Epidemiology of cancer in the elderly (aged ≥ 65 years ) in England
Supervisor 1: Prof Anjum Memon, Chair in Epidemiology and Public Health Medicine
Supervisor 2: Dr Max Cooper, Senior Lecturer in Primary Care
Supervisor 3: Professor Malcolm Reed, Professor of Surgical Oncology, and Dean of Brighton and Sussex Medical School
Application deadline: TBC
Applications are invited for a three-year PhD Studentship funded by Brighton and Sussex Medical School (BSMS).
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:
- 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.
- 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.
- 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.
Applicants for this three-year PhD Studentship, starting ASAP, should have a strong background and interest in epidemiology, or related discipline, with demonstrable experience in epidemiological study designs/methods and data analysis. Applications are invited from graduates with a First or Upper Second Class Bachelor’s degree (in Medicine, Health Sciences, Psychology/Sociology or a relevant health services research related subject) plus a Masters degree in epidemiology/Public Health or a related discipline or equivalent research experience.
The Studentship is for UK and EU citizens (home fees and stipend will be paid). However, for non-native English Speakers, a minimum score of 7.0 at IELTS is required.
Informal enquiries should be directed to Prof Anjum Memon
Applications will be considered on a first come, first served basis.