Dr Elizabeth Lemmon, Prof Peter Hall, Dr Jenni Burton

Project Description

Over the past decades, technological advancements have enhanced detection and treatment for cancer, leading to improvements in survival and mortality. In conjunction with population ageing, such shifts mean that the number of people living with and surviving cancer is increasing. As these changes have progressed, the myth that the needs of cancer patients are purely medical has been well and truly discredited (MacMillan, 2015). In reality, cancer is a chronic condition, requiring care that stems beyond the initial phases of diagnosis and treatment.

A 2015 study by MacMillan Cancer Support found significant unmet long-term care (LTC) need in a sample of cancer patients in the UK (MacMillan, 2015). Most of the time, these needs are directly related to their cancer and the consequences of treatment.
Needs can be met through paid and unpaid channels. For example, through formal social care services delivered by local authorities and private agencies in a person’s home or in a care home, or by family carers and friends who provide unpaid support.

Unmet need for people diagnosed with cancer could have substantial knock-on consequences for the NHS, e.g., through unplanned admissions to hospital for patients who without adequate support at home. Further, as the incidence of cancer rises, so too does demand on LTC services, increasing the likelihood of unmet need arising. Both factors put pressure on already tight budgetary constraints for government, individuals and care providers. Due to the association between cancer incidence and severity, with socio-economic factors including deprivation, unmet need may go hand in hand with inequalities.

At present, research into LTC use by people diagnosed with cancer is scarce. Scotland is in a unique position to contribute to this understanding due its data linkage infrastructure and the way it routinely collects data on adults receiving care and support through personal and nursing care allowances and local authority supported social care. Using these data coupled with national cancer data provide an untapped resource for research on an area of public, professional and policy interest.
This project will seek to fill this important evidence gap and capitalise on Scotland’s unique data infrastructure by exploring the use of LTC among cancer patients in Scotland.

Specifically, it will seek to meet the following objectives:
1) To quantify the utilisation of formal social care services for different cancer types as compared to the general population.
2) To identify the existence of inequalities and possible unmet in formal social care provision
3) To estimate the relationship between unpaid and formal paid care

The project will provide crucial evidence on how people diagnosed with cancer use LTC to inform future planning. The work will identify any inequities in provision to shed light on where outcomes could be improved for patients.
The successful candidate will be supported by a supervisory team with extensive expertise in the Scottish routine data landscape, oncology, economics and social care. They will be encouraged to undertake a range of relevant training and career development opportunities.

Training offered

The research project will carry out a retrospective analysis of a routinely collected, linked administrative dataset. This dataset will match, 1:1, patients aged 50+ diagnosed with cancer and recorded in the Scottish Cancer Registry, to the general population. This data will then be linked to Source social care records. The analysis will deploy a range of methods. These will include matching estimators e.g., propensity score matching and multivariate regression models e.g., Ordinary Least Squares, Generalised Linear Models and Two-Part Models. Statistical software packages Stata 18 and R will be used for the analysis.
The successful candidate will undergo information governance training via courses from the Medical Research Council and the Office for National Statistics. The student will undergo practical training on research using routine data e.g. via the Scottish Centre for Administrative Data Research. The student will take advanced courses on causal inference courses, e.g. those provided by the Centre for Microeconometric Methods and Practice .Furthermore, statistical software training in via the University of Edinburgh’s Healthy-R course (delivered by Prof Hall) will also be encouraged. The student will be encourage to engage in career development opportunities for example, by attending the University of Edinburgh’s annual PhD Horizons conference.

For further information on the project or informal enquiries, please contact Dr Elizabeth Lemmon, This email address is being protected from spambots. You need JavaScript enabled to view it.

To place an application, please visit this site at the University of Edinburgh: https://www.ed.ac.uk/studying/postgraduate/degrees/index.php?r=site/view&edition=2022&id=237

When submitting your application please upload the completed recruitment form.

Lab Websites

Dr Elizabeth Lemmon
Prof Peter Hall
Dr Jenni Burton
Edinburgh Health Economics

Papers of interest

1. Chitnis X, Steventon A, Glaser A and Bardsley M (2014) Use of health and social care by people with cancer. Research report. Nuffield Trust. Available: https://www.nuffieldtrust.org.uk/research/use-of-health-and-social-care-by-people-with-cancer

2. McConnachie A, Ellis DA, Wilson P, et al, 2023. Quantifying unmet need in General Practice: a retrospective cohort study of administrative data BMJ Open;13:e068720. doi: 10.1136/bmjopen-2022-068720

3. MacMillan Cancer Support, “Hidden at home: the social care needs of people with cancer,” 2015. https://edin.ac/39hvtfg

4. Scottish Government, 2023. Cancer Action Plan for Scotland 2023-2026. Available: https://www.gov.scot/publications/cancer-action-plan-scotland-2023-2026/documents/

5. Vlachantoni, A. 2019. Unmet need for social care among older people. Ageing and Society. 2019;39(4):657-684. doi:10.1017/S0144686X17001118