About the Project
Background: Cancer is primarily a disease of older people - about 63% of all cancer cases and 77% of cancer deaths occur in people aged ≥65 years. Considering the increasing proportion of elderly in the UK population, it is estimated that the elderly will represent 25% (16.9 million) of the population by 2035, and the number of cancer cases will increase by 55% (from 149 000 to 231 000) in men and 35% (from 149 000 to 201 000) in women between 2007 and 2030.
For many cancers, the survival rates in England are lower than the European average. The observed lower survival, predominantly in the first year after diagnosis, is largely attributed to delayed diagnosis; and the higher number of excess cancer deaths in England mainly occurs in older patients. Delayed diagnosis (advance stage at presentation) can be caused by delays in presentation and primary care recognition, referral delays, secondary care investigation and treatment delays, and co-morbidity, particularly in older patients. It has also been reported that about one in four (24%) of all cancer patients are first diagnosed on emergency presentation to hospital. The proportion of such presentations increases with increasing age (one in three for patients aged >70) and that these patients have substantially lower 1-year relative survival.
Objectives/methods: This mixed-methods study will have three components:
1. To conduct an epidemiological analysis of the cancer incidence data for England to determine trends in incidence, stage at diagnosis, morphology, method of diagnosis and type of treatment for the most common cancers in patients aged ≥65 years. The analysis will involve calculation of crude and age-standardised incidence rates; joinpoint regression; and age-period-cohort modelling.
2. To conduct qualitative (semi-structured) interviews with 30 elderly cancer patients (15 males and 15 females with the most common non-screened cancer diagnosed on emergency presentation) to ascertain factors associated with delays in their presentation and diagnosis (i.e. awareness of cancer signs/symptoms, pathways to diagnosis, reasons for the delay, and experience at primary/secondary care). The outcomes will be also examined by age group and socioeconomic status.
3. For these two types of cancer, primary and secondary healthcare records of a sub-sample of patients will be analysed and linked to the cancer incidence data to determine the role of co-morbidity in the presentation/diagnosis of cancer.
Expected outcomes of the study: The study will contribute to understanding the burden of cancer in the elderly, impact and changes in exposure to aetiological agents, and factors associated with delays in presentation and diagnosis. The results will inform the design of patients’ pathways for the elderly; planning, commissioning, and resource allocation for oncology services; and public health initiatives (including screening) to promote the earlier diagnosis of cancer. The study will yield a number of research outputs (conference presentations, peer-reviewed publications).
The Studentship provides valuable opportunity to gain skills and training in cancer epidemiology, health service research, and qualitative methods. The student will also attend relevant internal and external training courses.
Supervisory team: Prof Anjum Memon (Chair in Epidemiology and Public Health Medicine), Dr Max Cooper (Senior Lecturer in Primary Care), Professor Malcolm Reed (Professor of Surgical Oncology and Dean of BSMS).
Independent Advisor: Dr Richard McNally (Reader in Epidemiology, Newcastle University).
Funding Notes
Please note that funding is available for UK or EU nationals only.
We are seeking an individual with an interest in epidemiology, or related discipline, with some experience in statistical methods and data analysis. Applications are invited for a 3-year full-time PhD Studentship from graduates with a first or upper second class Bachelor’s degree plus a Master’s degree in epidemiology or a related discipline or equivalent research experience.
Applications now being accepted, considered on first-come, first-served basis.
References
Prof Anjum Memon: http://www.bsms.ac.uk/research/our-researchers/anjum-memon/
Dr Max Cooper: http://www.bsms.ac.uk/research/our-researchers/max-cooper/
For further details and informal enquiries please contact Prof Anjum Memon a.memon@bsms.ac.uk
Information about research at BSMS is given on: http://www.bsms.ac.uk/research