Dr Elizabeth Shephard
College House 1.16
I have been working with Professor Willie Hamilton as part of the DISCO (Diagnosis of Symptomatic Cancer Optimally) team since 2010. Funded by the National Institute for Healthcare Research (NIHR), the Policy Research Unit (PRU) and CRUK (Cancer Research UK), our team aims to identify which symptoms and abnormal test results (or ‘clinical features’) are indicators of cancer in primary care. We also estimate the risk of cancer each feature or combination of features produce. Ultimately, through our research, we want to help GPs to recognise patients whose symptom patterns may reflect a certain cancer, resulting in referral to the correct specialist and a prompt diagnosis.
Working as a research fellow, I use large electronic databases of anonymised GP patient data to investigate what people report to their doctor in the year before they receive a diagnosis of cancer. By comparing the records from cancer patients to people of the same age, sex and GP surgery, we can establish a clinical profile relevant for each cancer site. We use Risk Assessment Tools (RATs) in the form of mouse mats and computerised prompts to produce a visual representation of clinical features risk for each cancer site. My previous published work has been on urinary (bladder and kidney) and haematological cancers (multiple myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma and chronic and acute leukaemia) – see references section for links to the papers.
I am currently working on establishing a clinical risk assessment profile for testicular cancer, brain cancer and cancers of the head and neck.
- I am a co-applicant on a Department of Health Policy Research Programme (PRP) grant investigating bowel disease in young adults.
- I have co-supervised a PhD student within our team.
- I am a Scientific Communication Group (SCG) tutor for the Year 1 CSC1004 Fundamental Skills for Medical Scientists module.
- I am an SSU Progress Support Tutor within the BMBS undergraduate medical programme.
- I am a mentor from the UEMS Mentoring Scheme, supported by the UEMS Equality & Diversity Group, and am available to provide PhD, peer and other mentoring support. Please do get in touch if you would like to discuss this further.
- I am also a chartered psychologist and member of the British Psychological Society.
PhD in Psychology - 'Language and literacy in children and young adults with Turner's syndrome'. (University of Essex.)
MSc in Developmental Neuropsychology. (University of Essex)
BSc in Psychology. (University of Surrey: Roehampton Institute)
- Primary care cancer diagnostics
- Observational data
- Case-control method
- Clinical Practice Research Datalink (CPRD) electronic patient records
- Psychology and cancer
My research interests centre around using observational data to investigate the early clinical features of cancer in primary care. Through using large electronic databases containing anonlymised patient records, we are able to study how thousands of cancer patients interact with their GP in the year preceding their diagnosis - we can investigate things like:
- What symptoms do they report for each cancer site?
- How many times do they consult their GP?
- What test results are found in the months leading to their diagnosis?
- What is the risk estimate for bladder cancer for a man over 70 with haematuria?
- What are the symptoms of Hodgkin's versus non-Hodgkin's lymphoma?
- How do these results affect clinical practice?
My research aims to look at these questions, and many more.
Head and neck cancer in primary care: (PRU) Identifying the symptoms/test results sugestive of H&N cancer and quantifying their risk in patients 40 years of age and over.
Unexplained abdominal pain in primary care: establishing a clinical profile and diagnostic pathway for identifying cancer. DoH grant.
Abdominal pain is a symptom commonly reported to United Kingdom (UK) general practitioners (GPs). It can be a symptom of both transient illness and serious disease; often making its cause difficult for GPs to diagnose. This ambiguity influences GP decision making, such as where to refer the patient for further investigation – thus potentially causing delays in diagnosis. Existing research has shown abdominal pain to be a prior symptom of nine different cancers.
The aim of this research is to examine new cases of unexplained abdominal pain and to a) identify how many go on to have a cancer diagnosis in the next two years; b) categorise which cancers are diagnosed; c) investigate what co-symptoms are present for each cancer site and their impact on the chance of having cancer; d) use the results to recommend a best practice method of investigating abdominal pain; and, e) report what other diagnoses are found.
The results will help to guide GPs into providing appropriate action for patients with abdominal pain. They will also help to inform future policy on how best to investigate abdominal pain: in the GP surgery using ultrasound or in a specialist diagnostic clinic. New specialist clinics have been established, but have no relevant evidence to help them select the best sequence of tests for patients.
- 2017 Department of Health
Unexplained abdominal pain in primary care: establishing a clinical profile and diagnostic pathway for identifying cancer. The revised 2015 National Institute for health and Care Excellence (NICE) guidelines highlight abdominal pain as a feature of several cancers. This study aims to quantify the overall and individual cancer site risk of unexplained new abdominal pain episodes reported to primary care, stratified by age and gender, and by accompanying symptoms. There is a need for a more effective diagnostic pathway, which may include primary care testing or extend to investigation in the newly-established multidisciplinary diagnostic centres (MDC).
- 2014 Department of Health
Body Shop (Bowel Disease In Younger Adults: Selection For Investigation In Primary Care). The UK lags behind most of Europe in terms of survival from colorectal cancer. Diagnosis is often difficult, particularly in younger people, who are not well addressed by national guidance. Colorectal cancer (CRC) and inflammatory bowel disease (IBD) have overlapping features and both may be misdiagnosed as non-serious disease, often as irritable bowel syndrome. Diagnostic delays are therefore common in both. In CRC there is a widely accepted relationship between diagnostic delay and mortality: equally, delays in diagnosis of IBD allow further disease progression. However, no research has specifically investigated the features of CRC in younger age groups. Because the symptoms of CRC and IBD are so similar, it is logical to combine both conditions in a study aimed at identifying which patients warrant rapid investigation of their large bowel. Conclusion summary: This study quantified the risk of serious bowel disease in symptomatic patients aged
Publications by category
Publications by year
I am a Scientific Communication Group (SCG) tutor for the Year 1 Fundamental Skills for Medical Scientists module.
I supervise 5 students on their year 3 Research SSU project investigating brain cancer
I am also a SSU Progress Support Tutor within the BMBS undergraduate medical programme