Early detection, screening and treatment pathways

Early detection (through symptom identification, help-seeking or screening) is key to ensuring prompt access to treatment and improved outcomes for patients. Our work in this area focuses on understanding and improving help-seeking decisions across different illnesses and among patient groups that have poorer outcomes (including men, older adults and migrant populations).

Our work examines the psychological impact of different diagnostic and treatment pathways on longer term psychological outcomes. For example we have examined the impact of having a cancer ‘missed’ at screening on quality of life and emotional outcomes.

Miles A, et al (2015) The psychological impact of a colorectal cancer diagnosis following a negative fecal occult blood test result. Cancer Epidemiology Biomarkers and Prevention. 24(7); 1–7doi: 10.1158/1055-9965.EPI-15-0004

In addition we are currently exploring the effect of treatment decisions around radical vs. minimal surgery, and one vs two chemotherapy drugs on psycho-social outcomes in colorectal cancer patients with a view to developing between decisional support for this group.

Patient preferences for treatment for rectal cancer

Professor Anne Miles is currently looking at the role of risk of recurrence, bowel function and avoidance of a permanent stoma in patient preferences for treatment for rectal cancer, along with Professor Robert Steele (Chair of the National Screening Committee, and Professor of Surgical Oncology, Ninewells Hospital and Medical School, Dundee) and Professor Stephen Morris (Professor of Health Services Research, Cambridge). This research is funded by the Bowel Disease Research Foundation.

Patient decision-making about chemotherapy for colorectal cancer

Professor Anne Miles’s PhD student, Syreen Hassan is conducting research on patient decision making around chemotherapy use in stage III colorectal cancer patients, along with Dr Melanie Morris (at the London School of Hygiene and Tropical Medicine). This is funded by a Bloomsbury Colleges PhD Studentship. Professor Miles has also conducted research into developing a decision aid to help people with stage II colorectal cancer make the decision about whether or not to have adjuvant chemotherapy along with Dr Astrid Mayer, Dr Ionnis Chronakis and Professor John Fox, funded by the Royal Free Charity.

Miles A, Chronakis I, Fox J, Mayer A. The use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation. BMJ Open. 2016 http://dx.doi.org/10.1136/bmjopen-2016-012935

Patient experience of investigative tests

earlydetection.pngProfessor Anne Miles led the patient-experience strand of the Streamline trials (PI: Professor Stuart Taylor) looking at the effectiveness of whole-body MRI on the accurate staging of cancers of the lung (‘Streamline L’) and colorectum (‘Streamline C’) compared with standard staging pathways; and examined patient outcomes reported in the METRIC trial, which compared the relative accuracy of MRI vs ultrasound in the diagnosis and management of newly diagnosed and relapsing Crohn’s disease (PI: Professor Stuart Taylor). All trials were funded by the National Institute for Health Research.

Taylor SA, et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol. 2019 May 9. pii: S2468-1253(19)30056-1. doi: 10.1016/S2468-1253(19)30056-1.

Taylor SA, et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed non-small-cell lung cancer: the prospective Streamline L trial. Lancet Respir Med. 2019 May 9. pii: S2213-2600(19)30090-6. doi: 10.1016/S2213-2600(19)30090-6.

Evans REC., et al. Perceived patient burden and acceptability of whole body MRI for staging lung and colorectal cancer; comparison with standard staging investigations. British Journal of Radiology. 2018 doi: 10.1259/bjr.20170731.

Evans REC, et al. Patient experience and perceived acceptability of whole body magnetic resonance imaging for staging colorectal and lung cancer compared with current staging scans: a qualitative study. BMJ Open. 2017 http://dx.doi.org/10.1136/bmjopen-2017-016391

Miles A, et al. Patient preferences for whole body MRI or conventional staging pathways in lung and colorectal cancer: a discrete choice experiment. European Radiology 2019 29 (7) 3889-3900. doi: 10.1007/s00330-019-06153-4.

Miles A, Evans REC, Taylor, S.Predictors of distress among patients undergoing investigations for suspected colorectal and lung cancer. Psychology Health and Medicine  https://doi.org/10.1080/13548506.2020.1852477 .

Miles A, Evans REC, Halligan S, Beare S, Bridgewater J, Goh V, Janes S, Navani N, Oliver A, Morton A, Morris S, Rockall A, Taylor S. Predictors of patient preference for either whole body magnetic resonance imaging (WB-MRI) or CT/ PET-CT for staging colorectal or lung cancer. Journal of Medical Imaging and Radiation Oncology. 2020. http://dx.doi.org/10.1111/1754-9485.13038

Evans REC., Taylor S.A., Kalasthry J,  Sakai N. S., Miles A.  Patient deprivation and perceived scan burden negatively impact on the quality of WB-MRI. Clinical Radiology 2019 https://doi.org/10.1016/j.crad.2019.10.019