Cancer and comorbidity: impact of comorbid conditions on equity of access and safety and outcomes of cancer treatments

Department Name:

Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine

Supervisors names and email addresses:

1) Prof Jan van der Meulen:

2) Andrew Hutchings:

3) Prof David Cromwell:

4) Prof Ellen Nolte:

Application Deadline: 14:00 on 27/03/19

Interviews: during the w/c 08/04/19

Project Title:

Cancer and comorbidity: impact of comorbid conditions on equity of access and safety and outcomes of cancer treatments

Project Description:

The configuration of cancer services is rapidly changing. Service delivery is being re-designed in order to diagnose cancer earlier, accelerate access to treatment, improve patients’ experience, reduce side-effects of treatment and enhance cures for cancer. Two developments are at the centre of this change: 1) centralisation of services creating hub-and-spoke models and 2) increased use of specialist multi-modal treatments.

Existing research has shown that:

  • up to a third of cancer patients ‘bypass’ their nearest cancer centre (‘patient mobility’)
  • cancer centres that offer innovative treatments and employ clinicians with strong media profile are attractive to patients (‘patient choice’)
  • a hub-and-spoke configuration improves outcomes of specialist treatments but has a detrimental impact on equity of access (‘centralisation’)
  • comorbidities may create an ‘implicit barrier’ within referral pathways such that patients with comorbidities may get ‘lost’ to the system (‘equity and efficiency’).

This studentship would address the impact of comorbidities of cancer patients on access to specialist cancer treatments (especially, specialist multimodal treatments), safety (especially, side-effects), patient experience (patient-reported), and patient-centred outcomes (cancer progression, survival) in an era of ongoing top-down re-design of cancer services, which creates an increasingly complex structure of cancer services provision.

The student will mainly use existing data as we will analyse linked national data sets, including national cancer registry data, radiotherapy and chemotherapy data, and Hospital Episode Statistics. These analyses will build on our extensive experience in modelling patient mobility and care pathways, and short and long-term patient outcomes at a national level.

A key innovative element is the use of data from geographic information systems for the purpose of location-allocation and patient-choice-and-demand modelling.

The student will have access to detailed national data on the current organisation and availability of specialist cancer treatment modalities and supporting services. This work builds on our extensive portfolio of National Clinical Audits within the Clinical Effectiveness Unit, the collaborative unit of the London School of Hygiene and Tropical Medicine and the Royal College of Surgeons of England:

This will allow assessment of the impact of both patient and service characteristics on access to and outcomes of cancer services using multilevel modelling.

All candidates should hold a Master’s qualification (or complete their Master’s by September 2019) in an appropriate discipline and have a minimum of a 2:1 or equivalent in their first degree. Applicants should preferably have knowledge of the UK health and care system. All applicants are required to have excellent written and verbal communication skills. They should also be willing to work collaboratively in multi-disciplinary and multi-professional teams.

Project-specific skills and experience required:

Essential: being able to carry out statistical analyses of large complex data sets (e.g. regression techniques, time-to-event analysis, choice analysis, multilevel modelling); the project will analyse English administrative hospital data linked to national cancer registration records.

Desirable: having experience in using geographic information systems; the project will include analyses of patient mobility patterns as well as location-allocation modelling.

CLAHRC Research area: Health Economics and Data

Funding Notes:

Start date: 01/10/19

Duration: 3 years, full time

Stipend: £17,803

Institution: LSHTM

Enquiries email name and address:

For general enquiries, please email:

For project specific queries, please contact: Prof Jan van der Meulen: or Andrew Hutchings: