Dr Elizabeth Shephard
Postdoctoral Research Fellow
College House, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
I am a Research Fellow working in the Primary Care cancer diagnostics field. I have been working in Professor Willie Hamilton’s Discovery group since 2010, specialising in producing risk assessment tools (RATs) for over eight cancer sites. Three of these RATs have contributed to new recommendations in the 2015 updated NG12 cancer guidelines from the National Institute for Health and Care Excellence (NICE). RATs have been piloted across GP surgeries in the UK.
I am the Process Evaluation and Recruitment reseacher on the Electronic Risk Assessment for Cancer (ERICA) cluster randomised controlled trial. This large trial assesses the clinical and cost effectiveness of six electronic RATs (eRATs) for lung, colorectal, bladder, kidney, oesophago-gastric and ovarian cancers in general practice. It is hoped that these tools will help GPs to identify possible undiagnosed cancer earlier. Using English cancer registry data, we hope to see an ~4% increase in the proportion of early stage cancers diagnosed, potentially amounting to 6,000 cancer deaths avoided per year.
- Co-applicant on the NIHR SPCR funded OSCA Study investigating attendance at suspected-cancer investigations in people with anxiety and/or depression.
- Co-applicant on a Department of Health Policy Research Programme (PRP) grant investigating bowel disease in young adults.
- Co-supervisor to PhD student Dr Alex Burns who is investigating the uncertainty during cancer diagnosis in the ERICA trial. I have also co-supervised a successful PhD student within our team.
- Academic Tutor to Medical Sciences undergraduate students.
- Ran the cancer RSSU for year 3 students on the BMBS medical programme from 2017-2020.
- Chartered Psychologist and member of the British Psychological Society.
- Scientific Communication Group (SCG) tutor for the Year 1 CSC1004 Fundamental Skills for Medical Scientists module from 2017-19.
- SSU Progress Support Tutor within the BMBS undergraduate medical programme from 2017-19.
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).
Chartered Psychologist, British Psychological Society.
Fellow of the Higher Education Academy.
Research group links
- Primary Care cancer diagnostics
- Risk Assessment Tools (RATs) for calculating cancer risk
- Use of observational data
- The Clinical Practice Research Datalink (CPRD) electronic patient records
- Process evaluation
- GP and patient experience
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.
Sino-nasal and nasopharyngeal cancer in primary care: (PRU) Identifying the clinical profile sugestive of SN/NP cancer in pirmary care patients aged 40 years of age and over, and quantifying their risk.
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.
Research Special Study Unit (RSSU) BMBS - Cancer
2017-2020 I ran the cancer topic RSSU for third year medical students.
- 2017-18: Topic – cancer of the larynx. Winner of the year 3 poster prize (Molly Parkinson). Molly is also co-author on the resulting published paper: ‘Recognising laryngeal cancer in primary care: a large case-control study using electronic records’.
- 2018-19: Topic – cancer of the naso-sinus and nasopharynx. Students Tuba Khan and Yusera El-Sockary presented the work at the 2019 SAPC conference in Exeter (July 3rd-5th). They are authors on the paper currently being written up for submission.
- 2019-20: [With Dr Sarah Price] Topic – new and unexplained abdominal pain in primary care. Paper being written up for publication.
Dr Alex Burns will be exploring how patients and GPs deal with uncertainty during potential cancer diagnoses in the ERICA trial. (2019-2022).
Professional Training Year (PTY) supervisor.
Lead supervisor to a 3rd year Medical Sciences undergraduate student on their professional training year (2018-2019). Topic: Microcytosis as a risk marker for cancer in primary care: a cohort study using electronic patient records. Paper publised in the BJGP available here.
Academic tutor to 8 BSc Medical Sciences students (2018-2021).
Progress Support Tutor within the BMBS medical programme (2017-2019).
Tutor on the Fundamental Skills for Medical Sciences undergraduate programme (2018-2019).