Sarah Price is a research fellow in Professor Hamilton’s Discovery Group, working in the field of cancer diagnostics. She joined the University of Exeter Medical School as a postgraduate student in 2013. After completing her PhD in early 2016, she worked for a short while as an impact fellow, developing an impact case study of Professor Willie Hamilton for the Research Excellence Framework due in 2021.
She was appointed a research fellow in July 2016 and is lead researcher for a project funded by Cancer Research UK. In this study, she is evaluating trends in the timeliness of cancer diagnosis, and the impact of the 2015 National Institute for Health and Care Excellence (NICE) Guidelines on the recognition and referral for suspected cancer.
She is currently on a 6-month secondment to the Centre for Biomedical Modelling and Analysis, where is improving her skills in statistical modelling. She is working on the project “Detecting temporal patterns in the relationship between physical activity and mood using ecological momentary assessment (EMA)” with Lisa Price (CLES), Colin Greaves (UEMS) and Jeffrey Lambert (CLES).
Before joining University of Exeter Medical School, Sarah worked in the field of science, technology and medicine publishing, specializing in editorial and production roles.
Qualifications
- BSc (hons) Physiology (University of Manchester)
- PhD What are we missing by ignoring text records in the Clinical Practice Research Datalink? (University of Exeter)
Research
Research interests
Sarah has expertise in using large datasets of observational data, such as the Clinical Practice Research Datalink (CPRD) and National Cancer Registration Service data. She is interested in modelling and regression methods, and is developing her skills in survival analysis.
Sarah is also interested in whether pre-existing conditions complicate the presentation and interpretation of cancer symptoms, and whether cancer diagnosis is delayed in patients with multimorbidity.
Sarah works closely with other groups within University of Exeter, including health economics, and is developing research ideas in the area of cancer and multimorbidity with the Health Services & Policy Research Group.
Sarah’s PhD focused on bias in observational datasets associated with the standard practice of restricting analysis to coded fields of the medical record – ignoring information stored in text fields.
Her main interest is cancer diagnostics. She is currently lead researcher of a CRUK study evaluating trends in the timeliness of cancer diagnosis, i.e. time to diagnosis and stage at diagnosis. The study will examine the impact of the 2015 National Institute for Health and Care Excellence (NICE) Guidelines on the recognition and referral for suspected cancer.
She was co-applicant on a successful Health Technology Assessment Grant to assess the impact of cancer decision support tools implemented in GP IT software. This study, conducted jointly with Health Economics, will start in early 2017.
Research projects
- CRUK Impact study. Evaluating trends in the timeliness (time to diagnosis, stage at diagnosis) of cancer diagnosis in the UK population for 22 cancer, and the impact of recently updated NICE guidelines for GPs on which patients should be referred for investigation for possible cancer
- HTA Study of the impact of cancer decision support tools in primary care
Grants / funding
- Understanding the effectiveness, cost-effectiveness and current use of cancer diagnostic tools to aid decision-making in primary care. Peters, J, Lewis, R, Neal, R, Spencer A, Price S, Hamilton, W, Cooper, C. HTA £240,800. 2017-8
Key publications | Publications by category | Publications by year
Publications by category
Journal articles
Mounce LTA, Price S, Valderas JM, Hamilton W (2017). Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
Br J Cancer,
116(12), 1536-1543.
Abstract:
Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
BACKGROUND: Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis. METHOD: Incident cases (aged ⩾40 years, 2007-2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as 'competing demands' (unrelated to colorectal cancer) or 'alternative explanations' (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means. RESULTS: Out of the 4512 patients included, 72.9% had ⩾1 competing demand and 31.3% had ⩾1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14-39). CONCLUSIONS: the burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged ⩾80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.
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:
Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? a case-control study.
OBJECTIVES: to estimate data loss and bias in studies of Clinical Practice Research Datalink (CPRD) data that restrict analyses to Read codes, omitting anything recorded as text. DESIGN: Matched case-control study. SETTING: Patients contributing data to the CPRD. PARTICIPANTS: 4915 bladder and 3635 pancreatic, cancer cases diagnosed between 1 January 2000 and 31 December 2009, matched on age, sex and general practitioner practice to up to 5 controls (bladder: n=21â€
718; pancreas: n=16â€
459). The analysis period was the year before cancer diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: Frequency of haematuria, jaundice and abdominal pain, grouped by recording style: Read code or text-only (ie, hidden text). The association between recording style and case-control status (χ(2) test). For each feature, the odds ratio (OR; conditional logistic regression) and positive predictive value (PPV; Bayes' theorem) for cancer, before and after addition of hidden text records. RESULTS: of the 20 958 total records of the features, 7951 (38%) were recorded in hidden text. Hidden text recording was more strongly associated with controls than with cases for haematuria (140/336=42% vs 556/3147=18%) in bladder cancer (χ(2) test, p
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.
Martins T, Price S, Hjertholm P, Hamilton W (2015). Doing PhD in primary care diagnosis and treatment of cancer.
EUROPEAN JOURNAL OF CANCER CARE,
24, 58-58.
Author URL.
Full text.
Brown JM, Price SJ, Price RA (2015). Predicting risk after aneurysm surgery.
Anaesthesia,
70(11).
Author URL.
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. British Journal of General Practice, 626(64), 584-589.
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:
Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care.
BACKGROUND: Diagnosis of bladder cancer relies on investigation of symptoms presented to primary care, notably visible haematuria. The importance of non-visible haematuria has never been estimated. AIM: to estimate the risk of bladder cancer with non-visible haematuria. DESIGN AND SETTING: a case-control study using UK electronic primary care medical records, including uncoded data to supplement coded records. METHOD: a total of 4915 patients (aged ≥40 years) diagnosed with bladder cancer between January 2000 and December 2009 were selected from the Clinical Practice Research Datalink and matched to 21 718 controls for age, sex, and practice. Variables for visible and non-visible haematuria were derived from coded and uncoded data. Analyses used multivariable conditional logistic regression, followed by estimation of positive predictive values (PPVs) for bladder cancer using Bayes' theorem. RESULTS: Non-visible haematuria (coded/uncoded data) was independently associated with bladder cancer: odds ratio (OR) 20 (95% confidence interval [CI] =12 to 33). The PPV of non-visible haematuria was 1.6% (95% CI = 1.2 to 2.1) in those aged ≥60 years and 0.8% (95% CI = 0.1 to 5.6) in 40-59-year-olds. The PPV of visible haematuria was 2.8% (95% CI = 2.5 to 3.1) and 1.2% (95% CI = 0.6 to 2.3) for the same age groups respectively, lower than those calculated using coded data alone. The proportion of records of visible haematuria in coded, rather than uncoded, format was higher in cases than in controls (P
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.
Poole RC, Halestrap AP, Price SJ, Levi AJ (1989). The kinetics of transport of lactate and pyruvate into isolated cardiac myocytes from guinea pig. Kinetic evidence for the presence of a carrier distinct from that in erythrocytes and hepatocytes. Biochemical Journal, 264(2), 409-418.
Publications by year
2017
Mounce LTA, Price S, Valderas JM, Hamilton W (2017). Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
Br J Cancer,
116(12), 1536-1543.
Abstract:
Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
BACKGROUND: Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis. METHOD: Incident cases (aged ⩾40 years, 2007-2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as 'competing demands' (unrelated to colorectal cancer) or 'alternative explanations' (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means. RESULTS: Out of the 4512 patients included, 72.9% had ⩾1 competing demand and 31.3% had ⩾1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14-39). CONCLUSIONS: the burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged ⩾80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.
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:
Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? a case-control study.
OBJECTIVES: to estimate data loss and bias in studies of Clinical Practice Research Datalink (CPRD) data that restrict analyses to Read codes, omitting anything recorded as text. DESIGN: Matched case-control study. SETTING: Patients contributing data to the CPRD. PARTICIPANTS: 4915 bladder and 3635 pancreatic, cancer cases diagnosed between 1 January 2000 and 31 December 2009, matched on age, sex and general practitioner practice to up to 5 controls (bladder: n=21â€
718; pancreas: n=16â€
459). The analysis period was the year before cancer diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: Frequency of haematuria, jaundice and abdominal pain, grouped by recording style: Read code or text-only (ie, hidden text). The association between recording style and case-control status (χ(2) test). For each feature, the odds ratio (OR; conditional logistic regression) and positive predictive value (PPV; Bayes' theorem) for cancer, before and after addition of hidden text records. RESULTS: of the 20 958 total records of the features, 7951 (38%) were recorded in hidden text. Hidden text recording was more strongly associated with controls than with cases for haematuria (140/336=42% vs 556/3147=18%) in bladder cancer (χ(2) test, p
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.
Martins T, Price S, Hjertholm P, Hamilton W (2015). Doing PhD in primary care diagnosis and treatment of cancer.
EUROPEAN JOURNAL OF CANCER CARE,
24, 58-58.
Author URL.
Full text.
Brown JM, Price SJ, Price RA (2015). Predicting risk after aneurysm surgery.
Anaesthesia,
70(11).
Author URL.
2014
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. British Journal of General Practice, 626(64), 584-589.
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:
Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care.
BACKGROUND: Diagnosis of bladder cancer relies on investigation of symptoms presented to primary care, notably visible haematuria. The importance of non-visible haematuria has never been estimated. AIM: to estimate the risk of bladder cancer with non-visible haematuria. DESIGN AND SETTING: a case-control study using UK electronic primary care medical records, including uncoded data to supplement coded records. METHOD: a total of 4915 patients (aged ≥40 years) diagnosed with bladder cancer between January 2000 and December 2009 were selected from the Clinical Practice Research Datalink and matched to 21 718 controls for age, sex, and practice. Variables for visible and non-visible haematuria were derived from coded and uncoded data. Analyses used multivariable conditional logistic regression, followed by estimation of positive predictive values (PPVs) for bladder cancer using Bayes' theorem. RESULTS: Non-visible haematuria (coded/uncoded data) was independently associated with bladder cancer: odds ratio (OR) 20 (95% confidence interval [CI] =12 to 33). The PPV of non-visible haematuria was 1.6% (95% CI = 1.2 to 2.1) in those aged ≥60 years and 0.8% (95% CI = 0.1 to 5.6) in 40-59-year-olds. The PPV of visible haematuria was 2.8% (95% CI = 2.5 to 3.1) and 1.2% (95% CI = 0.6 to 2.3) for the same age groups respectively, lower than those calculated using coded data alone. The proportion of records of visible haematuria in coded, rather than uncoded, format was higher in cases than in controls (P
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.
1989
Poole RC, Halestrap AP, Price SJ, Levi AJ (1989). The kinetics of transport of lactate and pyruvate into isolated cardiac myocytes from guinea pig. Kinetic evidence for the presence of a carrier distinct from that in erythrocytes and hepatocytes. Biochemical Journal, 264(2), 409-418.
- 2014–2015: Postgraduate representative on the Research Degrees Liaison Forum
- 2015–2016: Postgraduate representative on the University of Exeter Athena SWAN Working Group
- Reviewer for Family Practice
