how to cite cancer research uk

Reference management. Clean and simple.

How to format your references using the Cancer Research citation style

This is a short guide how to format citations and the bibliography in a manuscript for Cancer Research. For a complete guide how to prepare your manuscript refer to the journal's instructions to authors .

Using reference management software

Typically you don't format your citations and bibliography by hand. The easiest way is to use a reference manager:

Journal articles

Those examples are references to articles in scholarly journals and how they are supposed to appear in your bibliography.

Not all journals organize their published articles in volumes and issues, so these fields are optional. Some electronic journals do not provide a page range, but instead list an article identifier. In a case like this it's safe to use the article identifier instead of the page range.

Books and book chapters

Here are examples of references for authored and edited books as well as book chapters.

Sometimes references to web sites should appear directly in the text rather than in the bibliography. Refer to the Instructions to authors for Cancer Research .

This example shows the general structure used for government reports, technical reports, and scientific reports. If you can't locate the report number then it might be better to cite the report as a book. For reports it is usually not individual people that are credited as authors, but a governmental department or agency like "U. S. Food and Drug Administration" or "National Cancer Institute".

Theses and dissertations

Theses including Ph.D. dissertations, Master's theses or Bachelor theses follow the basic format outlined below.

News paper articles

Unlike scholarly journals, news papers do not usually have a volume and issue number. Instead, the full date and page number is required for a correct reference.

In-text citations

References should be cited in the text by sequential numbers in parentheses :

About the journal
Other styles
Trends in Pharmacological Sciences
Journal of Turbomachinery

Pharmacology: Citing references

Key resources
Using EndNote

General guidance on referencing

Videos on referencing, avoiding plagiarism, using Turnitin, using quotes and paraphrasing

Which referencing style should I use?

The School of Pharmacy recommend two different styles of referencing depending on the type of assignment: Harvard (a name-date style) and Vancouver (a numbered style). The versions of these styles used are based on guidance given in the ' Cite Them Right' book. Note that other versions of these styles are not acceptable.

This guidance applies to students on the MPharm, Pharmacology, Physician Associate and CIPPET programmes.

To reference correctly you need to provide the full details for each source in a list at the end of your document AND have a citation in the text to indicate which parts came from each source. The style you use for these will depend on whether you are using Harvard or Vancouver.

Vancouver referencing guidance and examples
Harvard referencing guidance and examples

Further support with writing references

For further help with formatting your references consult your Academic Liaison Librarian, Jackie Skinner - email, come to the weekly drop-in, or make an appointment (contact details below).

This video gives an overview of why and how you should reference materials used in your assignments. You will need to login with your University username and password to view this video.

The next video gives tips on how to use references in your work to avoid being accused of plagiarism:

If you are unable to view this video on YouTube it is also available on YuJa - view the Avoiding Unintentional Plagiarism video on YuJa (University username and password required)

When you submit your work you will be asked to do so through the Turnitin similarity checker. This video explains what this does and how you can use it to improve your writing.

If you are unable to view this video on YouTube it is also available on YuJa - view the Getting the most out of Turnitin video on YuJa (University username and password required)

The next two videos give guidance on using supporting evidence from publications in your assignments by using quotes or paraphrasing.

If you are unable to view this video on YouTube it is also available on YuJa - view the How to use long and short quotes video on YuJa (University username and password required)

If you are unable to view this video on YouTube it is also available on YuJa - view the Using paraphrases video on YuJa (University username and password required)

Quick links to referencing guidance

Guidance on using the name-year Harvard referencing style.

Guidance on using the numbered Vancouver style of referencing.

Citing tables, figures & images

Referencing visual elements taken from other sources.

Secondary referencing

Guidance on citing a source you have read about in another source

Harvard referencing - click on the tabs for guidance on specific publications

General guidance
Harvard video intro
Chapters in edited books
Journal articles
British Pharmacopoeia
NICE guidelines
Local guidelines
SmPCs/PILs on EMC
Systematic reviews on The Cochrane Library
Clinical trials
Materials posted on Blackboard

The 'Cite Them Right' Harvard style is an author-date system. In-text citations include the author and year of the reference. Full references are listed at the end in alphabetical order by the author's surname. See the other tabs in this box for guidance on citing specific types of publication in this style.

In-text citations

For the Harvard style, your in-text citation should include:

The author of the cited work
The year of publication of the cited work.

There are two ways of including an in-text citation and you can use both depending on how you want to structure each sentence. You can include the citation with the author’s surname and date in brackets at the end of the sentence:

Medical systems need to be carefully considered and designed to reduce the likelihood of medication errors (Ferner, 2020).

Or, you can include the author’s surname as part of your sentence, in which case only the date is in brackets:

More recently, a paper by Ferner (2020) has suggested that...

You can use a mix of these approaches in your assignment.

How many authors do I need to include in the in-text citation?

If the citation has two authors.

List both authors with 'and' or '&' in between (but be consistent in your use of 'and' or '&').

A recent study by Morbey and Smith (2021) found that...

... (Morbey and Smith, 2021) .

If the citation has three authors

List all three authors with a comma after the first author, '&' or 'and' before the last author (but be consistent in your use of 'and' or '&').

A recent study by Chen, Savana and Patel (2022) found that...

... (Chen, Savana and Patel, 2022) .

If the citation has four or more authors

Use the first author's name followed by " et al. " in italics.

A recent study by Rang et al. (2020) found that...

It has been shown previously (Rang et al. , 2020) that....

Note: you will need to include ALL authors in the full reference at the end of your document.

How do I differentiate references by the same author in the same year?

Differentiate them using letters after the year - both in the in-text citation and the full reference.

Chen and Hussein (2021a) ... and Chen and Hussein (2021b) ...

Can I cite a work by a company or organisation?

Many works by organisations do not have individually named authors. In this case, you can use the name of the organisation or company, such as Cancer Research UK or National Institute for Health and Care Excellence (NICE), as the author. This is known as a corporate author.

Asthma UK (2015) studies have shown... ... (Asthma UK, 2015) .

What if I have multiple references by the same author in a sentence?

If you need to refer to two or more sources by the same author in different years, you do not need to keep repeating the author's surname in the citation. Include the surname and the oldest year first, then separate the other years by semicolons (;). The sources should be ordered by year of publication, with the oldest first.

NHS (2016; 2019; 2021) studies have consistently shown ... (NHS, 2016; 2019; 2021)

You must include all of the sources separately in your reference list.

Do I need to include page numbers in my citation?

You only need to include a page number if directly quoting from a work. Enclose the quote in single quotation marks and include a page number in the in-text citation. For example:

More recently, a paper by Walker et al. (2020) stated that 'student pharmacists are valuable and important to practice model transformation' (p. 47) .

A recent paper stated that 'student pharmacists are valuable and important to practice model transformation' (Walker et al., 2020, p. 47) .

How do I refer to a source referenced in another work?

This type of referencing is known as secondary referencing and should be avoided wherever possible , as the author citing the work may bring their own bias or misinterpretation. It is better to seek out the original reference and cite it directly if it is useful.

See further guidance on secondary referencing below.

Reference list

References must be listed at the end of your document in alphabetical order by author surname/organisation name. If you use the same source more than once, just use the same in-text citation as previously to refer to the same full reference.

Author names

Cited using Surname, Initials - place a comma and a space between the surname and initials. Full stops between initials e.g.:

Multiple authors

List all of the authors in the full reference in the order they appear on the publication.

Additional guidance

See the tabs in this box for additional guidance and relevant examples. Our Harvard guidance is closely aligned with that given in the 'Cite them right' book and website (below). You can find extra publication types and examples via this website. Note that we deviate from this guide in some case to make references simpler e.g. only requiring DOI or web address for articles which do not have page numbers or an article reference number.

Harvard referencing guidance in Cite Them Right

You will need to login with your University username and password to view this video.

Citing books and e-books

Most books and e-books can be cited in the same way. If you are viewing the PDF of a printed book there is no need to include the web address in your reference if you have the place published and publisher.

Include the following in your reference:

Author/Editor name(s) in the format 'Surname, Initials'
Year of publication (in round brackets)
Book title (in italics or underlined) followed by a full stop.
Edition (if 2nd edn or later)
Place of publication followed by a colon e.g. London:

Copy the format and punctuation of these examples.

Example: book with a single author/editor

Citation in the text: (Houghton, 2020)

Full reference: Houghton, A.R. (2020) Making sense of the ECG: a hands-on guide. 5th edn. Boca Raton: CRC Press.

Example: book with two authors/editors

Citation in the text: (Jeukendrup and Gleeson, 2019)

Full reference: Jeukendrup, A. and Gleeson, M. (2019) Sport nutrition . 3rd edn. Champaign: Human Kinetics.

Example: book with four or more authors/editors

Citation in the text: (Ritter et al. , 2023)

Full reference: Ritter, J.M., Flower, R.J., Henderson, G., Loke, Y.K., MacEwan, D., Robinson, E. and Fullerton, J. (2024) Rang & Dale's pharmacology, 10 th edn. London: Elsevier.

Note that all authors are included in the full reference.

Citing online only books

Where an e-book looks like a printed book (usually PDFs) and you can find all the publication information (including place published and publisher) - cite it in the same way as a printed book (above). You do not need to include the web address.

Some books are born digital and are not published in a traditional format. Where it is not possible to find the publication information include the web address and date accessed instead, as in the examples below:

Citation in the text: (UK Health Security Agency, 2020)

Full reference: UK Health Security Agency (2020) Immunisation against infectious disease (The Green Book) . Available at: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book (Accessed: 21 January 2024).

Citation in the text: (Grabrucker, 2021)

Full reference: Grabrucker, A.M. (ed.) (2021) Autism spectrum disorders. Available at: https://www.ncbi.nlm.nih.gov/books/NBK573612/ (Accessed: 25 January 2024).

Note: Using StatPearls? Follow the guidance on citing an online only book chapter .

EndNote tips

Use the Reference Type 'Book'
Author: in the format surname, initials, each author on a separate line
Place published:
Edition: if not the first - just add the number e.g. 2nd, 3rd
Use the Reference Type 'Edited book'
Editor: in the format surname, initials, each editor on a separate line
Other fields the same as above
Use the Reference Type 'Electronic Book'
Date Accessed: the date you looked looked at the book in the format day month year e.g. 17 January 2024
URL: paste in the web link

Citing book chapters

Chapter author name(s) in the format 'Surname, Initials'
Chapter title in single quotation marks
in followed by book editor(s) name(s) in the format 'Surname, Initials' followed by (ed.) or (eds)
Book title (in italics)
Edition (if second edition or later)
Publisher's name
Chapter pagination preceeded by pp.

Include the page extent of the whole chapter when writing your full citation. Put just the pages you have referred to in the in-text citation.

Example: book chapter with three authors

Citation in the text: (Singh, Khurana and Singh, 2018, p. 38)

Full reference: Singh, H., Khurana, L.K. and Singh, R. (2018) 'Pharmaceutical development', in Vohora, D. and Singh, G. (eds) Pharmaceutical medicine and translational clinical research . London: Academic Press, pp.33-46.

Example: book chapter with four or more authors

Citation in the text: (Hosznyak et al ., 2012, p. 199)

Full reference: Hosznyak, R., Hosznyak, E., Westaway, A. and Graveson, J. (2017) 'Eye, ear, nose and throat assessment', in Ranson, M. and Abbott, H. (eds) Clinical examination skills for healthcare professional . 2nd edn. Keswick: M & K Publishing, pp. 126-137.

Citing chapters in online only books

Where an e-book chapter looks like a printed book chapter (usually PDFs) and you can find all the publication information (including place published and publisher) - cite it in the same way as a printed book (above). You do not need to include the web address.

Where it is not possible to find the publication information include the web address and date accessed instead:

Chapter author(s) in the format 'Surname, Initials'
Chapter title in single quotation marks. Capitalise only the first letter of the first word and any proper nouns.
'in' followed by book editor(s) name(s) in the format 'Surname, Initials' followed by (ed.) or (eds)
Book title (in italics). Capitalise only the first letter of the first word and any proper nouns.
Edition (if 2nd or later)
Available at: https://doi.org... or web address
Accessed: date in round brackets (date in this format 25 January 2022)

Copy the format and punctuation of these examples:

UK Health Security Agency (2013) 'Immunisation by nurses and other healthcare professionals', in Immunisation against infectious disease (The Green Book) . Available at: https://www.gov.uk/government/publications/immunisation-by-nurses-and-other-health-professionals-the-green-book-chapter-5 (Accessed: 3 February 2024)

Kawakami, S and Otsuka, S. (2021) 'Multisensory processing in autism spectrum disorders', in Grabrucker, A.M. (ed.) Autism spectrum disorders . Available at: https://www.ncbi.nlm.nih.gov/books/NBK573612/ (Accessed: 7 January 2024)

Squadrito, F.J. and del Portal, D. (2022) 'Nitrofurantoin', in StatPearls . Available at: https://www.ncbi.nlm.nih.gov/books/NBK470526/ (Accessed: 1 February 2024).

Use the Reference Type 'Book Section'
Author: in the format surname, initials. Each author on a separate line.
Title: title of chapter
Editor: (include all the editors in the format surname, initials. Each editor on a separate line)
Book title:
Pages: page numbers for the chapter e.g. 301-335
Use the Reference Type 'Electronic Book Section'
Complete the details above (as much as possible)
Add URL: paste in the web link
Add Access Date: the date you looked looked at the book in the format day month year e.g. 3 February 2024

Note that the way you enter an online only chapter on EndNote for the Harvard style is different from the way you enter it for the Vancouver style. It is not possible to reuse one entry in both styles.

Note that the default 'Cite Them Right Harvard' style in EndNote does not handle e-book sections very well. Download and use our amended style which corrects these issues:

Reading Cite Them Right Harvard style Once downloaded open the style and go to 'File' and 'Save as' and 'Save'. This should save it into a location where EndNote can find it and use it. You will then need to select the 'Reading Cite Them Right-Harvard' style from the list of styles in Word (click on 'Select another style' to find it).

Alternatively as a final step before submission, create a plain text version of your document. Go to the EndNote toolbar in Word and select 'Convert citations and bibliography' to 'Plain text' (this will be under 'Tools' on the Mac version of the toolbar). This will create a copy of your document which is divorced from EndNote so that you can make final tweaks to the reference to match the guidance above.

Citing journal articles which have page numbers or article reference numbers

ALL Author name(s) in the format 'Surname, Initials'
Year of publication (in brackets)
Article title - in lower case apart from the first letter of the first word and any proper nouns
Journal title (in italics) - give the journal name in full, not abbreviated. Use initial capital letters on all significant words.
Volume number
Issue number (if present, in round brackets)
Page numbers or reference number (Include the page numbers of the whole article when writing your full citation, not just the pages you have referred to)

Example: journal article with a single author

Citation in the text: (Rhee, 2022)

Full reference: Rhee, E. (2022) 'The influence of obesity and metabolic health on vascular health', Endocrinology and Metabolism, 37(1), pp. 1-8.

Example: journal article with two authors

Citation in the text: (Rana and Neeland, 2022)

Full reference: Rana, M.N. and Neeland, I.J. (2022) 'Adipose tissue inflammation and cardiovascular disease: an update', Current Diabetes Reports, 22(1), pp. 27-37.

Example: journal article with four or more authors and an article reference number

Citation in the text: (Zheng et al ., 2021)

Full reference: Zheng, Y., Phillips, C.L., Sivam, S., Wong, K., Grunstein, R.R., Piper, A.J. and Yee, B.J. (2021) 'Cardiovascular disease in obesity hypoventilation syndrome – a review of potential mechanisms and effects of therapy', Sleep Medicine Reviews, 60, pp. 101530.

You must include all authors in the full reference.

Citing online journal articles without page numbers or article reference numbers

Available at: DOI (preceded by https://doi.org/) or Web link If including a weblink make sure it is as short as possible and doesn't include intermediate websites or your search string.
Accessed: date you looked at the article in the format day month year e.g. 12 January 2024.

Copy the format and punctuation of these examples:

Article with no page numbers or reference number:

Citation in the text: (Azpiroz et al ., 2017)

Full reference: Azpiroz, F., Dubray, C., Bernalier-Donadille, A., Cardot, J.M., Accarino, A., Serra, J., Wagner, A., Respondek, F., Dapoigny, M. (2017) 'Effects of scFOS on the composition of fecal microbiota and anxiety in patients with irritable bowel syndrome: a randomized, double blind, placebo controlled study'. Neurogastroenterology & Motility , 29(2). Available at: https://doi.org/10.1111/nmo.12911 (Accessed: 29 January 2024)

In Press article

Articles are often made available before they receive their official publication details (volume and issue number). If an article is shown as 'In press' or 'Online ahead of print' and doesn't yet have these details, just use (in press) after the journal name and add the DOI web address and date accessed.

Citation in the text: (Vaghari-Tabari et al ., 2023)

Full reference: Vaghari-Tabari, M., Jafari-Gharabaghlou, D., Mohammadi, M., & Hashemzadeh, M.S. (2023). Zinc oxide nanoparticles and cancer chemotherapy: helpful tools for enhancing chemo-sensitivity and reducing side effects? Biological Trace Element Research (in press). Available at: https://doi.org/10.1007/s12011-023-03803-z (Accessed: 25 January 2024)

You should be able to download details for most articles from databases such as Summon, Web of Science, Scopus and PubMed. If you need to type one in from scratch this is the information to include.

For most articles

Use the Reference Type 'Journal Article'
Author: in the format surname, initials - each author on a separate line
Title: title of the article - in lower case apart from the first letter of the first word and any proper nouns
Journal: name of the journal - give the journal name in full, not abbreviated. Use initial capital letters on all significant words.
Issue: (if present)
Pages: page numbers or article reference number

For online only articles without page numbers or an article reference number and 'In press' articles

Use the reference Type 'Electronic Article'
Periodical Title: name of the journal - give the journal name in full, not abbreviated. Use initial capital letters on all significant words.
Issue: (put in press here for articles currently being published)
Date Accessed: the date you looked at the article in the format day month year e.g. 25 January 2024.
URL: If there isn't a DOI add the web address for the article in the URL field. If there is already a URL in the box check that it goes to the article, not back to the reference on the database you downloaded it from. When including a web address make sure it is as short as possible and doesn't include intermediate websites or your search string.

Citing web pages or web sites

You should avoid citing webpages unless you are clear of their quality and suitability for inclusion in academic work. See the 'Websites' tab within this guide for more information on evaluating webpages.

Only follow this guidance if the item you want to reference is not a book, a book chapter or a journal article. When you search the internet you will find many different types of content. The first step to referencing correctly is to recognise what you are looking at.

Could it be a book? Is it a PDF? Does it have a title page giving the title and the authors/editors? Does it have a place published and publisher on the following page? If 'Yes' it is probably a book - follow the guidance on citing a book.
Could it be a book chapter? Does it say 'Chapter' on it? Does it have page numbers? If 'Yes' it could be a book chapter - follow the guidance on citing a book chapter.
Could it be journal article? Does it have an abstract or summary? Does it mention the name of a journal and have a volume number? If 'Yes' it could be a journal article - follow the guidance on citing a journal article.

For guidance on citing specific, commonly used pharmacy-related sources see the other tabs in this box.

Citing reputable websites and webpages

Author name(s) in the format 'Surname, Initials', or organisation that created the page
Year information was created or last edited (in brackets). You might need to scroll to the bottom of the page to find it. If there is no date put (no date)
Page title (in italics and in lower case apart from the first letter of the first word and any proper nouns)
Available at: followed by the web address. Make sure the address is as short as possible and doesn't include intermediate websites or your search string.
Accessed: date in round brackets

Example: webpage with a named author

Citation in the text: (Reynolds, 2023)

Full reference: Reynolds, M. (2023) How the team monitoring new and emerging infectious diseases could help prevent the next pandemic . Available at: https://ukhsa.blog.gov.uk/2023/08/08/how-the-team-monitoring-new-and-emerging-infectious-diseases-could-help-prevent-the-next-pandemic/ (Accessed: 2 February 2024)

Examples: webpages with an organisation as the author

Citation in the text: (DrugBank, 2024)

Full reference: DrugBank (2024) Ranitidine . Available at: https://www.drugbank.ca/drugs/DB00863 (Accessed: 8 February 2024).

Citation in the text: (Office for Health Improvement & Disparities, 2024)

Full reference: Office for Health Improvement & Disparities (2024) Cardiovascular disease . Available at: https://fingertips.phe.org.uk/profile/cardiovascular (Accessed: 31 January 2024).

Example: webpage without a date

If there isn't a date on the website, even at the bottom of the page, use 'no date'.

Citation in the text: (IUPHAR/BPS, no date)

Full reference: IUPHAR/BPS (no date) Ibuprofen . Available at: https://www.guidetopharmacology.org/GRAC/LigandDisplayForward?ligandId=2713 (Accessed: 6 February 2024).

Use the Reference Type 'Web Page'
Author: in the format surname, initials - each author on a separate line Organisation as the author? Put a comma after the name to ensure it formats correctly e.g. British Nutrition Foundation,
Year: use the updated date for the page, if there isn't a date use 'no date'
Title: (in lower case apart from the first letter of the first word and any proper nouns)
Access Date: the date you looked at the site in the format day month year e.g. 17 January 2024 Note there is a fault in the Cite Them Right Harvard style which omits the closing bracket after the date. Just type the closing bracket after the year in EndNote for it to appear e.g. 17 January 2024)
URL: paste in the web link. Make sure it is as short as possible and doesn't include intermediate websites or your search string.
Organisation as the author? Put a comma after the name to ensure it formats correctly e.g. British Nutrition Foundation,

You can also download our amended 'Cite Them Right-Harvard' style to correct the issue with the missing closing bracket:

Citing the BNF

Update December 2023: You can now choose which version of the BNF to use in your work: in print; on the NICE website; on the MedicinesComplete website; or via the BNF App. There's guidance on citing each below.

When citing the BNF you only need one generic reference, not specific references for each drug or piece of information you have used. Just make it clear in your text which drug/section you are referring to.

Print version

Author - Joint Formulary Committee
Title - British National Formulary (BNF) in italics
Place of publication: London
Publisher: BMJ Group and Pharmaceutical Press

Use the format and punctuation shown in this example - update the edition and year to the one you are using:

Citation in the text: (Joint Formulary Committee, 2023)

Full reference: Joint Formulary Committee (2023) British National Formulary (BNF) 86 . London: BMJ Group and Pharmaceutical Press.

Online versions (NICE and MedicinesComplete)

For the NICE website version take the year from the 'Last updated' date on the BNF homepage.
For the MedicinesComplete version use the year from the 'Publication last updated' date from the top of the page instead of the date the individual drug was updated
For the NICE website version take this from the 'Last updated' date on the BNF homepage.
For the MedicinesComplete take this from the 'Publication last updated' date from the top of the page.
Available at: https://bnf.nice.org.uk/ (Accessed: date) OR Available at: https://www.medicinescomplete.com (Accessed: date) Note that you just use the site web address, not the page address for the specific drug you are using. The accessed date is the date you looked at the information in the format day month year e.g. 25 January 2024.

Citation in the text: (Joint Formulary Committee, 2023)

Full reference (NICE version): Joint Formulary Committee (2023) British National Formulary (BNF). 13 December 2023 . Available at: https://bnf.nice.org.uk/ (Accessed: 8 February 2024)

Full reference (MedicinesComplete version): Joint Formulary Committee (2023) British National Formulary (BNF). 9 January 2024 . Available at: https://www.medicinescomplete.com (Accessed: 8 February 2024 )

Year of publication (in round brackets) - use the year given on the homepage of the app
Title - British National Formulary (BNF) app in italics
BNF update date - use the month and year from given on the homepage of the app
Format: [Mobile app].
Available at (use the Google Android or Apple Mac link depending on which you are using) followed by (Accessed: date): Available at: https://play.google.com/store/apps/details?id=com.pharmpress.bnf (Accessed: date) Available at: https://apps.apple.com/gb/app/bnf-publications/id1045514038 (Accessed: date) The accessed date is the date you looked at the information in the format day month year e.g. 25 January 2024.

Copy the format and punctuation of this example:

Citation in the text: (Joint Formulary Committee, 2024)

Full reference: Joint Formulary Committee (2024) British National Formulary (BNF) app. January 2024 . [Mobile app]. Available at: https://play.google.com/store/apps/details?id=com.pharmpress.bnf (Accessed: 25 January 2024).

For the print version

Author: Joint Formulary Committee, (make sure you put the comma after the name to make it format correctly)
Title: British National Formulary (BNF) followed by Version number e.g. British National Formulary (BNF) 86

For the online versions:

Use the Reference Type 'Web Page'
Year:
Title: followed by the update date e.g. British National Formulary (BNF). January 2024 OR 9 January 2024 (depending on which version you are using)
Access Date: the date you looked at the site in the format day month year e.g. 4 February 2024 Note there is a fault in the Cite Them Right Harvard style which omits the closing bracket after the date. Just type the closing bracket after the year in EndNote for it to appear e.g. 4 February 2024)
URL: https://bnf.nice.org.uk/ OR https://www.medicinescomplete.com (depending on which version you are using)
Note that if you have added Type of Medium 'Internet' to comply with the Vancouver style, you will need to remove it to create a correct Harvard reference.

For the app:

Title: followed by the update date e.g. British National Formulary (BNF). January 2024
Type of medium: Mobile app
URL: https://play.google.com/store/apps/details?id=com.pharmpress.bnf OR https://apps.apple.com/gb/app/bnf-publications/id1045514038 (depending on which version you are using)

Citing the British National Formulary for children (BNFC)

Update December 2023: You can now choose which version of the BNFC to use in your work: in print; on the NICE website; on the MedicinesComplete website; or via the BNF App. There's guidance on citing each below.

When citing the BNFC you only need one generic reference, not specific references for each drug or piece of information you have used. Just make it clear in your text which drug/section you are referring to.

Author(s): Pediatric Formulary Committee
Title: British National Formulary for children (in italics) and version
Publisher: BMJ Group, Pharmaceutical Press and RCPCH Publications

Copy the format and punctuation of this example. Make sure you check the date and edition of the version you are using.

Citation in the text: (Pediatric Formulary Committee, 2022)

Full reference: Pediatric Formulary Committee (2022) British National Formulary for children 2022-2023 . London: BMJ Group, Pharmaceutical Press and RCPCH Publications.

Year of publication (in round brackets) For the NICE website version take the year from the 'Last updated' date on the BNFC homepage. For the MedicinesComplete version use the year from the 'Publication last updated' date from the top of the page you are viewing.
Title: British National Formulary for children (BNFC) (in italics)
BNFC update date For the NICE website version take this from the 'Last updated' date on the BNFC homepage. For the MedicinesComplete take this from the 'Publication last updated' date from the top of the page.
Available at: https://bnfc.nice.org.uk/ (Accessed: date) OR Available at: https://www.medicinescomplete.com (Accessed: date) Note that you just use the site web address, not the page address for the specific drug you are using. The accessed date is the date you looked at the information in the format day month year e.g.5 February 2024.

Copy the format and punctuation of this example. Make sure you check the date and edition (month and year) of the version you are using.

Citation in the text: (Pediatric Formulary Committee, 2023)

Full reference (NICE version): Pediatric Formulary Committee (2023) British National Formulary for children (BNFC) . 13 December 2023 . Available at: https://bnfc.nice.org.uk/ (Accessed: 4 February 2024)

Full reference (MedicinesComplete version): Pediatric Formulary Committee (2023) British National Formulary for children (BNFC) . 9 January 2024 . Available at: http://www.medicinescomplete.com (Accessed: 4 February 2024)

Author - Pediatric Formulary Committee
Title - British National Formulary for children (BNFC) app in italics
BNFC update date - use the month and year from given on the homepage of the app
Available at (use the Google Android or Apple Mac link depending on which you are using) followed by (Accessed: date): Available at: https://play.google.com/store/apps/details?id=com.pharmpress.bnf (Accessed: date) Available at: https://apps.apple.com/gb/app/bnf-publications/id1045514038 (Accessed: date) The accessed date is the date you looked at the information in the format day month year e.g. 1 February 2024.

Citation in the text: (Pediatric Formulary Committee, 2023)

Full reference: Pediatric Formulary Committee (2023) British National Formulary for children (BNFC) app. December 2023 . [Mobile app]. Available at: https://play.google.com/store/apps/details?id=com.pharmpress.bnf (Accessed: 4 February 2024)

Author: Pediatric Formulary Committee, (make sure you put the comma after the name to make it format correctly)
Title: followed by version e.g. British National Formulary for children 2022-2023
Place published: London
Publisher: BMJ Group, Pharmaceutical Press and RCPCH Publications
Author: Pediatric Formulary Committee, (make sure you put the comma after the name to make it format correctly)
Title: followed by the latest update date (see above for where to find this date) e.g. NICE version: British National Formulary for children (BNFC). December 2023 MedicinesComplete version: British National Formulary for children (BNFC). 9 January 2024.
URL: https://bnfc.nice.org.uk/ OR https://www.medicinescomplete.com (depending on which version you are using)
Title: followed by the update date e.g. British National Formulary for children (BNFC). December 2023

Citing the British Pharmacopoeia

When citing the British Pharmacopoeia you only need one generic reference, not specific references for each drug or section you have used. Just make it clear in your text which drug/section you are referring to.

Author: British Pharmacopoeia Commission
Title: British Pharmacopoeia. Version. (in italics)
Available at: https://www.pharmacopoeia.com (Accessed: date)

Copy the format and punctuation of this example (make sure you change the Version and dates to match the ones you use):

Citation in the text: (British Pharmacopoeia Commission, 2024)

Reference list: British Pharmacopoeia Commission. (2024). British Pharmacopoeia . Ph. Eur. 11.4 update. Available at: https://www.pharmacopoeia.com (Accessed: 8 February 2024)

Author: British Pharmacopoeia Commission, (make sure you put the comma after the name to make it format correctly)
Title: followed by the update date e.g. British Pharmacopoeia. Ph. Eur. 11.4 update
Access Date: the date you looked at the site in the format day month year e.g. 8 February 2024 Note there is a fault in the Cite Them Right Harvard style which omits the closing bracket after the date. Just type the closing bracket after the year in EndNote for it to appear e.g. 8 February 2024)
URL: https://www.pharmacopoeia.com

Access the British Pharmacopoeia

Access to the latest edition of The British Pharmacopoeia (BP), the leading collection of standards for UK medicinal products and pharmaceutical substances.

Help and guidance How to use the BP

Citing NICE guidelines

Author: National Institute for Health and Care Excellence (NICE)
Year created/updated (use the most recent date) in round brackets
Title of document/page (in italics) followed by the guideline reference number in round brackets
Available at: followed by the web address

Copy the format and punctuation of this example.

In-text citation: (National Institute for Health and Care Excellence (NICE), 2021)

Full reference: National Institute for Health and Care Excellence (NICE) (2021) Acute heart failure: diagnosis and management (CG187). Available at: https://www.nice.org.uk/guidance/cg187 (Accessed: 28 January 2024)

Author: National Institute for Health and Care Excellence (NICE), - make sure you put a comma after the name so it formats correctly Organisation as the author? Put a comma after the name to ensure it formats correctly e.g. British Nutrition Foundation,
Access Date: the date you looked at the site in the format day month year e.g. 28 January 2024 Note there is a fault in the Cite Them Right Harvard style which omits the closing bracket after the date. Just type the closing bracket after the year in EndNote for it to appear e.g. 28 January 2024)
URL: paste in the web link (For a shorter reference use the link for the webpage instead of the longer PDF link)

Citing local guidelines

Local guidelines, although authored by individuals, should be ratified by a designated committee therefore are the work of the organisation.

Print guidelines

Author - organisation name
Year of publication in round brackets
Title of policy and Version (in italics)
Place of publication
Publisher (often the same as the author)

Use the text formatting and punctuation shown in this example.

Citation in the text: (Imperial College Healthcare NHS Trust, 2023)

Full reference: Imperial College Healthcare NHS Trust (2023) Non-medical prescribing policy . Version 5. London: Imperial College Healthcare NHS Trust.

Online guidelines

Title of policy and Version (in italics)

Citation in the text: (North East London Health & Care Partnership, 2023)

Full reference: North East London Health & Care Partnership (2023) North East London (NEL) management of infection guidance for primary care . August 2023 . Available at: https://gp-website-cdn-prod.s3.amazonaws.com/prescribing-guideline-downloads/1697724608-4663d459fc894709f71ce7beaa8662db.pdf (Accessed: 8 February 2024)

For print guidelines

Use the Reference Type 'Book'
Author: in the format surname, initials, each author on a separate line. If the author is an organisation put a comma after the name to make sure it formats correctly e.g. Imperial College Healthcare NHS Trust,
Title: (in lower case apart from the first letter of the first word and any proper nouns) include the Version after the title e.g. Non-medical prescribing policy. Version 5

For online guidelines

Use the Reference Type 'Web Page'
Author: in the format surname, initials, each author on a separate line. Organisation as the author? Put a comma after the name to ensure it formats correctly e.g. e.g. North East London Health & Care Partnership,

Citing SmPCs (Summaries of Product Characteristics) OR PILs (Patient Information Leaflets) on the Electronic Medicines Compendium

Author - drug company who wrote the SmPC
Year updated on EMC
Title followed by Electronic Medicines Compendium. (in italics)

Copy the format and punctuation of these examples.

Citation in the text: (Wockhardt UK Ltd, 2017)

Full reference: Wokhardt UK Ltd (2017) Aciclovir 400mg tablets summary of product characteristics . Electronic Medicines Compendium . Available at: https://www.medicines.org.uk/emc/product/2352/smpc (Accessed: 25 January 2024).

Citation in the text: (Dermal Laboratories Limited, 2024)

Full reference: Dermal Laboratories Limited (2024) Ibugel patient information leaflet . Electronic Medicines Compendium . Available at: https://www.medicines.org.uk/emc/product/3759/pil (Accessed: 7 February 2024).

Use the Reference Type 'Web Page'
Author: company name. Put a comma after the company name to ensure it formats correctly e.g. Wockhardt UK Ltd,
Title: (in lower case apart from the first letter of the first word and any proper nouns). Add ': Electronic Medicines Compendium' after the title.
Access Date: the date you looked at the site in the format day month year e.g. 7 February 2024 Note there is a fault in the Cite Them Right Harvard style which omits the closing bracket after the date. Just type the closing bracket after the year in EndNote for it to appear e.g. 7 February 2024)

Citing systematic reviews on The Cochrane Library database

Author(s) in the format Surname, Initials
Title of review (in single quotation marks)
Database name (in italics)
Issue number
Article number (CD ...)
DOI or Available at: web address (Accessed: date)

Citation in the text: (Crowe, Chang and Wallace, 2016)

Reference list: Crowe, L., Chang, A., and Wallace, K. (2016) 'Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation', Cochrane Database of Systematic Reviews, 8, CD005586, DOI: 10.1002/14651858.CD005586.pub3

Use the Reference Type 'Electronic article'
Title: title of the review - in lower case apart from the first letter of the first word and any proper nouns
Periodical Title: The Cochrane Database of Systematic Reviews
Volume: Issue number, Article number e.g. 8, CD005586

Note that the way you enter a Cochrane Review on EndNote for the Harvard style is very different from the way you enter it for the Vancouver style. It is not possible to reuse one entry in both styles.

Access The Cochrane Library

Systematic reviews, protocols and trials on the effects of interventions in health care. Free to UK residents

Includes: -The Cochrane Database of Systematic Reviews (Cochrane Reviews) -The Cochrane Central Register of Controlled Trials (CENTRAL) -The Cochrane Database of Methodology Reviews (Methodology Reviews) Help and guidance You can find training materials and videos by registering with the Cochrane Library Training Hub (requires an e-mail address).

Citing clinical trials

Although most references refer to the published paper as this details the results of the clinical trial, depending on the context of what you write you may need to reference the clinical trial itself.

Author(s) in the format Surname, Initials (this will be the primary contact for the trial)
Title of trial (in single quotation marks)
Database/registry name (in italics)
Trial reference number

Example 1: with a DOI

Citation in the text: (Crooks, 2023)

Full reference: Crooks, M. (2023) 'An investigation into how adding an inhaled steroid to COPD treatment may potentially protect against heart disease', ISRCTN , ISRCTN29148209. DOI: 10.1186/ISRCTN29148209 .

Example 2: without a DOI

Citation in the text: (Lingor, 2023)

Full reference: Lingor, P. (2023) 'Safety, tolerability and symptomatic efficacy of the ROCK-inhibitor Fasudil in patients with Parkinson's disease', ClinicalTrials.gov, NCT05931575. Available at: https://clinicaltrials.gov/study/NCT05931575 (Accessed: 9 January 2024).

Periodical Title: Database/Registry name
Volume: Trial number
Date Accessed: date you looked at it in the format day month year e.g. 9 January 2024 Note there is a fault in the Cite Them Right Harvard style which omits the closing bracket after the date. Just type the closing bracket after the year in EndNote for it to appear e.g. 9 January 2024)
DOI: add DOI if it has one
URL: the web link if no DOI
Note that the way you enter a Clinical Trial on EndNote for the Harvard style is very different from the way you enter it for the Vancouver style. It is not possible to reuse one entry in both styles.

Citing materials posted on Blackboard

Always check with your tutor if you are allowed to refer to course materials in your own work. It is preferable to use published sources where possible, such as articles and books.

Author's name in the format Surname, Initials
Year in round brackets
Title of document/presentation as given on Blackboard (in single quotation marks)
Medium in square brackets e.g. [PowerPoint presentation, Lecture, Recorded lecture)
Module code: module title (in italics)
Institution
Available at: https://www.bb.reading.ac.uk (Accessed: date) Note that you do not need to give the specific web address for the material you are citing. The address for Blackboard is sufficient.

Example 1: PowerPoint slides

Citation in the text: (Cottrell, 2023)

Full reference: Cottrell, G. (2023) 'The molecules of life: proteins' [Presentation slides]. PM1PY2: Fundamentals of Cell Biology . University of Reading. Available at: https://www.bb.reading.ac.uk (Accessed: 2 December 2023).

Example 2: Handout

Citation in the text: (University of Reading, no date)

Full reference: University of Reading (no date) 'Direct observation of procedural skills (DOPS) assessment form' [Handout] PM2PY1: Professional Practice 2 . University of Reading. Available at: https://www.bb.reading.ac.uk (Accessed: 20 November 2023).

For guidance on citing other types of materials posted on Blackboard see Section G7 of the following book:

Use the Reference Type 'Web Page'
Series title: module code and title
Publisher: University of Reading
Access Date: date you looked at it in the format day month year e.g. 25 January 2024
Type of Medium: add the Format here e.g. Presentation slides, Lecture notes, Recorded lecture, Handout
URL: https://www.bb.reading.ac.uk

Note that even with the information entered as above the default 'Cite Them Right-Harvard' style in EndNote will not quite format the reference correctly - the title of the document should be enclosed in single quotes and be in plain text; the module details should be in italics; there should be closing bracket after the access date; the Type of Medium should be after the document title. To correct this, as a final step before submission, create a plain text version of your document. Go to the EndNote toolbar in Word and select 'Convert citations and bibliography' to 'Plain text' (this will be under 'Tools' on the Mac version of the toolbar). This will create a copy of your document which is divorced from EndNote so that you can make final tweaks to the references.

Vancouver referencing - click on the tabs for guidance on specific publications

Vancouver video intro
Systematic reviews on the Cochrane Library

Vancouver is a numbered style. Each piece of work cited should have a unique number, assigned in order (your first reference is 1, your second is 2 etc.). It is a very plain style with little punctuation and no text formatting such as italics, underlining or bold.

When adding an in-text citation to your document you can write the number in brackets:

Medical systems need to be carefully considered and designed to reduce the likelihood of medication errors (1).

How do I cite multiple sources together?

When citing two or more sources at once, write a number for each separated by a comma e.g. (1, 2) or (6, 12)
When citing more than two sources which are numbered consecutively, use a hyphen instead of a comma e.g. (3-5)

For example:

There are many studies that have examined the effect of alcohol on cognitive impairment (1,2, 4-7, 9).

How should I refer to authors in the text?

You do not have to refer to the authors' names in the text but it may help the flow of your writing to do so.

Two authors: give both author's surnames linked with 'and'. For example:

A recent study by Chen and Lee (4) found that...

Three or more authors: use the first author's surname followed by "et al.". For example:

A recent study by Rang et al. (2) found that...

An organisation: give the full name with any recognised abbreviation in brackets afterwards e.g. National Institute for Health and Care Excellence (NICE). Thereafter you can refer to it using the abbreviation. Give the full name and abbreviation in the full reference. For example:

A survey by Asthma UK found that one in 20 people suffer from severe asthma (6).

How do I include a quote from a source?

If directly quoting from a work, you need to use single quotation marks. Include a page number in the in-text citation. For example:

More recently, a paper by Walker et al. (3) stated that 'student pharmacists are valuable and important to practice model transformation' (p. 47).

A paper by Walker et al.stated that 'student pharmacists are valuable and important to practice model transformation' (3, p. 47).

This type of referencing is known as secondary referencing and should be avoided wherever possible, as the author citing the work may have their own bias or misinterpretation. It is better to seek out the original reference (in this example, Ahmed’s) and cite it directly if it is useful.

You need to include both authors' names in the body of your text to show that you have not read the original article. In the final reference list, you should only include the reference you have read yourself (Jones in this example):

According to Ahmed as cited in Jones (5)...

References must be listed at the end of your document in numerical order based on the order of citation. If you use the same source more than once, the original citation number should be used.

Cited by Surname Initials - there is no comma between the surname and initials, nor any full stop or space between initials.

Authors should be listed in the order they appear on the publication. Only list the first six authors followed by et al.

Monzer NL, Hartmann M, Buckert M, Wolff K, Nawroth P, Kopf S et al.

See the tabs in this box for additional guidance and relevant examples. Our Vancouver guidance is closely aligned with that given in the 'Cite them right' book and website (below). You can find extra publication types and examples via this website. Note that we deviate from this guide in some case to make references simpler. For instance you should put journal names in full not abbreviated.

Vancouver referencing guidance in Cite Them Right
Author(s) or editors in the format Surname Initials (no full stops or spaces between initials). For books with more than six authors list the first six followed by 'et al.'
Title of book (capitalise only the first letter of the first word and any proper nouns)
Edition (if not the first)
Place of publication: Publisher; Year. You can usually find this information on the title page or following page.
Ritter JM, Flower RJ, Henderson G, Loke YK, MacEwan D, Robinson E, Fullerton J. Rang & Dale's pharmacology. 10th ed. London: Elsevier; 2024.
Ashley C, Dunleavy A, editors. The renal drug handbook: the ultimate prescribing guide for renal practitioners. 5th ed. Boca Raton: CRC Press; 2019.

Some books are born digital and are not published in a traditional format. If the book does not have a Place published and Publisher then you will need to follow this guidance. Include the following in your reference:

Author(s) or editors in the format Surname Initials (no full stops or spaces between initials) For books with more than six authors list the first six followed by 'et al.'
Year.
[cited year month day] - the date you looked at it e.g. [cited 2022 Jun 18] You can usually find this information on the title page or following page.
Available from: https://doi.org... or web address

Note: if you are unable to find a place published and publisher you will need to cite the item following the web page guidance.

UK Health Security Agency. Immunisation against infectious disease (The Green Book) [Internet]. 2021 [cited 2024 Jan 26]. Available from: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book.
Grabrucker AM, editor. Autism spectrum disorders [Internet]. 2021 [cited 2024 Feb 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK573612/.

Note: Using StatPearls? Follow the guidance on citing an online only book chapter .

Same as above but instead of the Author field fill in the Editor field
Type of Medium: Internet
Year Cited: in the format 2024
Date Cited: in the format month day e.g. Jan 23
URL: paste in the web link
Note that even with the information entered as above EndNote will not quite format the reference correctly - the edition will not appear and for edited e-books 'editors' will not be added after the editor names. To correct this, as a final step before submission, create a plain text version of your document. Go to the EndNote toolbar in Word and select 'Convert citations and bibliography' to 'Plain text' (this will be under 'Tools' on the Mac version of the toolbar). This will create a copy of your document which is divorced from EndNote so that you can make final tweaks to the references to match the guidance above.

Citing chapters in printed books and e-books with publication details

Follow this guidance to cite a printed book or an e-book which has the publisher and place published information. Include the following in your reference:

Chapter author(s) in the format Surname Initials (no full stops or spaces between initials)
Title of chapter. (capitalise only the first letter of the first word and any proper nouns)
Editor(s) of the book followed by , editors
Title of book. (capitalise only the first letter of the first word and any proper nouns)
Place of publication: Publisher; Year.
Page numbers of the chapter preceded by p. Abbreviate where appropriate e.g. 110-128 would be 110-28, 450-455 would be 450-5.

Copy the format and punctuation of this example

Singh H, Khurana LK, Singh R. Pharmaceutical development. In: Vohora D, Singh G, editors. Pharmaceutical medicine and translational clinical research. London: Academic Press; 2018. p. 33-46.
Davies J, Nuttall D. Prescribing for specific groups. In: Nuttall D, Rutt-Howard J, editors. The textbook of non-medical prescribing. 3rd ed. Hoboken: Wiley; 2020. p. 238-73.

Some books are born digital and are not published in a traditional format. When citing chapters in these include the following in your reference:

Chapter author(s) in the format Surname Initials (no full stops or spaces between initials)
Title of chapter. (capitalise only the first letter of the first word and any proper nouns)
[cited year month day] - the date you looked at it e.g. [cited 2022 Jun 18]
Page numbers of the chapter if available preceded by p. Abbreviate where appropriate e.g. 110-128 would be 110-28, 450-455 would be 450-5.
UK Health Security Agency. Immunisation by nurses and other healthcare professionals. In: Immunisation against infectious disease (The Green Book) [Internet]. 2013. p. 35-9 [cited 2024 Feb 3]. Available from: https://www.gov.uk/government/publications/immunisation-by-nurses-and-other-health-professionals-the-green-book-chapter-5.
Kawakami S, Otsuka S. Multisensory processing in autism spectrum disorders. In: Grabrucker AM, editor. Autism spectrum disorders [Internet]. 2021 [cited 2024 Jan 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK573612/.
Squadrito FJ, del Portal D. Nitrofurantoin. In: StatPearls [Internet]. 2022 [cited 2024 Feb 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470526/.

Endnote tips

Use the Reference Type 'Book Section'
Author(s): in the format surname, initials. Each author on a separate line.
Editor(s): in the format surname, initials. Each editor on a separate line.
Book title: capitalise only the first letter of the first word and any proper nouns
Pages: page numbers for the chapter
Use the Reference Type 'Electronic Book Section'
Title: chapter title
Editor: (if there is one)
Book Title:
Type of Work: Internet
Access Date: in the format year, month (abbreviated to three letters) day e.g. 2024 Jan 21
Note that even with all the required information entered in EndNote it will not format the reference correctly - the Edition and Type of Work will not be in the correct place. For edited e-books 'editors' will not be added after the editor names. The Access Date will be repeated at the end. To correct this, as a final step before submission, create a plain text version of your document. Go to the EndNote toolbar in Word and select 'Convert citations and bibliography' to 'Plain text' (this will be under 'Tools' on the Mac version of the toolbar). This will create a copy of your document which is divorced from EndNote so that you can make final tweaks to the references to match the guidance above.

Note that the way you enter a chapter on EndNote for the Vancouver style is different from the way you enter it for the Harvard style. It is not possible to reuse one entry in both styles.

Article author(s) in the format Surname Initials (no full stops or spaces between initials). For articles with more than six authors list the first six followed by 'et al.'
Title of article. (capitalise only the first letter of the first word and any proper nouns)
Journal title in full (use a capital letter at the start of each significant word in the title) Note: we are not following the 'Cite them right' guidance to abbreviate journal names.
Issue number in brackets (where present)
Page numbers or article reference number. Abbreviate page ranges where appropriate e.g. 110-128 would be 110-28, 450-455 would be 450-5.

Copy the format and punctuation of this example:

Rana MN, Neeland IJ. Adipose tissue inflammation and cardiovascular disease: an update. Current Diabetes Reports. 2022; 22(1):27-37.

Monzer NL, Hartmann M, Buckert M, Wolff K, Nawroth P, Kopf S et al. The cardiac autonomic response to acute psychological stress in type 2 diabetes. PloS One. 2022; 17(3):e0265234.

Article author(s) in the format Surname Initials (no full stops or spaces between initials). For articles with more than six authors list the first six followed by 'et al.'
Available from: https://doi.org/... or web address if no DOI. When including a web address make sure it is as short as possible and doesn't include intermediate websites or your search string.

Azpiroz F, Dubray C, Bernalier-Donadille A, Cardot JM, Accarino A, Serra J, Wagner A, Respondek F, Dapoigny M. Effects of scFOS on the composition of fecal microbiota and anxiety in patients with irritable bowel syndrome: a randomized, double blind, placebo controlled study. Neurogastroenterology & Motility [Internet]. 2017 [cited 2024 Jan 24] ;29(2). Available from: https://doi.org/10.1111/nmo.12911.

Note: if an article is in press and doesn't yet have a volume number treat like as above but add 'Forthcoming' before the year:

Vaghari-Tabari M, Jafari-Gharabaghlou D, Mohammadi M, Hashemzadeh MS. Zinc oxide nanoparticles and cancer chemotherapy: helpful tools for enhancing chemo-sensitivity and reducing side effects? Biological Trace Element Research [Internet]. Forthcoming 2024 [cited 2024 Jan 28]. Available from: https://doi.org/10.1007/s12011-023-03803-z

For online only articles without page numbers or an article reference number and 'In press' articles:

Use Reference Type 'Electronic Article'
Volume: (if the article doesn't yet have a volume number add 'Forthcoming ' before the year - as in the above example)
Issue: (put in press here for articles currently being published).
Date Cited in the format month day e.g. Feb 5.
URL: paste in the web link for the article or move the DOI from the DOI field and add https://doi.org/ in front of it e.g. https://doi.org/10.1136/ejhpharm-2021-003215 If there is already a URL in the box check that it goes to the article, not back to the reference on the database you downloaded it from. Replace any database links with the DOI with https://doi.org/ in front of it or add the direct link to the article. When including a web address make sure it is as short as possible and doesn't include intermediate websites or your search string.

Citing websites or webpages

Author(s)/Organisation name
Title of page/document (capitalise only the first letter of the first word and any proper nouns)
[Internet].
Year created/updated (for webpages with no date omit this element - see the final example)
[cited year month day] - the date you looked at it e.g. [cited 2022 Feb 18]
Available from: web link. When including a web address make sure it is as short as possible and doesn't include intermediate websites or your search string.

Use the format and punctuation shown in these examples:

Reynolds M. How the team monitoring new and emerging infectious diseases could help prevent the next pandemic [Internet]. 2023 [cited 2024 Feb 2]. Available from: https://ukhsa.blog.gov.uk/2023/08/08/how-the-team-monitoring-new-and-emerging-infectious-diseases-could-help-prevent-the-next-pandemic/.
DrugBank. Ranitidine [Internet]. 2024 [cited 2024 Feb 8]. Available from: https://www.drugbank.ca/drugs/DB00863.
IUPHAR/BPS. Ibuprofen [Internet]. [cited 2024 Feb 6]. Available from: https://www.guidetopharmacology.org/GRAC/LigandDisplayForward?ligandId=2713. (this example is for a webpage without a date)
Type of Medium: Internet
URL: paste in the web link. When including a web address make sure it is as short as possible and doesn't include intermediate websites or your search string.

Author - Joint Formulary Committee.
Title - British National Formulary (BNF).
Place of publication - London:
Publisher - BMJ Group and Pharmaceutical Press;
Joint Formulary Committee. British National Formulary (BNF). 86 ed. London: BMJ Group and Pharmaceutical Press; 2023.
[cited year month day] - the date you looked at it e.g. [cited 2024 Feb 4]
Available from: https://bnf.nice.org.uk/ OR Available from: https://www.medicinescomplete.com

Copy the format and punctuation of these examples:

Full reference (NICE version): Joint Formulary Committee. British National Formulary (BNF). 13 November 2023 [Internet]. 2023 [cited 2024 Feb 4]. Available from: https://bnf.nice.org.uk/.

Full reference (MedicinesComplete version): Joint Formulary Committee. British National Formulary (BNF). 9 January 2024 [Internet]. 2024 [cited 2024 Feb 4]. Available from: https://www.medicinescomplete.com.

Title - British National Formulary (BNF) app followed by the update date e.g. British National Formulary (BNF) app. January 2024.
Year of publication - use the year given on the homepage of the app
Available from: https://play.google.com/store/apps/details?id=com.pharmpress.bnf OR Available from: https://apps.apple.com/gb/app/bnf-publications/id1045514038

Citation in the text: (Joint Formulary Committee, 2024)

Full reference: Joint Formulary Committee. British National Formulary (BNF) app. January 2024 [Mobile app]. 2024 [cited 2024 Feb 4]. Available from: https://play.google.com/store/apps/details?id=com.pharmpress.bnf

Title: followed by the update date e.g. British National Formulary (BNF). December 2023 OR 13 December 2023 (depending on which version you are using)
Year Cited: in the format 2024
Date Cited: in the format month day e.g. Feb 4
Title: followed by the update date e.g. British National Formulary (BNF) app. January 2024

Citing the BNF for children

Title - BNF for children
Publisher - BMJ Group, Pharmaceutical Press and RCPCH Publications;

Use the format and punctuation shown in this example:

Pediatric Formulary Committee. BNF for children. 2022-2023 ed. London: BMJ Group, Pharmaceutical Press and RCPCH Publications; 2022.

Online versions (NICE and MedicinesComplete)

Title - British National Formulary for children (BNFC)
Update date For the NICE website version take this from the 'Last updated' date on the BNF homepage. For the MedicinesComplete take this from the 'Publication last updated' date from the top of the page.
Year published For the NICE website version take this from the 'Last updated' date on the BNF homepage. For the MedicinesComplete take this from the 'Publication last updated' date from the top of the page.
Available from: https://bnfc.nice.org.uk/ OR Available from: https://www.medicinescomplete.com

Copy the format and punctuation shown of these examples:

Full reference (NICE version): Pediatric Formulary Committee. British National Formulary for children (BNFC). 13 December 2023 [Internet]. 2023 [cited 2024 Feb 4]. Available from: https://bnfc.nice.org.uk/.

Full reference (MedicinesComplete version): Pediatric Formulary Committee. British National Formulary for children (BNFC) . 9 January 2024 [Internet]. 2024 [cited 2024 Feb 4]. Available from: https://www.medicinescomplete.com.

Title - British National Formulary for children (BNFC) app followed by the update date e.g. British National Formulary for children (BNFC) app. January 2024.
Year of publication - use the year given on the homepage of the BNFC section of the app

Citation in the text: (Pediatric Formulary Committee, 2024)

Full reference: Pediatric Formulary Committee. British National Formulary for children (BNFC) app. January 2024 [Mobile app]. 2024 [cited 2024 Feb 4]. Available from: https://play.google.com/store/apps/details?id=com.pharmpress.bnf

Title: followed by version e.g. BNF for children 2022-2023
Title: followed by the update date e.g. British National Formulary (BNF). 13 December 2023
Title: followed by the update date e.g. British National Formulary for children (BNFC) app. January 2024

Provides access to the British National Formulary, British National Formulary for Children and Stockley’s Drug Interactions.

Author - British Pharmacopoeia Commission
Title - British Pharmacopoeia
Version e.g. Ph. Eur. 11.4
[cited year month day] - the date you looked at it e.g. [cited 2024 Feb 8]
Available from: https://www.pharmacopoeia.com

Use the format and punctuation shown in this example (make sure you change the Version and dates to match the ones you use):

British Pharmacopoeia Commission. British Pharmacopoeia. Ph. Eur. 11.4 update [Internet]. 2024 [cited 2024 Feb 8]. Available from: https://www.pharmacopoeia.com.
Date Cited: in the format month day e.g. Feb 8
Author - National Institute for Health and Care Excellence (NICE)
Title of page/document including reference number in round brackets (capitalise only the first letter of the first word and any proper nouns)
Year created/updated
Available from: web link (For a shorter reference use the link for the webpage instead of the longer PDF link)
National Institute for Health and Care Excellence (NICE). Vaccine uptake in the general population (NG218) [Internet]. 2022 [cited 2024 Feb 9]. Available from: https://www.nice.org.uk/guidance/ng218.
National Institute for Health and Care Excellence (NICE). Acute heart failure: diagnosis and management (CG187) [Internet]. 2021 [cited 2024 Jan 10]. Available from: https://www.nice.org.uk/guidance/cg187.
Date Cited: in the format month day e.g. Jan 13
Title of policy (capitalise only the first letter of the first word and any proper nouns) and Version
Publisher (usually the same as the author)

Use the format and punctuation shown in this example:

Imperial College Healthcare NHS Trust. Non-medical prescribing policy: Version 3. London: Imperial College Healthcare NHS Trust; 2016.
Title of page/document (capitalise only the first letter of the first word and any proper nouns) and Version
Year created/updated (for guidelines with no date just use the cited date)
[cited year month day] - the date you looked at it e.g. [cited 2022 June 18]
Available from: web link
North East London Health & Care Partnership. North East London (NEL) management of infection guidance for primary care. August 2023 [Internet]. 2023 [cited 2024 Feb 8]. Available from: https://gp-website-cdn-prod.s3.amazonaws.com/prescribing-guideline-downloads/1697724608-4663d459fc894709f71ce7beaa8662db.pdf
Year Cited: in the format 2022
Date Cited: in the format month day e.g. Dec 20

Citing Summaries of Product Characteristics (SmPCs) or Patient Information Leaflets (PILs) on the Electronic Medicines Compendium

Author - drug company who wrote the SmPC
Title (capitalise only the first letter of the first word and any proper nouns) followed by Electronic Medicines Compendium
Year created/updated
[cited year month day] - the date you looked at it e.g. 2024 Jan 29
Available from: web link

Use the format and punctuation shown in these examples.

Wokhardt UK Ltd. Aciclovir 400mg tablets summary of product characteristics. Electronic Medicines Compendium [Internet]. 2017 [cited 2024 Jan 29]. Available from: https://www.medicines.org.uk/emc/product/2352/smpc.
Dermal Laboratories Limited. Ibugel patient information leaflet. Electronic Medicines Compendium [Internet]. 2024 [cited 2024 Feb 9]. Available from: https://www.medicines.org.uk/emc/product/3759/pil.
Author: company name. Put a comma after the company name to ensure it formats correctly e.g. Accord-UK Ltd.,
Date Cited: in the format month day e.g. Jan 20

Citing systematic reviews in the Cochrane Library

Title of review
Year month day of review
Title of database: The Cochrane Library
Article number
Available from: web address or DOI
Crowe L, Chang A, Wallace K. Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation. 2016 August 23. In: The Cochrane Database of Systematic Reviews [Internet]. Issue 8. Art. No.: CD005586. Available from: https://doi.org/10.1002/14651858.CD005586.pub3.
Title: title of the review - in lower case apart from the first letter of the first word and any proper nouns. Add the year month day of review after the title e.g. Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation. 2016 August 23.
Book title: The Cochrane Database of Systematic Reviews
Edition: Issue 8. Article no.: CD005586
Type of Work: Internet

Note that the way you enter a Cochrane Review on EndNote for the Vancouver style is very different from the way you enter it for the Harvard style. It is not possible to reuse one entry in both styles.

If a trial is still ongoing you may need to refer to it directly instead of to a published paper.

Author - primary contact for the trial
Trial title
Database/registry name
[cited year month day] - the date you looked at it e.g. [cited 2024 Jan 18]
Available from: DOI or web address

Use the format and punctuation shown in these examples:

Crooks M. An investigation into how adding an inhaled steroid to COPD treatment may potentially protect against heart disease. In: ISRCTN Registry [Internet]. 2023 [cited 2024 Jan 18]. Available from: https://doi.org/10.1186/ISRCTN29148209.
Lingor P. Safety, tolerability and symptomatic efficacy of the ROCK-inhibitor Fasudil in patients with Parkinson's disease. In: ClinicalTrials.gov [Internet]. 2023 [cited 2024 Feb 9]. Available from: https://clinicaltrials.gov/study/NCT05931575.
Title (in lower case apart from the first letter of the first word and any proper nouns) followed by . In: [name of Database/Registry] e.g. Implementing improved asthma self-management as routine. In: ISRCTN Registry

Note that the way you enter a Clinical Trial on EndNote for the Vancouver style is very different from the way you enter it for the Harvard style. It is not possible to reuse one entry in both styles.

Always check with the academic who set the assignment if you are allowed to refer to course materials in your own work. It is preferable to do your own research and use published sources, such as articles and books, instead of referring to lecture materials.

Author's name in the format Surname Initials
Title of document/presentation as given on Blackboard
Format in square brackets e.g. [PowerPoint presentation, Lecture notes, Recorded lecture, Handout]
Place of publication:
Institution;
Course details, date
[cited year month day] - the date you looked at it e.g. [cited 2024 Jan 18]
Available from: https://www.bb.reading.ac.uk Note that you do not need to give the specific web address for the material you are citing. The address for Blackboard is sufficient.

Cottrell G. The molecules of life: proteins [PowerPoint presentation]. Reading: University of Reading; PM1PY2: Fundamentals of Cell Biology; 2023 [cited 2023 Dec 2]. Available from: https://www.bb.reading.ac.uk.

Example 2: Handout with no date

University of Reading. Direct observation of procedural skills (DOPS) assessment form [Handout] Reading: University of Reading; PM2PY1: Professional Practice 2. [cited 2023 Nov 30]. Available from: https://www.bb.reading.ac.uk.

Use the 'Web Page' Reference Type
Place published: Reading
Type of Medium: add the Format here e.g. PowerPoint presentation, Lecture notes, Recorded lecture, Handout
Contents: module code and title e.g. PM2PY1: Professional Practice 2
Date Cited: in the format month day e.g. Jan 20
URL: https://www.bb.reading.ac.uk

Note that even with the information entered as above EndNote will not quite format the reference correctly - the module details will be in the wrong place. To correct this, as a final step before submission, create a plain text version of your document. Go to the EndNote toolbar in Word and select 'Convert citations and bibliography' to 'Plain text' (this will be under 'Tools' on the Mac version of the toolbar). This will create a copy of your document which is divorced from EndNote so that you can make final tweaks to the references.

Citing tables, figures & images

Images, graphs, charts, diagrams and tables that you have used from books, websites and other texts should be referenced in the same way that you would any other material.

The captions for both tables and figures should include a citation if taken from or based on another source (name-year or number depending on the style you are using). When you refer to it in your writing, use the figure/table number. Give a full citation in the reference list for the source of the image.

Citing tables

Tables should be sequentially numbered with the title/legend above the table - as in this example which uses the Harvard referencing style:

Example of citing a table showing the table legend containing a citation

Example of referring to a table in a sentence:

The macronutrient content of the diets used in the study is shown in Table 2.

Full details for reference list (Harvard style):

Mitchell, N.S. and Ard, J.D. (2021) 'Weight loss, lifestyle, and dietary factors in cardiovascular diseases in African Americans and Hispanics', in Ferdinand, K.C., Taylor, H.A. and Rodriguez, C.J. (eds) Cardiovascular disease in racial and ethnic minority populations . Cham: Humana Press, pp. 167-182.

Citing figures (images, graphs and diagrams)

Images, graphs and diagrams should be labelled as 'Figure' and sequentially numbered with the caption below - as in this example which uses the Harvard referencing style:

Example of citing a diagram with the Figure number and legend below.

Example of referring to a figure in a sentence:

The prebiotics can induce direct or indirect effect on the gut-associated epithelial and immune cells (Figure 3).

Pujari, R. and Banerjee, G. (2021) 'Impact of prebiotics on immune response: from the bench to the clinic', Immunology and Cell Biology , 99(3), pp. 255-273.

Decorative images

If the image is purely decorative you should still acknowledge the creator and source but there is no need to include a full reference.

See the example on the right which includes the caption: 'Image: [creator] via [website image captured from]'.

If it is a picture you have taken use this format:

'Image by author'.

Compiling your own table from multiple sources

If you are taking information from multiple sources and compiling your own table you still need to acknowledge those sources.

The following link shows two ways of doing this. Although this is a guide to using the APA style the approaches can be adapted for use with Harvard and Vancouver.

How to cite sources in a table (APA)

Secondary referencing (citing a source you have read about in a different source)

A secondary reference is used when you are referring to a source which you have not read yourself, but have read about in another source. Where possible, you should always try to read the original of anything you wish to refer to ; otherwise you are relying on the author who cited the reference to have interpreted it correctly and not taken it out of context. Use the reference list at the end of the source you are reading to find details of the reference and search for it using the search boxes below.

Find books using the Enterprise catalogue

Just type in the first author's surname and a few words from the title.

Find journal articles using Summon

Just type in the first author's surname and first part of the article title.

If you can't get hold of the original source you'll need to do a secondary reference and you should make clear that you are not using the original source. Only include the source you have used in your list of references following the guidance above on citing that type of publication. Indicate in your in-text citation that it is a secondary reference by preceeding the citation with 'as cited in' or 'as quoted in'.

Vancouver example

In-text citation:

According to France as cited in Weingart et al. (4) , hospitals use internal reporting procedures to identify...

4. Weingart, SN, Zhang L, Sweeney M, Hassett M. Chemotherapy medication errors. The Lancet Oncology, 2018; 19(4): e191-e199.

Harvard example

According to France (2003, as cited in Weingart et al. , 2018), hospitals use internal reporting procedures to identify...

Reference:

Weingart, S.N., Zhang, L., Sweeney, M, & Hassett, M. (2018) 'Chemotherapy medication errors', The Lancet Oncology , 19(4), pp. e191-e199.

Vancouver - just edit your text as in the example above and insert the reference for the paper you have read in the usual way.

Insert the in-text citation for the paper you have read in the usual way.
Right-click on the in-text citation and select ' Edit Citation(s) ' and ' More... '.
In the prefix box type the year of the paper you haven't read followed by a comma and space and 'as cited in ' (as in the example above). Click OK.
In front to the in-text citation type in the author name(s) for the paper you haven't read (as in the example above), including the correct number of authors.

Quotes and copying information

Copying information
Example 1 (prose)
Example 2 (standards)
When taking information from a reference source which you are not putting into your own words i.e. copying and pasting you need to put quotes around the words to indicate that it is not your own work
Students are expected to put the majority of information into their own words to demonstrate their understanding and independent thought - the amount of information in quotes should therefore be minimal
Quotes should be reserved for situations where no alternative wording is possible and/or where it is not appropriate (e.g. quoting a standard or particular statement which supports your argument)
Wenger (1998, p. 181) argues that 'Engagement, imagination and alignment each create relations of belonging'.
The focus of Wenger's discussion is on the way that different aspects come together to build notions of identity (Wenger, 1998).
Theorists have considered the impact of a variety of circumstances on the creation and expansion of identity (Wenger, 1998; Lee, 2013; Morton and Grainger, 2009).

Avoid quoting large blocks of text:

The NICE guidance for hypertension (NICE, 2019) states the following:

'Beta-blockers are not a preferred initial therapy for hypertension. However, beta-blockers may be considered in younger people, particularly:

those with an intolerance or contraindication to ACE inhibitors and angiotensin II receptor antagonists or
women of child-bearing potential or
people with evidence of increased sympathetic drive'

Instead this could be paraphrased as:

NICE no longer recommend beta-blockers to be used as initial therapy for hypertension, although it is recognised that there may be circumstances in which younger patients may benefit from beta-blockers (NICE, 2019). In my practice I may review younger patients, therefore I will consider the recommendations from NICE on appropriate prescribing of beta-blockers, for example women of child-bearing age, patients with increased sympathetic drive or unable to take ACE inhibitors and angiotensin II receptor antagonists.

Reading School of Pharmacy referencing guide A summary and printable version of the School's referencing guidance (note this does not include as much detail as the information on this page).
Using quotes and paraphrases How to build references into your writing, using short and long quotes and paraphrases.

Support from your librarian

Using a reference management system is vital when you do your final year projects and useful for creating accurate references for other assignments. EndNote is one such system which can be used to store references, and then insert the citation in your Word document, automatically building the bibliography for you in the correct style.

Use the following styles in EndNote:

Cite Them Right-Harvard

There are tips for using EndNote for each type of publication in the Vancouver and Harvard referencing guidance on the left. However, for some non-standard publications EndNote may not format your references correctly. To overcome this insert the reference in EndNote following the guidance and add it to your Word document. As a final step before submission, create a plain text version of your document. Go to the EndNote toolbar in Word and select 'Convert citations and bibliography' to 'Plain text' (this will be under 'Tools' on the Mac version of the toolbar). This will create a copy of your document which is divorced from EndNote so that you can make final tweaks to the references.

Find out more in the EndNote page in this guide:

Using EndNote for pharmacology students
<< Previous: Key resources
Next: Using EndNote >>
Last Updated: Jun 3, 2024 10:12 AM
URL: https://libguides.reading.ac.uk/pharmacology

Cancer: Citing Sources in APA Style

Citing Sources in APA Style

Tools for Citing Sources

Noodletools Use NoodleTools to cite your sources and create a list of works cited. Username: same as what you use to log into the KUA portal (Last name, first initial, year of graduation. For example: smithj23) Password: wildcat20
Purdue OWL: Research and Writing An excellent guide to writing papers and citing sources properly, with many examples. There are sections for both APA and MLA citation style -- make sure you choose the right style according to your teacher's instructions!

APA citations for articles and websites

Format for a journal or magazine article:

AuthorLastName, A. A., AuthorLastName, B. B., & AuthorLastName, C. C. (Year). Title of article.

Title of Magazine or Journal, volume number (issue number), pages. URL or

DOI https://doi.org/xx.xxx/yyyy

Peterzell, J. (1990, April). Better late than never. Time Magazine, 135 (17), 20–21.

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=57902263&site=ehost-live

The matching in-text reference in a sentence:

One researcher found that "[s]tudents didn't find APA style difficult once they got used to it" (Peterzell, 1990, p. 21).

Peterzell (1990) found that "students didn't find APA style difficult once they got used to it" (p. 21).

Format for a webpage:

AuthorLastname, A. A. (Year, Month Date). Title of page. Site name. URL

National Cancer Institute. (2019, October 16). Non-small cell lung cancer treatment (PDQ): Patient

version. Retrieved April 1, 2020, from https://www.cancer.gov/types/lung/patient/

non-small-cell-lung-treatment-pdq#

The matching in-text reference in a sentence:

One organization's research found that possible symptoms of lung cancer include "a cough that doesn't go away" as well as shortness of breath (National Cancer Institute, 2019).

The National Cancer Institute (2019) found that possible symptoms of lung cancer include "a cough that doesn't go away" as well as shortness of breath.

Easy citations from Gale in Context: Science database

In this video, learn how to find the APA-style citation for articles in the Gale in Context: Science database. You can copy and paste the citation directly into your References list, or export the citation into NoodleTools.

APA citations for images and video

Format for an online image:

PhotographerLastName, FirstInitial. (Year of publication). Title of photograph [Photograph].

Source . URL.

Ryan, S. (2019). Sea smoke on Lake Michigan [Photograph] New York Times .

https://www.nytimes.com/interactive/2019/world/year-in-pictures.html

Format for an online video:

Account or username of uploader. (Date of publication). Title of video [Video].

Website host. URL.

Nathan Winch - Sciencey Stuff. (2016, January 4). What is cancer? What causes cancer?

[Video]. Youtube. https://www.youtube.com/watch?v=WPgJafGz4fg

These examples are taken from the Purdue Owl's APA guide. Look there for examples of other source types and formats.

<< Previous: Resources
Last Updated: Nov 2, 2021 4:50 PM
URL: https://kua.libguides.com/cancer

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Review Article
Open access
Published: 19 November 2022
Epidemiology

UK Biobank: a globally important resource for cancer research

Megan C. Conroy ORCID: orcid.org/0000-0002-3847-6202 1 ,
Ben Lacey 1 ,
Jelena Bešević 1 ,
Wemimo Omiyale 1 ,
Qi Feng 1 ,
Mark Effingham 2 ,
Jonathan Sellers 2 ,
Simon Sheard 2 ,
Mahesh Pancholi 2 ,
Gareth Gregory 2 ,
John Busby 2 ,
Rory Collins 1 , 2 &
Naomi E. Allen 1

British Journal of Cancer volume 128 , pages 519–527 ( 2023 ) Cite this article

10k Accesses

29 Citations

19 Altmetric

Metrics details

Cancer epidemiology
Genetics research
Research data

UK Biobank is a large-scale prospective study with deep phenotyping and genomic data. Its open-access policy allows researchers worldwide, from academia or industry, to perform health research in the public interest. Between 2006 and 2010, the study recruited 502,000 adults aged 40–69 years from the general population of the United Kingdom. At enrolment, participants provided information on a wide range of factors, physical measurements were taken, and biological samples (blood, urine and saliva) were collected for long-term storage. Participants have now been followed up for over a decade with more than 52,000 incident cancer cases recorded. The study continues to be enhanced with repeat assessments, web-based questionnaires, multi-modal imaging, and conversion of the stored biological samples to genomic and other ‘–omic’ data. The study has already demonstrated its value in enabling research into the determinants of cancer, and future planned enhancements will make the resource even more valuable to cancer researchers. Over 26,000 researchers worldwide are currently using the data, performing a wide range of cancer research. UK Biobank is uniquely placed to transform our understanding of the causes of cancer development and progression, and drive improvements in cancer treatment and prevention over the coming decades.

Identifying proteomic risk factors for cancer using prospective and exome analyses of 1463 circulating proteins and risk of 19 cancers in the UK Biobank

Temporal dynamics of the multi-omic response to endurance exercise training

A deep catalogue of protein-coding variation in 983,578 individuals

Cancer is now the most common cause of death in many parts of the world, including North America, Europe, Australia, and China [ 1 , 2 , 3 ]. However, the major determinants of many cancers remain unclear, despite decades of biological and epidemiological research [ 4 ]. UK Biobank is a large-scale biomedical database and research resource, containing in-depth information on genetic, physiological, lifestyle, and environmental factors on half a million UK participants, with their health followed up through linkage to electronic health records. The resource is available to all bona fide researchers to perform health-related research, and its unique combination of scale, depth, maturity and accessibility has led to it becoming the world’s most important biomedical resource, offering enormous potential to improve understanding of the determinants of a wide range of cancers.

The risk of developing cancer reflects the combined effect of genetic and environmental factors, each of which may have only a modest effect on cancer risk [ 4 , 5 , 6 ]. As such, research on the effects of these factors requires epidemiological studies that collect detailed information on a very large number of people. However, previous epidemiological studies have typically involved collection of either a large amount of data on a small number of participants, or a small amount of data on a large number of participants. By contrast, UK Biobank contains extensive questionnaire data, physical measures and biological samples for a very large number of participants (i.e., both depth and breadth have been achieved). This was made possible by the establishment of highly efficient, purpose-designed centralised processes with detailed input from UK Biobank’s extensive academic collaborative network [ 7 ].

UK Biobank was established by the Medical Research Council (UK) (MRC), Wellcome, the UK Department of Health, and the Scottish Government in response to the challenge of understanding the determinants of common complex disease [ 8 ]. Participants have been followed up for over a decade, and there are now ~50,000 incident cancer cases. From inception, the study data was intended to be made available to academic and commercial researchers worldwide and the resource is now uniquely placed to enable major scientific discoveries into the causes, treatment and prevention of cancer and other diseases. UK Biobank now receive core funding from the MRC, Wellcome, Cancer Research UK, British Heart Foundation and the National Institute of Health and Care Research [ 9 ].

UK Biobank: data collection and enhancements

Recruitment and data collection.

Between 2006 and 2010, about 9.2 million people aged 40–69 years, who were registered with the NHS and living within reasonable travelling distance (up to 25 miles) of one of 22 assessment centres across the UK, were invited to join UK Biobank. Overall, 502,000 adults (5.5% of those invited) were recruited [ 10 , 11 ]. Participants underwent an extensive range of baseline assessments, including touchscreen questionnaires on sociodemographic factors, family history, lifestyle, medical history, cognitive function tests and environmental exposures. Physical measurements were taken, including blood pressure, bone mineral density, hand grip strength, eye and lung function, and cardiorespiratory fitness; and blood, urine and saliva samples were collected for long-term storage (Table 1 ) [ 7 , 12 ]. A proportion of the cohort also underwent an eye examination (including refractive index, intraocular pressure, retinal photograph, and optical coherence tomography), a hearing test, a cardiorespiratory fitness test with 4 lead ECG test, calcaneal ultrasound for bone density, and pulse wave velocity of arterial stiffness.

The original sample size was selected to maximise the number of incident cases of a wide range of important diseases to support the reliable investigation of their potential determinants. Power calculations prior to study recruitment indicated that for an exposure in 10% of the cohort, 5000 cases of a health outcome (i.e., 1% of the cohort) would be required to identify a minimum detectable odds ratio of 1.26 at a critical P value of 10 −4 [ 8 ]. For gene-by-environment analyses, assuming a 10% prevalence of both the genotype and environmental exposure, 5000 cases would enable the identification of a minimum odds ratio of 1.98. As a result, very large numbers of participants are needed to identify large numbers of cases of particular diseases during a reasonable follow-up period. However, despite the large sample size of UK Biobank, some gene-by-environment analyses will not be possible for rare exposures or outcomes, and pooling data across other cohort studies is necessary to ensure adequate sample sizes for reliable investigation.

Due to the volunteer nature of the cohort, the UK Biobank cohort is not representative of the current general UK population in a number of ways [ 11 ]. However, the extent to which this actually matters depends on the aims of the specific research question. To ensure associations are generalisable to a wider population (or future populations), what may be more important is to have sufficiently large numbers of participants with different levels of exposures and incident disease [ 13 ]. For example, although the UK Biobank cohort contains a lower proportion of participants who live in more deprived areas compared with the UK population (16% [82,000] vs. 33% in the UK population), it still includes sufficiently large numbers to allow associations of socio-economic deprivation with disease risk to be investigated with high internal validity.

As a consequence of the healthy volunteer effect, cancer incidence rates are generally lower in UK Biobank in comparison to the general UK population but this varies by cancer site, as previously reported [ 11 ]. As such, UK Biobank should not be used to estimate cancer prevalence or incidence rates, but can be used to assess reliably the aetiological associations between exposures and cancer outcomes.

Outcome ascertainment

Participants provided consent for UK Biobank to follow their health over time through linkage to electronic medical and other health-related records. To date, linkage has been achieved to national death and cancer registries and hospital inpatient admissions (including critical care), with linkage to primary care available for ~45% of the cohort (Table 2 and Fig. 1 ). Cancer registry data provides curated data on the histological tumour type and date of diagnosis, both prior to recruitment (with data from the mid-1950s onwards) and during follow-up. Cancer registry data are considered the gold standard method for ascertaining cancer outcomes in the UK, owing to mandatory reporting of cancer outcomes within the NHS [ 14 ]. However, due to data being curated from multiple sources, there is a time lag to completeness, with data from cancer registries usually complete within 2 years of diagnosis. Primary care records include data on rapid referral under the 2-week pathway, cancer-relevant biomarkers (e.g., prostate-specific antigen testing and CA-125 measurements) and other information on the route to diagnosis, co-morbidities and medication use. Linked health data are updated approximately annually within UK Biobank (except GP data). UK Biobank also periodically contacts participants directly to obtain information on health-related conditions that are not well-captured in healthcare records (e.g., cognitive function, mental health, pain, etc.) through a series of web-based questionnaires (Table 1 ). These data are potentially important for cancer research as they can be used, for example, to assess pain among cancer patients, as well as enabling research into cognition and mental health of cancer survivors. Further details on data linkages, cleaning, validation and data availability (including summary statistics for all data fields) can be found on the UK Biobank data showcase webpage ( https://biobank.ctsu.ox.ac.uk/crystal/ ).

a Prevalent cancers by sex; b incident cancers by sex. Cancer registry data available until February 29, 2020 for England and Wales and January 31, 2021 for Scotland. Graphs reproduced from UK Biobank cancer summary report ( https://biobank.ndph.ox.ac.uk/~bbdatan/CancerSummaryReport.html accessed 27/9/2022).

Enhancements to the resource

Following the baseline assessment between 2006 and 2010, additional data have continued to be collected to enhance the value of the resource for health-related research. During 2013, a reasonably representative sample of about 20,000 participants was invited back for a repeat of the baseline assessment visit (including sample collection and storage) in order that researchers can make essential allowance for regression dilution bias due to measurement error and within-person fluctuations in exposure levels in their disease association analyses [ 15 ].

UK Biobank has also collected data on physical activity using wrist-worn accelerometers in 100,000 participants between 2013 and 2015, which was repeated on a seasonal basis in a subset of 2500 participants a few years later to assess changes in activity over time [ 16 ]. National guidelines on physical activity are based mainly on epidemiological studies that have used self-reported data, and the accelerometer data [ 16 ] in UK Biobank is now enabling robust research into the associations of objectively measured physical activity and sleep patterns with health outcomes (Table 1 ).

In 2014, UK Biobank initiated the world’s largest imaging sub-study, which aims to recruit up to 100,000 participants to undergo magnetic resonance imaging (MRI) of the brain, heart, and body, whole-body dual-energy X-ray absorptiometry (DXA), carotid ultrasound, together with a repeat of the baseline assessment, including questionnaires, physical measures and biological sampling (blood and urine) [ 17 ]. By the end of 2021, 50,000 participants had been scanned at one of four bespoke UK Biobank imaging centres, with a subset also invited to wear a cardiac monitor for 2 weeks. Furthermore, repeat imaging of up to 60,000 participants has also started, allowing research into the relationship between changes in internal physiology (such as muscle and fat distribution), and risk of disease onset and progression, which is likely to be of particular value for research into identifying early detection biomarkers and for refining risk prediction models.

Plans are underway to incorporate further information on cancer phenotyping by expanding its linkage to national datasets with information on tumour aggressiveness (i.e., stage, grade), morphology, and treatment (including radiotherapy, chemotherapy, immunotherapy and hormone treatments). These data will allow for more detailed research into risk factors for different cancer subtypes, as well as identifying suitable prognostic markers for survival and provide data for pharmacogenomics research [ 18 ]. However, researchers should be aware that data completeness varies by cancer site, as these data are not compulsory to provide to the National Cancer Registration and Analysis service [ 19 ]. For tumour grade, the amount of missing data varies from 0% to about 70%, with breast, colorectal, pancreatic and oesophageal cancers having the most complete data, and brain and uterine having the least. Tumour stage data are available for between 55 and 90% of cancers, with brain, hepatobiliary and pancreatic being most complete and colorectal, endometrial and ovarian the least. Pilot studies are also currently underway to assess the feasibility of incorporating digitised histopathology slides into UK Biobank to enable researchers to ascertain different morphological subtypes of cancer. It may also be possible to link to datasets that contain information on the molecular characterisation of cancer subtypes (e.g., biomarkers or genetic changes in cancer tissue), which will accelerate research into their aetiological pathways and how best to treat and manage them. For example, it is now well-established that colorectal cancer evolves through multiple pathways, which can be classified according to their molecular features (e.g., DNA microsatellite instability and methylation) [ 20 ]. Detailed phenotyping of cancers, together with better characterisation of key exposures (such as imaging-derived body composition and genomic data), will support powerful research into the determinants of different cancer subtypes.

UK Biobank’s policy has been, wherever possible, to perform cohort-wide assays on the biological samples, thereby allowing the limited biological samples to be used for the widest possible range of research [ 21 ]. This unique approach facilitates good quality control and effective management of the limited and depletable sample volume [ 21 ]. The availability of a wide range of biomarkers in all 500,000 participants increases the resource’s utility, as it allows research between biomarkers and a wide range of outcomes (which is simply not possible if using a case–control design). To date, cohort-wide data have been made available on: haematological and biochemistry assays [ 22 ] (including several biomarkers of relevance to cancer research, such as sex hormones and insulin-like growth factor-I); leukocyte telomere length; [ 23 ] and genome-wide genotyping using an Affymetrix array of ~850,000 variants, with imputation on >90 million variants (Table 3 ) [ 24 ]. In addition, industry consortia have performed whole-exome [ 25 ] and whole-genome sequencing for all 500,000 participants, making this biomedical database the world’s largest resource for scientists to gain valuable insights into the genetic determinants of disease. Of course, the availability of genetic data - coupled with lifestyle information and clinical outcomes on such a large-scale - will also accelerate the identification of potential drug targets.

Arising from previous consortia to fund genetic sequencing, a pharmaceutical consortium is investing in proteomic measurements for 3000 proteins in 57,000 participants using the O-LINK platform. These samples were selected randomly (~45,000) or enhanced for diseases of interest by the consortium members (~8000). These data are expected to be released in 2023 (Table 3 ), and there is significant interest in extending these measures to the full cohort to accelerate the development of drug targets and identifying early detection biomarkers [ 26 ].

Metabolomics assays using nuclear magnetic resonance (NMR) spectroscopy (funded by Nightingale Health) are underway for all 500,000 participants, with the first tranche of data released in 2021 for >200 circulating metabolites for 120,000 participants at baseline and 3000 participants at resurvey [ 27 ]. Data on serological markers of infectious agents, including a number of known or potential oncogenic pathogens, are also available for a subset of participants [ 28 ], with recent funding (from Open Philanthropy) to extend these data to an additional 50,000 participants (Table 3 ).

Dates for the future release of data, such as the enhanced cancer data and proteomics, are available on our website ( https://www.ukbiobank.ac.uk/enable-your-research/about-our-data/future-data-release-timelines?src=future_timelines ).

UK Biobank works with, and is guided by, the research community to ensure the resource is continually enhanced, and welcomes proposals from researchers to improve its utility. In addition to samples being available for assay, proposals for exposure and outcome measurement to develop the resource are considered. Researchers that wish to discuss potential enhancements (such as further linkages) that would be beneficial to the cancer research community are encouraged to contact UK Biobank’s access team ( https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/contact-us ).

UK Biobank and cancer research

UK Biobank is an important resource for population-based cancer research. There are already over 43,000 incident cancer cases recorded to date in the national cancer registry among UK Biobank participants (in addition to the 26,000 prevalent cases at baseline, including 9000 prevalent breast cancers, 3000 prevalent prostate cancers and 2200 prevalent colorectal cancers (Fig. 1 )). This includes 9500 incident prostate cancers, 7900 incident breast cancers, 4900 incident colorectal cancers and 3300 incident lung cancers (Fig. 1 ). Even for some relatively rare cancers, such as renal cell carcinoma and endometrial cancer, there are already over 1100 incident cases. As the cohort ages (the average age is now 70 years), the number of cancer cases will increase substantially, with incident prostate, breast, colorectal and lung cancers predicted to increase to 16,000, 14,000, 8000 and 6000 cases, respectively, by 2027 (these estimated numbers are adjusted for age, sex, and the healthy volunteer effect seen in UK Biobank). The full cancer reports and methodology can be accessed on the UK Biobank data website [ 29 , 30 ].

UK Biobank is particularly suited to enable studies on the determinants of disease; identifying risk factors that make people more or less likely to develop a particular disease, and quantifying the strength of the associations. This can often be challenging using small-scale studies, due to the limited power from low numbers of disease events. UK Biobank’s size, together with its deep phenotyping, allow associations to be quantified with greater precision, and across levels of other risk factors. Furthermore, variation in the strength of the associations across a broad range of demographic, socio-economic, and lifestyle characteristics can be used to assess the generalisability of the associations to important population subgroups [ 11 , 31 ].

Since the release of genome-wide genotyping data for all UK Biobank participants in 2017, the study has played a central role in accelerating the identification of genetic variants associated with cancer risk. Recent studies using UK Biobank data have identified new susceptibility loci for specific cancers, including endometrial cancer [ 32 ], colon cancer [ 33 ] and cervical cancer [ 34 ]. Such studies are particularly valuable in understanding the biological mechanisms underlying the development of cancer. For example, many genetic variants associated with cervical cancer risk are in the region of PAX8, CLPTM1L and HLA genes, suggesting a disruption in apoptotic and immune function pathways [ 34 ]. Research has also identified genes that affect the risk of more than one type of cancer (many of which appear to be regulatory elements and/or influence cross-tissue gene expression), offering further insight into the complex genetic architecture of cross-cancer susceptibility [ 35 ]. Further, research has identified shared genetics between known cancer risk factors and cancer development (such as alcohol consumption and oral cancer [ 36 ] and obesity and progression of a number of cancers [ 37 ]) which will help to disentangle the causal pathways of known associations.

Genotyping data have also facilitated causal inference through the use of Mendelian randomisation, a technique whereby genetic variants that are associated with a given exposure are used to investigate the causality of associations between an exposure and outcome of interest [ 38 ]. Mendelian randomisation takes advantage of the random assortment of genes from parents to offspring that occurs during gamete formation and conception to mimic the effect of a randomised controlled trial for a particular exposure. Analyses using Mendelian randomisation have supported the causality of the associations of circulating insulin-like growth factor-1 concentration with colorectal, breast and prostate cancer risk [ 39 , 40 , 41 , 42 ], obesity with endometrial cancer [ 43 ], and height with overall cancer risk [ 44 ]; but refute previous observational evidence for an inverse association between vitamin D concentration and colorectal cancer risk [ 45 ].

In addition to research on the causes of disease, GWAS data can also be used to construct polygenic risk scores, which combine the effects of genetic variants (each of which may have only a small effect on cancer risk) to improve risk prediction [ 46 , 47 , 48 , 49 , 50 , 51 ]. These scores could then be used to stratify the population according to their genetic risk, or used to enhance existing risk prediction algorithms (such as QCancer for cancer risk [ 52 , 53 ]) that use information on sociodemographic, lifestyle or clinical factors. Polygenic risk scores have been developed for a wide range of cancers using UK Biobank data. For example, an academic consortia (Breast Cancer Association Consortium) have developed a polygenic risk score for breast cancer composed of 313 genetic variants, with those in the highest group having a lifetime risk of about 30% for developing ER + breast cancer, compared to 2% in the lowest, with a range of 0.55–4% for ER− disease [ 54 ]. Many of those in the high PRS category do not have a strong family history of breast cancer, so would not be identified by standard risk screening tools. The clinical utility of polygenic risk scores is being assessed, but such scores may well be used to inform clinical decision-making or to inform screening programmes (e.g., to target individuals with a high polygenic risk score for certain cancers to undergo earlier or higher frequency screening programmes [ 54 , 55 ]).

The release of whole-exome and whole-genome sequencing for 500,000 participants will be extremely valuable to research into new cancer therapies. In particular, variants in the exome region of the genome (which encode for proteins) can be used to identify genetic variants of particular relevance for drug discovery. For example, a study using UK Biobank data has already found that a genetic variant in the gene that encodes the GPR75 receptor is associated with a significantly lower rate of obesity in homozygous carriers [ 56 ]. This has subsequently been confirmed in animal models [ 56 ], and paves the way for pharmaceutical trials to develop new treatments for obesity. Whole-genome sequencing makes it possible for scientists to investigate the impact of coding and non-coding DNA and of repeated, missing or extra sequences of DNA, on disease risk. These data offer an opportunity to understand the potential impact of inhibiting or agonising the product of a gene, with relevance to drug development [ 57 ]. It also allows the detection of rare, non-coding variants that will help us understand gene regulation and disease mechanisms, as well as the identification of structural variations, such as short tandem repeats, which can be used to further understand the aetiologies of complex diseases.

In addition to understanding the genetic determinants of disease, the rich characterisation of participants in UK Biobank has been used to assess the behavioural and environmental determinants of cancer, such as from dietary factors [ 58 , 59 ] and physical activity [ 60 , 61 , 62 ] to shift work [ 63 ] and exogenous hormone use [ 64 , 65 ], with some results directly impacting public health policy. For example, researchers using dietary data collected at baseline and at resurvey (supplemented by the dietary web-based questionnaire) found higher consumption of red and processed meat was positively related to risk of colorectal rectal, even within the current UK guidelines that recommend no more than 90 g of red and processed meat per day [ 59 ]. Researchers have also used accelerometer-based measures of physical activity to improve understanding of the associations of physical activity and risk of breast cancer [ 66 ]. The study found that greater physical activity was associated with a reduction in breast cancer risk in both pre- and post-menopausal women, independent of any association it may have on risk through its effects on adiposity.

A wide range of anthropometric measures were collected as part of the baseline survey in UK Biobank, and these have been used to assess the impact of adiposity on cancer risk. A recent study assessed the association of six adiposity-related markers (including body-mass index, body fat percentage, waist-hip ratio, waist-height ratio, and waist and hip circumference), with risk of 24 different cancers [ 67 ]. The study found strong associations with a number of cancers, including cancers of the stomach cardia, gallbladder, liver and kidney. The availability of imaging data on large numbers of participants will substantially enhance research into the effect of adiposity (and other endogenous markers of body size and structure and composition) with disease risk, allowing more precise analyses of the risks associated with specific measures of body composition. Imaging-derived adiposity measures from DXA and MRI images have already been used to assess the relation between the distribution of body fat and risk of several cancers. For example, a recent study found that for a given level of total body fat, increased central adiposity was associated with an increased risk of colorectal cancer, but increased hip fat was associated with a reduced colorectal cancer risk [ 68 ].

The cohort-wide assays performed on the blood samples from all 500,000 participants are already enabling robust research into the role of sex hormones and risk of cancer onset and progression. For example, analyses using UK Biobank have shown that the risk of endometrial cancer is positively related to circulating levels of total and free testosterone but inversely related to levels of sex hormone-binding globulin [ 69 ] with Mendelian randomisation analyses supporting the causality of these association [ 69 ]. In men, higher free testosterone, but not total testosterone, has been found to be associated with risk of prostate cancer [ 41 ]. Conversely, biomarkers of inflammation do not appear to be related to risk of glioma [ 70 ] and circulating lipid levels are not strongly associated with ovarian cancer risk [ 71 ]. Biomarkers can also be used to investigate the pathways between known risk factors and cancer diagnosis, with research showing that the increased risk of colorectal cancer associated with obesity is unlikely to be driven by adiposity-induced chronic inflammation, insulin resistance or sex-steroid hormone levels [ 72 ]. Proteomic data, in particular, may help identify individuals at high risk of specific cancers or may aid in their diagnosis, with small-scale analyses in other cohorts indicating its utility [ 73 ]. Proteomics—particularly when combined with genetics and metabolomics data in a single cohort—will enhance the opportunities to investigate the biological pathways by which genes affect cancer risk, with the potential to identify novel drug targets and treatments [ 73 ].

With such a complex dataset, researchers have employed artificial intelligence tools to identify risk factors for cancer incidence and to improve risk prediction models for cancer onset and survival [ 74 , 75 ]. For example, machine-learning algorithms have been used to predict overall survival in breast cancer patients from whole-exome sequencing data in UK Biobank [ 76 ]. Researchers have also used machine learning to derive phenotypes from complex data, such as sleep phenotypes from the accelerometer data or imaging phenotypes, such as organ segmentation, from the MRI data [ 77 , 78 , 79 ]. Machine-learning methods allow the relationships among different variables and types of data to be learnt from the data itself, and this may have advantages over classical statistical methods, where the relationships among variables need to be pre-specified, and only a limited number of factors can be modelled at a time [ 80 ].

Accessing UK Biobank data

What makes UK Biobank so unique is the easy accessibility of a vast range of data on 500,000 participants to all bona fide academic or commercial researchers, anywhere in the world [ 81 ]. Researchers must register prior to submitting an application, and the application must be for health-related research that is in the public interest. UK Biobank has a policy of no preferential access, ensuring all applicants (whether academic, governmental, charitable or commercial) are treated in the same way [ 82 ], and has seen an exponential rise in registered researchers, with over 25,000 registered researchers and 2800 applications by the end of 2021 (Fig. 2 ). This has been borne out with over 1600 publications arising from UKB data in 2021 alone (Fig. 2 ).

a Researchers registrations; b Project applications; c Publications, by year.

UK Biobank is a registered charity, and manages access fees on a cost recovery basis, which are reviewed on a periodic basis and are subsidised for student projects and research groups based in low and low-to-middle-income countries [ 83 ]. Applications to access biological samples are reviewed more stringently, due to the limited and depletable nature of the samples. Information on how to access the dataset can be found on the UK Biobank website ( https://www.ukbiobank.ac.uk/enable-your-research/apply-for-access ).

The data included in the UK Biobank resource is expected to grow to 50 petabytes by 2027. In the past, UK Biobank data have been provided to approved researchers for download, which requires a non-trivial level of local computing power and storage. The continuing expansion of data requires a more democratic approach to ensure the data are available to all researchers. Consequently, UK Biobank has made available a new cloud-based Research Analysis Platform, developed by DNAnexus (Mountain View, CA) and hosted by Amazon Web Services (London, UK). This ensures that access to UK Biobank data will remain open to all, and not just those with the information technology infrastructure to store and analyse such large data. Further, research credits to subsidise the cost of running analyses on the Research Analysis Platform have been provided to support early career researchers and those from low-and middle-income countries ( https://www.ukbiobank.ac.uk/enable-your-research/research-analysis-platform/the-uk-biobank-platform-credits-programme ).

UK Biobank is a large-scale prospective study with deep phenotyping and genomic data. Easy accessibility to this vast biomedical resource allows researchers from around the world to make scientific discoveries to improve population health. The sheer depth and breadth of data mean that UK Biobank is now arguably the world’s most important health resource for understanding the determinants major diseases in middle and old age; it is now being used by over 25,000 researchers internationally and generating thousands of peer-reviewed publications. The resource has already demonstrated it value in enabling novel and robust research into the determinants of cancer, and will only grow in value as more incident cancer cases occur over time. In particular, the combination of whole-genome sequencing, imaging, proteomics, and metabolomic data, will enable the world’s best minds to transform our understanding of the causes of cancer development and progression and drive improvements in cancer treatment and prevention.

Data availability

UK Biobank is an open-access resource. Applications to access the data from bone fide researchers can be made at https://www.ukbiobank.ac.uk/enable-your-research/apply-for-access .

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Acknowledgements

We would like to thank all the participants of the UK Biobank for their vital contribution to the resource.

UK Biobank is funded by the Medical Research Council, Wellcome, Department of Health, Scottish Government, Welsh Assembly Government, British Heart Foundation, Cancer Research UK, Diabetes UK, National Institute for Health and Care Research (NIHR), and the Northwest Regional Development Agency.

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The review was conceived and written by MCC, BL and NEA. All authors reviewed and approved the final manuscript.

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UK Biobank received ethical approval from the National Information Governance Board for Health and Social Care and the National Health Service North West Centre for Research Ethics Committee (Ref: 21/NW/0157). All participants provided informed consent at recruitment to the study for their data to be used for health-related research that was in the public interest.

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Conroy, M.C., Lacey, B., Bešević, J. et al. UK Biobank: a globally important resource for cancer research. Br J Cancer 128 , 519–527 (2023). https://doi.org/10.1038/s41416-022-02053-5

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The value of the patient and public contribution to cancer research UK’s review of covid-19 impact on its clinical research portfolio

Anne Croudass ORCID: orcid.org/0000-0001-6584-7999 1 &
Richard Stephens 2

Research Involvement and Engagement volume 7 , Article number: 35 ( 2021 ) Cite this article

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In July 2020 Cancer Research UK undertook a rapid review of the studies in its clinical research portfolio to assess the impact of the Covid-19 pandemic. The review examined over 160 research studies funded by the charity, and in keeping with its usual practice, the charity involved patient/public contributors in the review process.

Cancer Research UK (CRUK) spends over £450 million pa on research, including clinical trials, tissue collections, laboratory science and biomarker studies. It has involved patient/public contributors in clinical research funding decisions for ten years, recruiting volunteers from the National Cancer Research Institute’s (NCRI) Consumer Forum. The NCRI is a partnership of funders, including the 4 UK governments and major charities such as CRUK. Its Consumer Forum is a group of volunteers with personal experience of cancer as patients or carers, who are trained for and experienced in working on national strategic bodies as well as on individual research studies.

The CRUK whole-portfolio review was held over a two-week period in a series of online meetings. A pair from the team of patient/public contributors was included in each meeting, and they made comments on every application reviewed as well as participating in reaching decisions.

Conclusions

The process not only demonstrated CRUK’s continued commitment to involving patient/public contributors in their funding decisions, but also provided an opportunity for these contributors to take a holistic view of processes to inform future patient/public contribution in the charity’s work, as well as to influence the decisions about the individual studies being reviewed.

Plain English summary

The process not only demonstrated CRUK’s continued commitment to involving patients and the public in their funding decisions, but also provided an opportunity for these contributors to take a holistic view of processes to inform future patient/public contributionin the charity’s work, as well as to influence the decisions about the individual studies being reviewed.

Peer Review reports

Clinical trials play an essential role in determining the effectiveness and safety of new cancer drugs, and in the process provide patients with access to potentially life-saving new treatments still early in development. Cancer Research UK (CRUK) funds nearly 200 clinical studies at any one time in order to make progress in achieving the charity’s ambition that by 2034, 3 in 4 patients will survive their cancer by ten or more years [ 1 ].

In July 2020 Cancer Research UK undertook a rapid review of the studies in its clinical research portfolio. This review was in response to the challenges posed by the initial impact of the Covid-19 pandemic, which included an almost blanket suspension of recruitment to non-Covid clinical trials by sponsors, investigators and study sites, redeployment of National Health Service (NHS) and laboratory staff, the closure of university laboratories, some changes to standard of care and for many patients, reduced access to resources and services. The purpose of the review was to assess the impact of Covid-19 on these clinical trials and on the infrastructure supporting them and to establish whether they would still be viable in a “post-Covid” world.

Whilst it was not a criteria for judgements in the review, the Covid-19 pandemic had already significantly affected charitable income. Therefore it was important to understand which studies would be able to complete recruitment, how much delay there might be, and if the finished study would then still contribute to CRUKs strategic aims within the context of a more limited budget to support research in the short-term future.

Since 2011 CRUK has routinely involved patient/public contributors in the funding decisions made by its Clinical Research Committee (CRC) and various feeder panels (Fig. 1 ), and the rapid portfolio review was no exception. With the potential impact of Covid 19 on cancer patients, care and clinical research, having the patient’s perspective was essential to the portfolio review process, as decisions made as part of the review could potentially have an impact on those patients already recruited to trials, and might also affect future cancer patients.

CRC and associated panels

Cancer Research UK

CRUK is the world’s largest charity dedicated to saving lives through research. In 2019/20 CRUK spent £455 million on research, including laboratory based science, prevention, clinical trials and infrastructure awards. CRUK works with over 150 hospital trusts, supports over 4000 Researchers, Doctors and Nurses and funds up to 200cancer research studiesacross all cancer sites [ 2 ].

The review process

The review included 163 current clinical studies of the 180 funded or endorsed through the CRC (Table 1 ). These included clinical trials sample collections, experimental medicine awards and biomarker awards. The 17 studies that were not included had either completed all follow up and were in the write-up stage or were biomarker projects that were funded by CRUK and did not rely on NHS resources. At the time of the review, these were deemed unlikely to be directly affected by the impact of Covid-19.

Review meetings were held using the Microsoft Teams platform, and focused on the progress or otherwise of the studies up to the end of May 2020 (ie 4–5 weeks before the review), their likely new reporting dates and the continued relevance of the findings at that point. The review was held over several days, with studies being grouped to reflect the topic areas of the National Cancer Research Institute (NCRI) Research Groups (RG) (Table 2 ).

Each review session was undertaken by a panel of between 12 and 15 members, including scientists, clinicians, statisticians and patient/public contributors, as is usual for CRUK clinical research funding committees. In addition, for this whole-portfolio review the NCRI RG Chairs or their nominated representative attended relevant sessions, so that the recommendations of the panel took account of the particular NCRI RG’s strategic priorities for their national portfolios.

The role of patient and public contributors

CRUK has had patient/public representation on its funding committees for over 10 years. Initially there was one contributor, on the main funding committee only, and the role was as an observer to ensure due process. The role and remit have evolved so that there are now two patient/public contributors on each panel and committee. They are full voting members, and as such they have equal scoring rights, are bound by the same confidentiality, governance and conflict requirements and are offered the same honoraria as other members. They comment on each application under consideration. They provide the perspective of people affected by cancer on applications, considering areas including but not limited to, the patient acceptability of study design, the value of the study aims to the intended patient populations and whether there are any potential unexpected adverse effects from the point of view of the participants. They also provide insight and advice on the level of patient and public involvement in the applications received.

All the current CRUK patient/public committee members are, or have previously been, active members of the NCRI Consumer Forum (Table 3 ). This membership is extremely beneficial as it confers the level of understanding, training and professionalism required to contribute fully at CRUK (and other) strategic research meetings. The patient/public contributors involved in the rapid portfolio review were those who also sit on the Panels and Committees shown in Fig. 1 .

This whole-portfolio review was a new experience for the team at CRUK and for the patient/public contributors. Working with their mentor (CRUK’s lead research nurse), the contributors were assigned in pairs to cover up to 3 of the 6 review meetings each. For the Paediatric/Teenager and Young Adult review, patient/public contributors with specific experience in this field were recruited from the NCRI Consumer Forum. For the other 5 review meetings, all the contributors had had previous experience of working with CRUK funding committees or other CRUK research initiatives. The contributors knew each other and had worked together previously, which for this task was another benefit.

Debbie Keatley, PPI representative stated,

“To be honest, the request from CRUK for public members to be involved in the reviews that took place in summer 2020 felt daunting. This felt very different to funding and monitoring meetings in the course of an ordinary year and I was honoured to take part but under the circumstances it could not be anything but a difficult process.”

As this review was different to the standard funding committee meetings, a new template form was developed by CRUK and the patient/public contributors to guide and capture their feedback (Table 5 in Appendix ). This reflected the questions asked of those submitting the trial paperwork for review and provided consistency across each meeting. For each study discussed, 3 lead reviewers were nominated; a clinician, a statistician and a patient/public contributor, ensuring that the patient view was given equal consideration to the scientific views. After each meeting there was opportunity for a debrief with theirmentor, where the contributors could reflect on the meeting and make suggestions that would improve their experience of the process for subsequent meetings.

Involving patient/public contributors in this review demonstrates CRUKs commitment to putting patients at the heart of all that the charity undertakes. It was evident to CRUK staff and participating researchers that the patient/public contributors were adding a unique and essential expertise. Without exception they were well prepared and engaged. They were flexible and accommodating to the tight schedules, new technological requirements and evolving time frames, giving concise, thoughtful and objective feedback throughout. Most importantly the patient voice was not only heard but carried equivalent weight to that of other panel members.

Mat Baker commented,

“I was delighted to have the opportunity to contribute to this research review and to the future of so many potentially practice changing trials. It was important to ensure that the patient perspective was clearly articulated, and I was pleased that its value in the decision-making process was so positively acknowledged.”

The value of a pool of patient/public contributors with appropriate skills to respond at short notice and to contribute effectively to the review validated the CRUK stance that for this type of strategic meeting and decision-making process, patient/public contributors representatives should ideally have a background understanding of the research environment, such as that provided by NCRI involvement.

Ian Walker, Director of Research Funding, Communications and Partnerships said,

“As always, the comments from our patient contributors were insightful, thoughtful and added great value to the discussions. The insights and intelligence we have gathered through the process will provide us with really important data to support both our research agenda and our policy priorities going forward.”

The portfolio review had to make difficult decisions about the future of clinical trials. Involving patient/public contributors in these decisions gives credibility to those decision and outcomes, for the cancer community as a whole and in particular for people affected by cancer, especially those participating in research studies.

Paula Ghaneh, Professor of Surgery, University of Liverpool and Chair of the Upper GI and Colorectal review meeting commented,

“The patient contribution to the portfolio review was and continues to be extremely valuable. In all manner of committee meetings, they always manage to sum up the key issues in a clear and precise way. With the ethos of CRUK at the centre of their arguments, they remind us of all the people who raise the money for CRUK and what really matters for patients. They always give us the perspective to make the best decisions even if they are difficult or tough.”

A further benefit of involving patient/public contributors in the review was the identification of cross cutting themes. Four of the contributors attended at least three review sessions each, whereas the majority of the other panellists attended only one or two. Moreover, the patient/public contributors worked together informally during the review and more formally afterwards to identify themes for CRUK and for other patient/public contributors to consider for the future. These included

the need for robust remote assessment processes

the involvement of primary care in delivering protocol-led care

the need to update patient information to reflect impact of Covid-19 and the opportunity to incorporate electronic consenting procedures.

The patient/public contributors also collated a report for their NCRI Consumer colleagues. As well as providing an overview of the process and outcomes, it included reflections on how their involvement in this review could benefit and inform wider NCRI consumer activity (Table 4 ). By circulating the report to all 100 members of the NCRI Consumer Forum, they encouraged other patient/public contributors to discuss, debate and disseminate the information in the report.

This was a further demonstration of the value of having patient/public contributors linked into NCRI consumer activities and thence to their own national, international, local and online networks of patient representatives and groups. Mat Baker observed,

“CRUK have once again demonstrated that they are at the forefront of good practice in involving patients and carers at the heart of the research decision making process. A necessary corollary is that patients and carers possess the knowledge and skills to contribute effectively at this level. Fortunately the NCRI Consumer Forum, through its collaborative ethos and exacting standards, enables patients and carers such as myself to step up and to forge partnerships with the leading teams in cancer research.”

The novel nature of the review for both CRUK staff and committee members provided equal opportunity for patient/public contribution to the discussions and in the decisions. This increased the levels of engagement and responsibility of the patient/public contributors,, demonstrated their ability to provide useful and relevant input and kept patients at the centre of the process. As Debbie Keatley said,

“This was an extraordinary series of reviews, brought about by extraordinary events but at the end of it all were real patients, and for some, taking part in *their* trial offered access to otherwise unavailable treatments and not being able to take part carried real consequences. It was sobering to absorb how hard research teams had worked to keep trials open wherever possible, to adjust protocols, to attempt to keep as much valuable work and learning as possible and to restart as soon as possible. It was clear that CRUK staff too had worked extremely hard to support trials, and us - a resource intensive process, providing us with rich information and context. The impact of COVID-19 on clinical research will be felt for a long time but we found many examples of good practice under very difficult conditions and the recommendations we made were taken together, equally, with outcomes for current and future patients held firmly in mind.”

This review has provided CRUK with a further opportunity to develop the patient/public contributor role in funding committees and has prompted a review of the patient/public contribution to funding committee practices. This will lead to a piece of work to further strengthen the patient/public contribution, including increasing the number of patient/public contributors involved, and will be developed jointly by staff and patient/public contributors.

CRUK would like to thank all the patient/public contributors, Mat Baker, Debbie Keatley, Angela Polanco, Janette Rawlinson, Richard Stephens and Max Williamson for their valuable input to the review.

Availability of data and materials

Not Applicable.

Abbreviations

Clinical Research Committee

National Cancer Research Institute

National Health Service

Research Group

https://www.cancerresearchuk.org/about-us/our-organisation/our-strategy-to-beat-cancer-sooner Accessed 31 Mar 2021.

https://www.cancerresearchuk.org/ Accessed 6 Jan 2021.

https://www.ncri.org.uk/ Accessed 6 Jan 2021.

https://www.ncri.org.uk/groups/ Accessed 6 Jan 2021.

https://www.ncri.org.uk/how-we-work/patients-carers/ncri-consumer-forum/ Accessed 6 Jan 2021.

https://www.ncri.org.uk/wp-content/uploads/NCRI-Group-Membership-Consumer-Recruitment-Pack-UPDATED-17.12.pdf Accessed 2 Apr 2021.

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AC is an employee of Cancer Research UK.

RS received an honorarium for his contribution to the portfolio review, but no payment for his authorship of this article.

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CRUK Lead Research Nurse, 2 Redman Place, London, E20 1JQ, UK

Anne Croudass

Patient and Public Representative, 18 Russell Close, Stevenage, PB, SG2 8, UK

Richard Stephens

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AC and RS were co-authors on this paper. As such, both have contributed equally, and have read and approved the final manuscript.

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Correspondence to Anne Croudass .

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Ethics approval and consent to participate, consent for publication, competing interests.

AC has no competing interests.

RS is co-editor in chief of the Research Engagement and Involvement journal.

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For trials in set up

For trials open to recruitment

For trials in follow up

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Croudass, A., Stephens, R. The value of the patient and public contribution to cancer research UK’s review of covid-19 impact on its clinical research portfolio. Res Involv Engagem 7 , 35 (2021). https://doi.org/10.1186/s40900-021-00279-w

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DOI : https://doi.org/10.1186/s40900-021-00279-w

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Importance of clinical research for the UK's 10-year cancer plan

Richard w lee.

a Early Diagnosis and Detection, NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London SW3 6JJ, UK

Sarah Danson

b Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

c Department of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

Martin Elliot

d Department of Paediatric Oncology and Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

e NIHR Clinical Research Network, Leeds, UK

Thomas D Pinkney

f Academic Department of Surgery, University of Birmingham, Birmingham, UK

Clare E Shaw

Dale vimalachandran.

g Department of Surgery, Countess of Chester NHS Trust, Chester, UK

Tim Maughan

h Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford

Matt Seymour

i Department of Oncology, St James's University Hospital, Leeds, UK

Pippa Corrie

j Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Jonathan Wadsley

k Department of Oncology, Weston Park Cancer Centre, Sheffield, UK

The ambition of the UK Government's 10-year cancer plan consultation document to transform cancer outcomes is highly welcome. 1 This consultation must reflect on the extraordinary role played by the UK research community in responding to COVID-19—a response enabled by clinical research delivery infrastructure embedded within the National Health Service (NHS), which allowed rapid clinical evaluation of novel treatments and vaccines to save and transform lives. This unique national research delivery capability is the legacy of more than two decades of national clinical research networks, with co-operation between government agencies, charitable funders, and many others. This national capability started in cancer with the inception of the National Cancer Research Network and the National Cancer Research Institute (NCRI) in 2001. Now, through the National Institute for Health and Care Research (NIHR) Clinical Research Network (CRN), it extends across the full spectrum of health and social care. Cancer outcomes have been radically improved during this time, but further gains will require reinvigoration and realignment of our research capability at multiple levels, starting with the health-care workforce.

Driving large-scale research programmes requires major clinical leadership, time, and resources. The NCRI Research Groups and NIHR CRN Cancer Specialty Oversight Groups are established networks of expert clinicians, scientists, and consumers, ready to advise on key priorities and develop research proposals addressing them, whereas both the NIHR and medical royal colleges have initiatives to train and enthuse tomorrow's investigators and innovators. However, urgent attention is needed to maintain momentum, and support existing consultants, who, in the post-pandemic climate of a severely overstretched cancer workforce, face unprecedented service demands; time for research is scarce. National leaders applauding COVID-19 research programmes demand that research becomes integral with NHS service delivery. 2 , 3 To achieve this goal, research time must be embedded within consultant job plans. Furthermore, releasing highly trained staff to lead research requires funding to backfill service commitments. Clinical academic excellence must be valued and fairly rewarded, to avoid demoralisation and clinicians disengaging from research.

Screening, Prevention and Early Detection (SPED) research has perhaps the greatest potential to reduce our population's cancer mortality. Rapidly evolving SPED technologies need detailed evaluation through robust, large-scale prospective trials. National clinical initiatives, such as Targeted Lung Health Checks, Rapid Diagnostic Centres, and Community Diagnostic Hubs, are ideal platforms for such endeavours, exemplified by NIHR portfolio lung screening and biomarker research. Multicancer early detection tests, such as in the Galleri trial and related studies supported by NHS England and NIHR, are particularly attractive, but require rigorous analysis of many aspects of implementation, beyond simply assay performance. 4 The UK's research infrastructure is uniquely capable of rapidly recruiting large numbers of at-risk individuals across wide geographical and cultural strata. However, SPED research is predominantly a community endeavour, done outside acute hospital oncology and surgery departments, so requires new infrastructure distinct from existing resources, which instead focus primarily on patients already diagnosed with cancer. Stretched primary care services are poorly equipped to embrace research expansion that is crucial for SPED to flourish. This needs careful consideration with better resourcing, and primary and secondary care experts collaborating on optimal use of finite resources. In particular, systematic expansion of research infrastructure supporting screening, Rapid Diagnostic Centres, and Community Diagnostic Hubs should be mandated to host research as a matter of course.

Modern cancer drugs, which have transformed survival outcomes for some types of cancers, largely stem from laboratory discoveries associated with cancer biology, with effective partnership between academia and life sciences industries. In the UK, much of this early-phase research has been led by our Experimental Cancer Medicine Centre Network, which must be sustained and expanded if we are to retain the strong pharmaceutical industry relationships that exist, given international competition from EU member countries, the USA, and Australia, among others. NHS genomics services are developing rapidly, offering many benefits for precision medicine; however, our full research potential is often constrained by manpower, equipment, and commissioning arrangements, which are substantial barriers to attaining our full research capability. The current NHS genomics focus is necessarily on comparatively few genetic alterations associated with approved targeted cancer medicines—generation of far more extensive genetic information to signpost patients to trials of novel diagnostics and therapies must be developed and made readily accessible in real time through initiatives such as Our Future Health .

The NIHR portfolio contains more than 1300 cancer studies, with more than 800 actively recruiting. The burden on multiple elements of the NHS to undertake this research activity is not insignificant. Our resources are finite, so we need a manageable portfolio, but with sufficient breadth and variety to ensure that all patients who wish to engage with research can benefit from state-of-the art interventions. We must propagate the successes of the urgent public health COVID-19 studies and generate efficiencies in study setup and study design (eg, platform studies) if we are to become more cost-effective with our time and manpower. The new NIHR National Patient Recruitment Centres are generating successes by adopting single approval and costing processes that need to be implemented across all NHS trusts. Regulatory and research governance processes, so risk averse that they restrict even access to anonymised patient data, require urgent revitalisation and risk-proportionate approaches.

Demand for access to new treatments is fierce, generating a substantial risk of new treatment adoption based on scarce early positive data, not borne out in subsequent phase 3 trials. The UK's robust evidence-based approach to evaluating new innovations gives an important opportunity to work with commercial partners to address health economic endpoints and prioritise cost-effective interventions. Our new proton beam radiotherapy centres in Manchester and London, combining traditional randomised trials and thorough Commissioning through Evaluation by NHS England, is already generating data likely to be internationally practice changing. Learning from this approach (ie, bringing health-care providers closer to our research community) and applying it to other expensive health-care technologies could become a key UK strength. For example, evidence-based practice in surgery has grown rapidly in the past decade, and remains a key treatment modality for many patients with cancer. Implementation of new surgical technologies or devices needs well governed processes if we are to avoid harm and adverse outcomes. 5

Above all, we are mindful that substantial inequalities in access to routine health services and research participation were exacerbated by the COVID-19 pandemic. Patients with cancer in England, UK, deserve equitable access to clinical trial participation, evidenced transparently by NIHR and NHS England data collection systems. The NIHR Be Part of Research platform has huge potential to signpost patients and clinicians to clinical trials in real time, but needs substantial development to be truly effective. The NIHR Best Research for Best Health: The Next Chapter expects research to improve outcomes for diverse and underserved communities, addressing at-risk populations and promoting equity of access. 2

Routinely collected real world health data must revolutionise research data curation. Despite impressive UK national datasets and IT capability, data remain disproportionately difficult to access. Flagship digital policy documents, such as those of The Health Foundation and Goldacre Review, 6 should be scrutinised for research opportunities, and recommendations implemented. The 10-year cancer plan must include investment in technologies to facilitate research within all services and in digital environments, with focus on keeping patients closer to home, using virtual interaction tools, remote consultations, and e-consent platforms.

UK cancer research has a strong track record in designing and delivering academically led studies investigating treatment de-escalation, reducing the burden of treatment on individual patients physically, emotionally, and financially, and on the health-care system, while maintaining best outcomes. 7 , 8 , 9 Such trials save health-care resources and are globally relevant. However, few countries can deliver such trials, which are rarely prioritised by pharmaceutical companies. Optimising use of high-cost cancer interventions through prospective studies depends on a strong programme of NIHR-led and NCRI-led research, underwritten by coordinated support from regulators, research funders, and cancer care commissioners. This unique strength of UK academia could be the focus of a specific Health Technology Assessment programme supported by NIHR and NHS funding. Much academic research developed in direct partnership with patient and public involvement includes important patient-centred outcomes focusing on quality, as much as quantity, of life. Our strong research programmes addressing end-of-life care and long-term survivorship issues are unique strengths affording great potential for the UK to be world-leading in these challenging areas of cancer care.

Health-care innovation and technological advances depend on important research infrastructure and translational research community resource. It is imperative to prioritise and properly resource all aspects of cancer research capacity, from bench to bedside, if we are to make substantial gains in cancer outcomes in the next decade. We call on the UK government and oncology research community to draw on these views to ensure a research-embedded 10-year cancer plan.

Acknowledgments

RWL reports funding for this work from the Royal Marsden Cancer Charity and the National Institute for Health Research (NIHR) Clinical Research Network (CRN); reports grants from Innovate UK—Cancer Research UK, Roche—Optellum, RM Partners Cancer Alliance, National Health Service (NHS) England, NIHR, and SBRI Healthcare—Qure; reports consulting fees from the Royal Marsden Private Care; reports honoraria from Cancer Research UK; reports fees for travel from Royal Marsden and NIHR CRN; has a role in NHS England's Joint National Clinical Lead Targeted Lung Health Check programme; is a non-financial member of the Lung Screening Research Steering Group for the IDX Lung Study, and is co-chair for the Early Diagnosis Steering Group for the NIHR Oncology Translational Research Collaboration. SD reports funding for being the chief investigator for the DANTE study, and funding from NIHR—Cancer Research UK for the role as a clinical lead at the Sheffield Experimental Cancer Medicine Centre; reports grants for being a chief investigator at the Yorkshire Cancer Research, Weston Park Cancer Charity, and Sheffield Hospital Charity; reports honoraria from Cancer Research UK; and participates in data safety monitoring board for various trials run by the Glasgow Clinical Trials Unit and Leeds Clinical Trials Unit. TM reports grants from the Medical Research Council, the NIHR Efficacy and Mechanism Evaluation Programme, and Cancer Research UK; reports consulting fees from AstraZeneca and Teysuno; reports participation fees from Pierre Fabre and Pfizer; and has a role at Perspectum, NCRI, and the Institute for Cancer Research. PC reports grants from Merck Sharpe & Dohme, Bristol Myers Squibb, Novartis, AstraZeneca, Nektar, Pfizer, Pierre Fabre, Iovance, InstilBio, and Achilles, all paid to the institution; reports personal fees from Merck Sharpe & Dohme, Bristol Myers Squibb, Novartis, and Pierre Fabre; and is chair and receives personal payments for participation on an advisory board at Bristol Myers Squibb. All other authors declare no competing interests. All authors have secondment roles within the NIHR CRN as National Specialty Leads or in an advisory capacity to the NCRI. Authors were not precluded from accessing the content of the Comment. No original data were necessary to the creation of this Comment, which derives from the views of previous meetings and correspondence between the group as well as cocreation electronically. All authors accept responsibility for publication. PC and JW contributed equally. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

The impact of cancer research: how publications influence UK cancer clinical guidelines

Affiliation.

1 School of Library, Archive & Information Studies, University College London, Gower Street, London WC1E 6BT, UK.
PMID: 18521087
PMCID: PMC2441955
DOI: 10.1038/sj.bjc.6604405

There has been a substantially increased interest in biomedical research impact assessment over the past 5 years. This can be studied by a number of methods, but its influence on clinical guidelines must rank as one of the most important. In cancer, there are 43 UK guidelines (and associated Health Technology Assessments) published (up to October 2006) across three series, each of which has an evidence base in the form of references, many of which are papers in peer-reviewed journals. These have all been identified and analysed to determine their geographical provenance and type of research, in comparison with overall oncology research published in the peak years of guideline references (1999-2001). The UK papers were cited nearly three times as frequently as would have been expected from their presence in world oncology research (6.5%). Within the United Kingdom, Edinburgh and Glasgow stood out for their unexpectedly high contributions to the guidelines' scientific base. The cited papers from the United Kingdom acknowledged much more explicit funding from all sectors than did the UK cancer research papers at the same research level.

Publication types

Research Support, Non-U.S. Gov't
Biomedical Research*
Neoplasms / therapy*
Practice Guidelines as Topic*
Publishing*
United Kingdom

Grants and funding

WT_/Wellcome Trust/United Kingdom
CRUK_/Cancer Research UK/United Kingdom

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Thousands of NHS patients to access trials of personalised cancer ‘vaccines’

31 May 2024

Today, the NHS announced it has treated its first patient in England with a personalised vaccine against their bowel cancer, in a clinical trial part of NHS England’s new Cancer Vaccine Launch Pad .

As part of the platform, which is run by our Southampton Clinical Trials Unit , thousands of cancer patients in England are set to gain fast-tracked access to trials of personalised cancer vaccines following the launch of a world-leading NHS trial ‘matchmaking’ service to help find new life-saving treatments.

The vaccines being tested as part of the trials aim to help patients with different types of cancer and, if successfully developed, researched and approved, cancer vaccines could become part of standard care.

“It’s incredibly exciting that patients in England are beginning to access personalised cancer vaccines for bowel cancer,” said Iain Foulkes, executive director of research and innovation at Cancer Research UK.

“This technology pioneers the use of mRNA-based vaccines to sensitise people’s immune system and in turn detect and target cancer at its earliest stages.

“Clinical trials like this are vital in helping more people live longer, better lives, free from the fear of cancer. If successful, the vaccine will be a game changer in preventing the onset or return of bowel cancer.”

A UK first trial

Elliot Pfebve, 55, received the developmental jab at University Hospitals Birmingham NHS Foundation Trust, one of several sites taking part in the colorectal cancer vaccine trial sponsored by BioNTech SE.

A higher-education lecturer, Elliot had no cancer symptoms and was diagnosed through a routine health check with his GP.

Following blood tests, he was immediately invited to Manor Hospital in Walsall and triaged to a hospital ward to receive blood transfusions.

A CT scan and a colonoscopy confirmed he had colon cancer and Eliott had surgery to remove the tumour and 30 cm of his large intestine.

He was then referred to the Queen Elizabeth Hospital Birmingham for initial rounds of chemotherapy and to take part in a clinical trial.

“Taking part in this trial tallies with my profession as a lecturer, and as a community-centred person,” he said.

“I want to impact other people’s lives positively and help them realise their potential.

“Through the potential of this trial, if it is successful, it may help thousands, if not millions of people, so they can have hope, and may not experience all I have gone through. I hope this will help other people.”

How do cancer vaccines work?

The vaccine trial Elliot’s taking part in is one of several that will be taking place across the country to treat different types of cancer.

Patients who agree to take part have a sample of their cancer tissue and a blood test taken.

If they meet a clinical trial’s eligibility criteria, they can be referred to their nearest participating NHS site, meaning patients from hospitals across the country will find it easier than ever to take part in groundbreaking research.

The investigational cancer vaccines evaluated in the colorectal cancer trial are based on a molecule called mRNA, the same technology used for the COVID-19 vaccine .

They’re created by analysing a patient’s tumour to identify mutations specific to their own cancer. Using this information, medics can create an individualised cancer vaccine.

The developmental vaccines are designed to induce an immune response that may prevent cancer from returning after surgery by stimulating the patient’s immune system to specifically recognise and potentially destroy any remaining cancer cells.

The investigational cancer vaccines, which are being jointly developed by biopharmaceutical companies BioNTech and Genentech, are still undergoing trials and have not yet been approved by regulators.

If successful, the vaccine will be a game changer in preventing the onset or return of bowel cancer.

The launch pad

19 hospitals in England are already signed up to the Cancer Vaccine Launch Pad, one of the biggest projects of its kind in the world, with more sites joining the platform over the coming months.

Some trials have already enlisted patients, although the majority of participants are expected to be enrolled from 2026 onwards.

The scheme aims to expand and work with a range of partners in the pharmaceutical industry to include patients across many cancer types who could potentially join a vaccine trial, such as those with pancreatic and lung cancer.

“Seeing Elliot receive his first treatment as part of the Cancer Vaccine Launch Pad is a landmark moment for patients and the health service as we seek to develop better and more effective ways to stop this disease,” said Amanda Pritchard, NHS chief executive.

“Thanks to advances in care and treatment, cancer survival is at an all-time high in this country, but these vaccine trials could one day offer us a way of vaccinating people against their own cancer to help save more lives.

“The NHS is in a unique position to deliver this kind of world-leading research at size and scale, and as more of these trials get up and running at hospitals across the country, our national match-making service will ensure as many eligible patients as possible get the opportunity to access them.”

The NHS is working in partnership with Genomics England on the launch pad, with work already helping patients access the latest testing technologies and ensures they are given more targeted precision treatments for their cancer.

Such fascinating, good news!

This would be amazing. I have ALk Positive lung cancer diagnosed at 52 and having never ever smoked. When the targeted therapy stops working if I have access to these trails that would be incredible

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Thousands of NHS patients to access trials of personalised cancer ‘vaccines’

Thousands of cancer patients in England are set to gain fast-tracked access to trials of personalised cancer vaccines following the launch of a world-leading NHS trial “matchmaking” service to help find new life-saving treatments.

The NHS today announced it has treated its first patient in England with a personalised vaccine against their bowel cancer, in a clinical trial part of NHS England’s new Cancer Vaccine Launch Pad .

In a national first, father-of-four Elliot Phebve received the developmental jab at University Hospitals Birmingham NHS Foundation Trust, one of several sites taking part in the colorectal cancer vaccine trial sponsored by BioNTech SE.

The German biotechnology company will tomorrow (1 June) present new preliminary data at the American Society of Clinical Oncology’s annual conference in Chicago on how measuring circulating tumour DNA could potentially help early detection of colorectal cancer.

The vaccine trial involving Elliot is one of several that will be taking place in NHS trusts across the country to treat different types of cancer. Thousands more patients are expected to benefit from NHS England’s new Cancer Vaccine Launch Pad, which will enable those wanting to participate in clinical trials to be fast-tracked to one of the nearest participating hospitals.

Patients who agree to take part have a sample of their cancer tissue and a blood test taken. If they meet a clinical trial’s eligibility criteria, they can be referred to their nearest participating NHS site, meaning patients from hospitals across the country will find it easier than ever to take part in groundbreaking research.

The investigational cancer vaccines evaluated in the colorectal cancer trial are based on mRNA – the same technology used for the Pfizer-BioNTech COVID-19 vaccine – and are created by analysing a patient’s tumour to identify mutations specific to their own cancer. Using this information, medics then create an experimental individualised cancer vaccine.

The developmental vaccines are designed to induce an immune response that may prevent cancer from returning after surgery on the primary tumour, by stimulating the patient’s immune system to specifically recognise and potentially destroy any remaining cancer cells.

The investigational cancer vaccines being jointly developed by biopharmaceutical companies BioNTech and Genentech, a member of the Roche Group, are still undergoing trials and have not yet been approved by regulators.

Higher-education lecturer Elliot, 55, had no cancer symptoms and was diagnosed through a routine health check with his GP.

Following blood tests, he was immediately invited to Manor Hospital in Walsall and triaged to a hospital ward to receive blood transfusions.

A computed tomography (CT) scan and a colonoscopy confirmed he had colon cancer and Eliott had surgery to remove the tumour and 30 cm of his large intestine. He was then referred to the Queen Elizabeth Hospital Birmingham for initial rounds of chemotherapy and to take part in a clinical trial.

Eliott said : “Taking part in this trial tallies with my profession as a lecturer, and as a community-centred person. I want to impact other people’s lives positively and help them realise their potential.

Thirty hospitals in England are already signed up to the pioneering Cancer Vaccine Launch Pad – one of the biggest projects of its kind in the world – with more sites joining the platform over the coming months.

Amanda Pritchard, NHS chief executive, said : “Seeing Elliot receive his first treatment as part of the Cancer Vaccine Launch Pad is a landmark moment for patients and the health service as we seek to develop better and more effective ways to stop this disease.

Trials have already enlisted dozens of patients, although the majority of participants are expected to be enrolled from 2026 onwards.

Professor Peter Johnson, NHS national clinical director for cancer at the NHS said : “We know that even after a successful operation, cancers can sometimes return because a few cancer cells are left in the body, but using a vaccine to target those remaining cells may be a way to stop this happening.

“Access to clinical trials could provide another option for patients and their families, and I’m delighted that through our national launch pad we will be widening the opportunities to be part of these trials for many more people, with thousands of patients expected to be recruited in the next year.”

Principal Investigator for the trial at Queen Elizabeth Hospital Birmingham, Consultant Clinical Oncologist, Dr Victoria Kunene, said: “The investigational cancer vaccines are based on mRNA and are created by analysing a patient’s tumour to identify mutations specific to their own cancer. Using this information, we can create an individualised investigational cancer vaccine, but it is too early yet to say if these will be successful, though we are extremely hopeful. Based on the limited data we currently have of the in-body response to the vaccine, this could prove to be a significant and positive development for patients, but more data is yet needed and we continue to recruit suitable patients to the trial to establish this further.”

Executive Director of Research and Innovation at Cancer Research UK, Iain Foulkes, said: “It’s incredibly exciting that patients in England are beginning to access personalised cancer vaccines for bowel cancer.

“This technology pioneers the use of mRNA-based vaccines to sensitise people’s immune system and in turn detect and target cancer at its earliest stages. Clinical trials like this are vital in helping more people live longer, better lives, free from the fear of cancer. If successful, the vaccine will be a game changer in preventing the onset or return of bowel cancer.”

Last year, the Government signed an agreement with BioNTech to provide up to 10,000 patients with precision cancer immunotherapies by 2030.

BioNTech has already begun conducting clinical trials in the UK, and the NHS launch pad is helping to accelerate the identification of eligible patients for those trials in England.

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Personalised cancer vaccine is a 'landmark moment', as thousands set to trial it

Clinicians look for specific mutations in a patient's tumour and create a personalised treatment designed to stimulate the immune system after surgery to remove tumours so it can recognise and attack any remaining cancer cells.

Friday 31 May 2024 12:21, UK

Undated handout photo issued by NHS England of Elliot Pfebve (left), the first patient in England to have been treated with a personalised vaccine for his bowel cancer, with Hayley Rolfe (right), a research sister at Queen Elizabeth Hospital Birmingham. The jab is designed to stimulate a patient's immune system after surgery to remove tumours so it can recognise and attack any remaining cancer cells, and has been hailed as "a landmark moment" for patients and the NHS. Issue date: Friday May 31,

A personalised cancer vaccine jab that could help prevent the illness returning after surgery, has been given to a patient for the first time in what's been called a "landmark moment" for people who have the disease.

Elliot Pfebve, a bowel cancer patient, was referred to the Queen Elizabeth Hospital Birmingham for chemotherapy and to take part in the clinical trial after having a 30cm tumour removed from his large intestine.

How do cancer vaccines work?

Mr Pfebve, a 55-year-old father-of-four, discovered he had the illness during a routine health check with his GP.

Undated handout photo issued by NHS England of Elliot Pfebve (centre), with (left to right) research sister Hayley Rolfe, colorectal cancer support worker Keely Holloway, oncology consultant Dr Victoria Kunene, oncology consultant Dr Mark Openshaw and research sister Zoe Haygarth. Mr Pfebve, 55, is the first patient in England to have been treated with a personalised vaccine for his bowel cancer, which was administered at Queen Elizabeth Hospital, Birmingham, and is designed to stimulate a patie

The higher education lecturer said: "Taking part in this trial tallies with my profession and as a community-centred person.

"I want to impact other people's lives positively and help them realise their potential. This trial, if it is successful, it may help thousands, if not millions, of people, so they can have hope and may not experience all I have gone through."

Thousands of other NHS cancer patients in England will be recruited to take part in vaccine trials for various forms of cancer in the coming years as part of a new scheme, officials have said.

More on Cancer

An employee of BioNTtech works at the "Area 100 R&D" research laboratory for personalised mRNA-based cancer vaccines at a new facility of BioNTech in Mainz, Germany, July 27, 2023. REUTERS/Wolfgang Rattay

New cancer vaccine treatment 'one of the single biggest developments' for illness

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Example 2: without a DOI

Citing materials posted on Blackboard

Example 2: Handout

Vancouver referencing - click on the tabs for guidance on specific publications

How do I cite multiple sources together?

How should I refer to authors in the text?

How do I include a quote from a source?

Citing chapters in printed books and e-books with publication details

Endnote tips

For online only articles without page numbers or an article reference number and 'In press' articles:

Citing websites or webpages

Citing the BNF for children

Online versions (NICE and MedicinesComplete)

Citing Summaries of Product Characteristics (SmPCs) or Patient Information Leaflets (PILs) on the Electronic Medicines Compendium

Citing systematic reviews in the Cochrane Library

Citing tables, figures & images

Citing tables

Citing figures (images, graphs and diagrams)

Decorative images

Compiling your own table from multiple sources

Secondary referencing (citing a source you have read about in a different source)

Quotes and copying information