Two initial projects will be the focus for this position but the individual will be expected to work on new projects as they are funded.

Overview of initial projects for the post
Initial study to coMpare the carbon footPRINT, patient experience and resources of standard and hypofractionated radiotherapy (IMPRINT): The NHS aims to be net zero by 2040. Radiotherapy (RT) has a high environment impact as about 120,000 UK cancer patients (50% of all cancer patients) are treated per year. Also, RT uses linear accelerators (linacs) to treat patients with high energy radiation requiring a high number of visits per patient (typically 15-30), with implications for patient transport. Recent clinical trials show that shorter courses of RT (delivered over 3-5 visits) are as effective as standard courses (15-30 visits) for tumour control and toxicity in many patient groups. This approach, “hypofractionation” may significantly reduce the carbon footprint of RT, since patient travel forms 70%. In addition, hypofractionation would: (a) reduce travel time to a RT centre increasing the likelihood of patients receiving a full course of RT especially for more deprived groups, (b) greater acceptability to patients, and (c) free up staff and equipment resources to help clear the backlog of cancer cases. This study aims to provide evidence on the feasibility of a definitive evaluation of moving from standard to
hypofractionated RT schedules. The are four objectives: (i) To elicit the views of key decision makers about the main barriers to implementing hypofractionation, with a focus on the role of carbon footprint of treatment (ii) To quantify the possible reduction in carbon footprint from increased adoption of hypofractionation over the UK (iii) To identify the feasibility of assessing the impact of moving to hypofractionation for patients, in terms of travel, acceptability and other concerns identified (iv) To produce indicative estimates of the effect on workflows and hospital costs of hypofractionation versus standard RT. The mathematical modeller employed on this study will contribute to objective (iv). This will involve building mathematical models (discrete event simulation) to represent the workflow of hypofractionation rather than standard RT for two
exemplar cancers (breast and lung). This project is led by Robert Chuter, Principal Clinical Scientist in the Department of Medical Physics and Engineering at The Christie NHS Foundation Trust. It involves working with health economists, behavioural scientists, clinicians and experts in sustainable health care.

Building a natural history model of cervical cancer: The UK National Screening Committee recommended the use of a national screening programme for cervical cancer. New strategies are being explored to use home-based self-sampling or urine sampling and testing for human papillovirus (HPV) in cervical cancer screening. Cervical cancer screening in the UK currently involves a health professional taking a cervical swab in a health care setting and sending the swab for testing. Recent research has suggested that a vaginal swab could instead be taken by the patient themselves at home and such self-sampling has been introduced in other countries. Trials are currently underway in the UK to establish the performance of self-sampling compared to health professional sampling. This study would complement the ongoing clinical research by building a natural history model for cervical cancer. This model would be cognisant of the need to model the impact of infection with Human papillomavirus (HPV), a common sexually transmitted infection, as the primary underlying cause of cervical cancer. In addition, it would take account of the impact of vaccination on the HPV infection rate. This work will be conducted with Dr Stuart Wright, Wellcome Trust Research Fellow with guidance from Professor Ian Hall (Professor of Mathematical Epidemiology and Statistics) and Professor Emma Crosbie (Professor of Gynaecological Oncology) and Dr Jennifer Davies-Oliveira (Clinical Research Fellow in Gynaecological Oncology) at the University of Manchester.