosis of these cancers. Our research addresses that gap.
Celia: Leading Public Patient Involvement and Engagement (PPIE) on the project
Becoming a co-applicant of this study and leading the Public Patient Involvement and Engagement (PPIE) is a real privilege. I am so excited to be involved in this world leading research group on a project which promises to improve the lives for so many people though something as simple and widely available as a blood test.
I’ve been involved with other projects over the last few years and had the opportunity to attend and present at conferences and learn about the wider field. Though this I have gained a real insight into how the feedback from public collaborators (members of PPI groups) can shape the communication and approaches used by health services (particularly in primary care). This inspired me to do more.
So far in this project I have had the unique opportunity to jointly develop the project application and once funded, form the team of public collaborators and design the welcome meeting to create an inclusive and relaxed atmosphere where everyone feels empowered to share their views and experiences and explore their motivations for getting involved.
A warm welcome to collaborative research
The welcome meeting kicked off with lunch, and then discussing the main pathways to cancer diagnosis, why primary care is such an important setting for early detection, clarified where our data comes from, discussed the use of routine blood tests by GPs, introduced the neutrophil-to-lymphocyte ratio and what it can tell us.
We also outlined the project timeline and emphasised the critical role of the public collaborators in ensuring that our work is relevant and effective. This welcome meeting created space for rapport among the group which paved the way for rich conversations to unfold.
Fresh perspectives on routine blood tests
One of the most striking discussions revolved around how patients perceive routine blood tests, and how the context of a GP suggesting a blood test can shape its impact. Is it framed as routine, precautionary or urgent? This nuance in communication can significantly influence how patients feel and respond. These insights will undoubtedly help us refine our research, ensuring that we ask the right questions and interpret findings in ways that resonate with the people they aim to serve.
The value of diversity in perspectives
One of the most enriching aspects of our first Public Patient Involvement (PPI) meeting was the recognition and celebration of the diverse perspectives within the group. Each collaborator brought unique insights shaped by their individual experiences, heritage, backgrounds and interactions with primary care. The range of views shared was thought-provoking.
For example, some collaborators saw routine blood tests as a reassuring response, an indication that their concerns were being taken seriously, while others highlighted concerns about the how the ‘need’ for tests is communicated and the anxiety it can create. The members of the group were quick to acknowledge these differing viewpoints, emphasizing the strength that diversity brings to PPI groups. This diversity of thought is essential in addressing the complexities of intersectionality in our research.
Moving forward, together
This meeting was just the beginning, but it has set the tone for a collaborative process where patient and public voices will continue to shape our work. As we dive deeper into understanding the clinical utility of NLR in primary care, these PPI discussions underscore why Involvement of member of the public is so essential, not as an add-on but as an integral part of meaningful research.
A few words from Neomi, Ayodele, Andrew
“This project has been a means of expressing what I have found to be amazing about the NHS, but it will hopefully also be a way of sharing invaluable information that will enable patients and their families to better understand the processes of clinical diagnoses. This will hopefully help to identify cancer significantly quicker than current protocols but more importantly, this project will help us put together a pathway that leads to better understanding and outcomes for all involved. The added bonus is the fact that we are actively working towards reducing if not eliminating health inequalities across the board. An exciting project that is an opportunity to be part of a change that will benefit all.” Neomi
“The topic of cancer is such a sensitive topic that can trigger emotions of victims or carers and thus require utmost caution, not only in how we approach it, but also in trying to find ethically acceptable solutions to deal with it. I think that public involvement in the NLR project is so critical considering it can enhance study relevance, improve awareness, and foster trust, which may ultimately lead to better outcomes. I feel extremely proud to be part of a small group that is doing our bit to support a project that we believe can create remarkable positive change in our world“. Ayodele
“I’m really pleased to be involved in study. The importance of regular blood tests is well known, but to make full use of this data for early detection and treatment of cancer will be a game changer. I am looking forward to seeing the results.” Andrew
“I am really excited to be involved with this project which has so much potential to gain critical information from something as simple and widely available as a blood test. Hopefully during the project we will be able to find links between the neutrophil to lymphocyte ratio and cancer of various types, leading to earlier cancer detection and better outcomes for patients.” Celia