Mental illness and incidence of, survival from and clinical care for, colorectal Cancer

People with a severe mental illness (SMI), defined as schizophrenia, other psychotic disorders, bipolar disorder or major depression, live about 10-15 fewer years than the general population. This premature mortality is due to a higher burden of physical disease, with an excess risk of death from multiple disease groups, including cardiovascular disease and cancer. Paradoxically, although SMI is associated with increased risk of cancer death, cancer incidence is often reported as being similar or lower in those with versus without a SMI. This might be partly due to competing risks of death from other causes and under-diagnosis of cancer in those with SMI. Some of the excess cancer mortality may be explained by later diagnosis in people with SMI, with presentation with advanced disease more common in people with versus without SMI. Studies also report that people with SMI are less likely to receive stage-appropriate treatment, suggesting differences in access to and delivery of cancer care in those with and without SMI.

To date, most studies in this space have focused on SMI and all-cancer mortality, with less reporting of associations with cancer types or cancer survival. Where cancer types have been studied, research has focused on breast and lung cancer and on specific SMIs, particularly schizophrenia. There is a paucity of studies reporting on SMI in relation to colorectal cancer, the fourth most common cancer in the UK. Moreover, there has been little study of cancer care pathways in people with mental illness and to the best of our knowledge, none on colorectal cancer care in particular.

In this project, we aim to determine how the incidence, survival and clinical care for colorectal cancer differs by severe and complex mental illness (SCMI) status in Scotland, using national linked electronic health data. This work will identify health disparities relating to cancer in people with SCMI and identify points along the care pathway, from colorectal cancer screening to post-treatment follow-up, where this vulnerable group may be disadvantaged. This will inform initiatives to improve the timely detection and treatment of cancer in people with a SMI and ultimately improve survival in this vulnerable group.  

Supervisors:

·      Dr Caroline Jackson, Centre for Population Health Sciences, Usher Institute, University of Edinburgh

·      Prof Evropi Theodoratou, Centre for Global Health, Usher Institute, University of Edinburgh

In collaboration with:

·      Prof. Farhat Din, Institute of Genetics and Cancer, University of Edinburgh

Requirements

A strong academic track record with a 2:1 or higher in a relevant undergraduate degree, or its equivalent if outside the UK. It is also essential to have a strong performance in a relevant postgraduate degree, such as epidemiology, public health or medical statistics (or similar). Candidates with either of the two latter degrees must be able to demonstrate a solid foundational understanding of epidemiology.

Following interview, the selected candidate will need to apply and be accepted for a place on the Usher Institute Population Health Sciences PhD programme. Details about the PhD programme can be found here: https://www.ed.ac.uk/studying/postgraduate/degrees/index.php?r=site/view&id=213

 Application procedure

Please provide a CV, a personal statement detailing your research interests and reasons for applying, degree certificate(s), marks for your degree(s) and 2 written academic references. All documents should be in electronic format and sent via e-mail to: [email protected]

The closing date for applications is: 21^st June. Interviews will be held during August.

The expected start date is September 2024 to January 2025.