Identifying and understanding inequalities in breast cancer treatment: a multi-methods studentship

Background. Breast cancer is a leading cause of mortality in the United Kingdom. Chances for survival are improved when patients receive treatment (‘treatment receipt’), initiate treatment early (shorter ‘time-to-treatment’) and receive treatment in accordance with national guidance (‘treatment adherence’). Unfortunately, all three are subject to inequalities. The evidence for these inequalities, however, is limited, with little-to-no research conducted for most marginalised groups, treatments, and aspects of treatment. Further, there is a lack of understanding as to why treatment inequalities exist, and how best to address them.

Aims. The aims of this studentship, therefore, are to:

1. identify which marginalised groups experience inequalities in treatment receipt, time-to-treatment and treatment adherence (‘treatment inequalities’), for which treatments (Study 1);
2. identify differences in cancer care experience, and the extent to which they mediate treatment inequalities (Study 2);
3. understand how differences in cancer care experience, and wider factors, lead to treatment inequalities (Study 3).

Techniques and methodology. Studies 1 and 2 will comprise a series of matched studies. In Study 1, differences in treatment receipt, time-to-treatment and treatment adherence will be assessed using linked data from the Clinical Practice Research Datalink, Hospital Episode Statistics and the Cancer Registry. In Study 2, differences in cancer care experience, and the extent to which they mediate treatment inequalities, will be assessed using data from the National Cancer Patient Experience Survey. In Study 3, the mechanisms by which observed differences in cancer care experience (and wider factors), lead to treatment inequalities, will be explored through a series of interviews, conducted with patients, carers and healthcare professionals.

Impact on breast cancer research. The results will be used to identify which marginalised groups experience treatment inequalities, and the reasons why. The findings will be used to inform future interventional research to help make treatment more equitable.

Open to candidates who pay UK/home rate fees. See UKCISA for further information.