Exploring the complex relationships between pre-existing conditions and cancer diagnosis in an ageing population (PhD)

Start Date Jan 2020

Code E16-Aff, PhD

Status Ongoing

Project Lead
Supervisors: Professor Antonieta Medina-Lara (Exeter), Professor Stephen Birch, Dr Katharine Wallis (both University of Queensland)
Collaborator: Professor Willie Hamilton (Exeter)


With the majority of cancer patients diagnosed after the age of 65, there is a substantial proportion of patients dealing with co-occurring chronic conditions (comorbidities). As the world’s population is ageing the prevalence of comorbidities will increase, which interferes with the cancer diagnostic and treatment pathway. For example, the presence of comorbidities has been shown to delay diagnosis of many cancers due to competing clinical attention and/or the masking of cancer symptoms.

This delay in diagnosis is associated with poor survival. The complex relationship between comorbidities and cancer therefore needs to be explored to better understand the impact on cancer diagnostic testing and treatment strategies.

Aims & objectives

The overall aim of this project is to explore the relationship between comorbidities and cancer diagnosis and treatment. It will achieve this by:

  • Exploring the extent to which diagnostic testing, treatments and outcomes for symptomatic cancer patients differ systematically according to comorbidity
  • Using choice modelling approaches to explore if patient and practitioner preferences among diagnostic test strategies and outcomes differ systematically according to comorbidity


This project entails three phases. A systematic literature review and observational study will explore the impact of comorbidity on cancer treatments and outcomes. The final phase will then consist of choice-based experiments to explore patient and practitioner preferences for diagnostic test strategies.

Outputs & impact

The project will provide an improved understanding of the complex relationship between comorbidity and cancer diagnosis and treatment.

Next steps

We are working on a systematic literature review on the impact of co-morbidities on treatment pathways and outcomes for cancer patients.

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