Incidence, care pathways and outcomes of colorectal cancer across demographic, geographic, and socioeconomic groups in Scotland

Supervisors: Prof Evropi Theodoratou, Dr Caroline Jackson, Prof Malcolm Dunlop & Prof Farhat Din

Evropi Theodoratou Research image

Application deadline

30th June 2025

Funding information (students eligible to apply) 

UK & International students

The CRUK Scotland Centre studentships are for 4 years and provide an annual tax-free stipend of £22,113 + 1.75% indexation in Year 2,3&4, university tuition fees and a consumables budget. 

Students will be registered for their degree at either the University of Glasgow or Edinburgh, depending on the project they apply for. This scheme is open to both UK and international applicants. 

https://www.crukscotlandcentre.ac.uk/training/phd-studentships

Project description

Background

Colorectal cancer (CRC) remains the third most common malignancy and second cause of cancer deaths worldwide.

Sociodemographic inequalities, including demographic, geographic (i.e., proximity to health services) and socioeconomic, can significantly impact CRC incidence, care and survival.  For example, ethnicity has been found to be a health inequality for CRC and should be considered in service planning and outreach programmes. Furthermore, patients diagnosed with CRC living in more deprived areas experience worse survival than those in more affluent areas. This may be partly explained by socioeconomic inequalities in access to and receipt of treatment for CRC. However, more research is needed to try and understand the underlying mechanisms of how sociodemographic inequalities could impact CRC across the whole pathway from diagnosis to care and prognosis.

Aim and objectives

The aim of this project is to investigate the mechanisms of sociodemographic inequalities in the incidence, clinical care and survival for CRC in Scotland.

In particular the specific objectives are:

  • To compare the incidence of CRC, routes to diagnosis and engagement with CRC screening across sociodemographic groups;
  • To compare receipt of clinical care, including type of treatment, and follow-up post-treatment, recurrence and survival from CRC across sociodemographic groups;
  • To determine whether any disparities in incidence, survival and clinical care when looking at different sociodemographic groups differ by age and sex and how disparities were affected by the COVID-19 pandemic;
  • To investigate the mechanisms of how sociodemographic inequalities influence care of and survival from CRC via mediation analysis and multistate modelling.

Analysis plan

The student will create two prospective cohort studies using national linked electronic health data in Scotland. The first cohort study will investigate sociodemographic inequalities in the incidence of CRC in Scotland (2014-2024). The second cohort study will include all CRC cases (2014-2024), to look at care and survival. For these cohort studies, CRC incidence will be determined using both cancer registry (SMR06) and death records. Scottish morbidity records (SMR01) will also be used to create a comorbidity index. We estimate the number of CRCs for 2014-2024 to be ~45,000.

In addition, the student will have access to the Scottish Colorectal Cancer Study (SOCCS) a large population-based study that includes over 9,000 CRC cases and controls. This is a deeply characterised study with detailed data on health inequalities, co-morbidities, lifestyle factors (e.g., smoking, BMI, diet), staging, recurrence and outcomes and it will be utilised for the mediation and multistate analysis.

The exposure will comprise various measures of sociodemographic inequalities. The main outcomes will include CRC incidence, receipt of care and CRC survival. The student will use a number of multivariate analyses including logistic/linear/survival regression adjusting for confounders including comorbidities, cancer stage and treatment. The student will also apply mediation analysis to understand the impact of care on recurrence and survival. They will also use multistate modelling to model the impact of sociodemographic inequalities in CRC progression. Finally, they will also run sensitivity analyses for both cohort studies to examine the impact of the COVID-19 pandemic.

Biological Sciences

Bacteriology; Behavioural Biology; Biochemistry; Biodiversity; Bioinformatics; Biophysics; Biotechnology; Cancer Biology; Cell Biology; Developmental Biology; Ecology; Ecotoxicology; Entomology; Environmental Biology; Evolution; Genetic Engineering; Genetics; Genomics; Human Genetics; Immunology; Marine Biology; Microbiology; Molecular Biology; Molecular Genetics; Neuroscience; Other; Parasitology; Plant Biology; Plant Cell Biology; Reproductive Biology; Structural Biology; Systematic Biology; Virology; Zoology

Chemistry

Analytical Chemistry; Applied Chemistry; Computational Chemistry; Environmental Chemistry; Industrial Chemistry; Inorganic Chemistry; Organic Chemistry; Other; Petrochemical Chemistry; Pharmaceutical Chemistry; Physical Chemistry; Polymer Chemistry; Structural Chemistry; Synthetic Chemistry

Computer Science

Artificial Intelligence; Computer Architectures; Computer Graphics; Computer Vision; Cyber Security; Data Science; Human Computer Interaction; Internet of Things; Machine Learning; Networks; Other; Quantum Computing; Software Engineering; Videogames

Mathematics

Applied Mathematics; Applied Statistics; Computational Mathematics; Data Analysis; Engineering Mathematics; Mathematical Modelling; Medical Statistics; Operational Research; Other; Probability; Pure Mathematics; Statistics; Stochastic Processes

Medicine

Anatomy; Audiology; Biomechanics; Cardiology; Complementary Medicine; Dentristry; Endocrinology; Epidemiology; Neural Engineering; Neurology; Nutrition; Ophthalmology; Optometry; Other; Pathology; Pharmacology; Pharmacy; Physiology; Physiotherapy; Podiatry; Radiology; Speech Science; Tissue Engineering; Toxicology

Physics

Acoustics; Astronomy; Astrophysics; Chemical Physics; Computational Physics; Electromagnetism; Environmental Physics; Experimental Physics; Medical Physics; Nuclear Physics; Optical Physics; Other; Particle Physics; Quantum Mechanics; Semiconductors; Solid State Physics; Space Science; Theoretical Physics

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