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Dr Elizabeth Shephard

Dr Elizabeth Shephard

Research Fellow

6030

01392 726030

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.

 

Further information:

  • 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.

Qualifications

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)

Research

Research interests

  • 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.

Research projects

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.

Research grants

  • 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

Key publications | Publications by category | Publications by year

Publications by category


Journal articles

Stapley SA, Hamilton WT, Rubin GP, Alsina D, Rutter M, Shephard EA (In Press). Clinical features of bowel disease in primary care: a large case-control study. British Journal of General Practice Full text.
Bailey SE, Ukoumunne OC, Shephard EA, Hamilton W (2017). Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data. Br J Gen Pract, 67(659), e405-e413. Abstract.  Author URL.  Full text.
Price SJ, Stapley SA, Shephard E, Barraclough K, Hamilton WT (2016). Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? a case-control study. BMJ Open, 6(5). Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton W (2016). Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records. Br J Gen Pract, 66(644), e182-e188. Abstract.  Author URL.  Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2015). Does the GP method of recording possible cancer symptoms reflect the probability that cancer is present?. EUROPEAN JOURNAL OF CANCER CARE, 24, 30-30. Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case-control study using electronic records. Br J Gen Pract, 65(634), e289-e294. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose P, Walter FM, Litt EJ, Hamilton WT (2015). Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case-control study using electronic records. Br J Gen Pract, 65(631), e106-e113. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of non-Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a large case-control study using electronic records. Br J Gen Pract, 65(634), e281-e288. Abstract.  Author URL.  Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. Br J Gen Pract, 64(626), e584-e589. Abstract.  Author URL.  Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). The risk of bladder cancer with non-visible haematuria: a primary care study using electronic records. EUROPEAN JOURNAL OF CANCER CARE, 23, 32-32. Author URL.  Full text.
Shephard E, Neal R, Rose P, Walter F, Hamilton WT (2013). Clinical features of kidney cancer in primary care: a case-control study using primary care records. Br J Gen Pract, 63(609), e250-e255. Abstract.  Author URL.  Full text.
Shephard EA, Stapley S, Neal RD, Rose P, Walter FM, Hamilton WT (2012). Clinical features of bladder cancer in primary care. Br J Gen Pract, 62(602), e598-e604. Abstract.  Author URL.  Full text.
Temple CM, Shephard EE (2012). Exceptional lexical skills but executive language deficits in school starters and young adults with Turners syndrome: Implications for X chromosome effects on brain function. Brain and Language, 120(3), 345-359.
Shephard E, Stapley S, Hamilton W (2011). The use of electronic databases in primary care research. Family Practice, 28(4), 352-354. Full text.

Reports

Bailey SER, Ukoumunne OC, Shephard EA, Hamilton W (2014). How useful is thrombocytosis in predicting an underlying cancer in primary care?: systematic review protocol. Full text.
Bailey SER (2014). PROTOCOL: How useful is thrombocytosis in predicting underlying cancer? a systematic review.  Full text.

Publications by year


In Press

Stapley SA, Hamilton WT, Rubin GP, Alsina D, Rutter M, Shephard EA (In Press). Clinical features of bowel disease in primary care: a large case-control study. British Journal of General Practice Full text.

2017

Bailey SE, Ukoumunne OC, Shephard EA, Hamilton W (2017). Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data. Br J Gen Pract, 67(659), e405-e413. Abstract.  Author URL.  Full text.

2016

Price SJ, Stapley SA, Shephard E, Barraclough K, Hamilton WT (2016). Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? a case-control study. BMJ Open, 6(5). Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton W (2016). Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records. Br J Gen Pract, 66(644), e182-e188. Abstract.  Author URL.  Full text.

2015

Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2015). Does the GP method of recording possible cancer symptoms reflect the probability that cancer is present?. EUROPEAN JOURNAL OF CANCER CARE, 24, 30-30. Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a case-control study using electronic records. Br J Gen Pract, 65(634), e289-e294. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose P, Walter FM, Litt EJ, Hamilton WT (2015). Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case-control study using electronic records. Br J Gen Pract, 65(631), e106-e113. Abstract.  Author URL.  Full text.
Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton WT (2015). Quantifying the risk of non-Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a large case-control study using electronic records. Br J Gen Pract, 65(634), e281-e288. Abstract.  Author URL.  Full text.

2014

Bailey SER, Ukoumunne OC, Shephard EA, Hamilton W (2014). How useful is thrombocytosis in predicting an underlying cancer in primary care?: systematic review protocol. Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. Br J Gen Pract, 64(626), e584-e589. Abstract.  Author URL.  Full text.
Bailey SER (2014). PROTOCOL: How useful is thrombocytosis in predicting underlying cancer? a systematic review.  Full text.
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). The risk of bladder cancer with non-visible haematuria: a primary care study using electronic records. EUROPEAN JOURNAL OF CANCER CARE, 23, 32-32. Author URL.  Full text.

2013

Shephard E, Neal R, Rose P, Walter F, Hamilton WT (2013). Clinical features of kidney cancer in primary care: a case-control study using primary care records. Br J Gen Pract, 63(609), e250-e255. Abstract.  Author URL.  Full text.

2012

Shephard EA, Stapley S, Neal RD, Rose P, Walter FM, Hamilton WT (2012). Clinical features of bladder cancer in primary care. Br J Gen Pract, 62(602), e598-e604. Abstract.  Author URL.  Full text.
Temple CM, Shephard EE (2012). Exceptional lexical skills but executive language deficits in school starters and young adults with Turners syndrome: Implications for X chromosome effects on brain function. Brain and Language, 120(3), 345-359.

2011

Shephard E, Stapley S, Hamilton W (2011). The use of electronic databases in primary care research. Family Practice, 28(4), 352-354. Full text.

For 2017:

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

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