Enhancing understanding of the likelihood and consequences of peripheral neuropathy following adjuvant chemotherapy for colorectal cancer
Principal supervisor: Dr Anne Miles (Bbk)
Co-supervisor: Dr Melanie Morris (LSHTM)
Colorectal cancer is the second most common cause of cancer death in the UK. Whilst surgery is highly effective for localised disease, up to 85% of patients with lymph node involvement (stage III) relapse within five years. Fluorouracil-based chemotherapy can prevent recurrence in up to 22% of these patients. While the addition of the chemotherapy drug ‘oxaliplatin’ increases 10-year overall survival by a further 8.1%, 12% of patients who have taken this drug experience persistent neuropathy 4 years after treatment. Peripheral neuropathy manifests as numbness or ‘pins and needles’ in the hands and feet. Severe peripheral neuropathy during treatment has been associated with higher rates of depression and anxiety, and poorer sleep quality (Hong et al 2014), and persistent post-treatment neuropathy contributes to patient distress in the longer-term. Since there is currently no established treatment for this side effect, it is important that patients are correctly informed of the likelihood and consequences of developing this when they are making decisions about whether or not to have adjuvant chemotherapy.
Recent work on patient understanding of the pros and cons of undergoing chemotherapy for stage II colorectal cancer showed there was a lack of understanding of key information among some patients about their risk of recurrence in the absence of treatment, and about the additional benefit offered by oxaliplatin over single chemotherapy treatment (Miles et al 2016). Accurate knowledge of outcomes may affect both treatment choice and adjustment to post-treatment side-effects. Treatment-related toxicities are associated with higher levels of decisional-regret in prostate cancer patients, but regret was lower among patients who were better informed (Christie et al 2015).
Accurate understanding of the risks of treatment also has to take into account the broader context of what is important to the patient (the patient’s values) as patients have to decide whether reducing risk of cancer recurrence is more important than living with permanent neuropathy, and what degree of risk reduction would be worth trading for permanent neuropathy. However, there is currently no consensus about which methods of helping patients clarify what is important to them are best, due to a lack of research in this area (Fagerlin et al 2013).
The successful candidate will develop research that will test methods of enhancing people’s understanding of the likelihood and consequences of developing persistent neuropathy following different chemotherapy regimes, examine what people think is an acceptable reduction in risk of recurrence in exchange for permanent neuropathy, and compare the effectiveness of different methods of helping patients clarify what is important to them (“values clarification” exercises).
We invite applications from outstanding and highly motivated students who have an undergraduate degree (1st class honours or 2.1) in psychology and a Masters degree in health psychology, epidemiology or a related area, with excellent skills in statistical analysis.
The studentship only covers fees at the Home/EU rate, in addition to a stipend at the Research Councils UK rate, currently listed as £14,553 for 2017-18.
 Belkora JK, Hutton DW, Moore DH, Siminoff LA. Does use of the adjuvant! model influence use of adjuvant therapy through better risk communication? J Natl Compr Canc Netw 2011; 9(7):707-712.
 Christie DR, Sharpley CF, Bitsika V. Why do patients regret their prostate cancer treatment? A systematic review of regret after treatment for localized prostate cancer. Psychooncology 2015; Sep;24(9):1002-11.
 Fagerlin A, Pignone M, Abhyankar P, Col N, Feldman-Stewart D, Gavaruzzi T et al. Clarifying values: an updated review. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S8.
 Gigerenzer G, Edwards A. Simple tools for understanding risks: from innumeracy to insight. BMJ 2003; 327(7417):741-744.
 Hong JS, Tian J, Wu LH. The influence of chemotherapy-induced neurotoxicity on psychological distress and sleep disturbance in cancer patients. Curr Oncol. 2014 Aug;21(4):174-80.
 Reyna VF, Nelson WL, Han PK, Pignone MP. Decision making and cancer. Am Psychol 2015; 70(2):105-118.
 Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PK et al. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S7.
 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. (in press).
Further details about the project may be obtained from:
Principal supervisor: Dr Anne Miles (email@example.com)
Co-supervisor: Dr Melanie Morris (firstname.lastname@example.org)
Further information about Phds at Birkbeck is available from:
Application forms and details about how to apply are available from:
Please note Application Requirements include a CV, cover letter, 2 academic references, an example piece of academic writing and the standard application form and you must state that you are applying for the studentship with Dr Anne Miles.
Questions regarding the application process can be directed to the Postgraduate Administrator: Ida Akhtar,
Closing date for applications is:
31 May 2017