The SORT Study is a 3-year NIHR-funded project which will assess inequalities in receipt of cancer treatments and the relative effectiveness and cost-effectiveness of curative surgery versus radiotherapy for three types of cancer (lung, oesophageal and bladder).
The SORT Study will use secondary data analysis and target emulated studies to answer the study objectives and qualitative research methods to enrich our understanding of the results. Patient and public engagement and involvement will help shape the study and its outputs.
The SORT Study will compare radiotherapy versus surgery for treatment of people with early-stage cancers of the lung, oesophagus and bladder, and provide recommendations to help improve patients’ outcomes.
The main objectives are to understand:
- the effect of having radiotherapy rather than surgery on patient’s outcomes
- the NHS costs of radiotherapy compared to curative surgery
- the impact of the COVID-19 pandemic on inequalities in the receipt of treatments.
Background to the research
For patients with common cancers, survival in England is worse than in comparable countries. This could be partially explained by inequalities in cancer care. For example, cancer patients who are older, of black ethnicity or living in poorer areas are less likely to have either treatment. A major concern is that the COVID-19 pandemic has made these inequalities worse.
In England, cancers of the lung, oesophagus and bladder cause almost a third of cancer deaths, but there is little evidence about which treatment is better.
This new study will answer these questions:
- Why do some patients receive treatments while others do not?
- Does radiotherapy lead to similar outcomes and cost the NHS less than surgery?
- Has COVID-19 made access to these treatments worse for some patient groups?
The SORT study is funded by NIHR award reference NIHR153580.
Eva Kagenaar
Research Fellow
Paula Fry
Project Coordinator
Corinne Finn
Professor, The Christie NHS Foundation Trust
Dave Chuter
Patient Advocate
Jo Cresswell
Consultant, South Tees Hospitals NHS Foundation Trust
John Edwards
Consultant Thoracic Surgeon, Sheffield Teaching Hospital
Paul Charlton
Patient Advocate, The Rotherham NHS Foundation Trust
Ravinder Vohra
Consultant, University of Nottingham
The SORT Study will use secondary data analysis and target emulated studies to answer the study objectives and qualitative research methods to enrich our understanding of the results. Patient and public engagement and involvement will help shape the study and its outputs.
First, we will look the numbers of patients who had radiotherapy or surgery rather than no treatment. We will see whether there are inequalities, for example, by age or ethnicity in the numbers of people who have either treatment. We will then consider whether any inequalities became worse during the pandemic. Second, we will compare the number of patients who died within two years after their diagnosis, after having radiotherapy rather than surgery. We will also consider the impact of the decision to have radiotherapy rather than surgery on patients’ quality of life. We will interview people affected by these 3 cancers to understand their views about the treatments they received, and the information they had about treatment choices. Third, we will compare the long-term costs to the NHS of patients having radiotherapy rather than surgery. Fourth, we will work with different groups to develop and share clear recommendations to make sure all patients have the same opportunities to receive the best treatment.
We will prioritise involvement of people with experience of cancer and those from communities who have the worst outcomes. Our PPI co-applicants and 2 PPI groups provided input into the proposal during its’ development. During the study a diverse and representative PPI panel will feed into the research and outputs of results. We will work with charities, such as Fight Bladder Cancer and collaborators including the Centre for Ethnic Health Research, to reach, involve, listen, and respond to the voices of those from relevant communities.
See further details of our PPIE activities or to get involved.
How the results will be shared
We will work with diverse groups to ensure the results reach patients and the public, health professionals and policy makers. We will hold a workshop with all stakeholders in the final year to agree the important messages and how to translate these into recommendations. Developed with our patient and public team members and contributors, we propose to use short videos, infographics and social media campaigns to make sure results are easy to understand and to share recommendations.
The London School of Hygiene & Tropical Medicine (a higher education institution established by Royal Charter and an exempt charity with registration number RC000330) of Keppel Street, London, WC1E 7HT, is a data controller for the purposes of the Data Protection Act 1998 and the General Data Protection Regulation (GDPR). LSHTM is registered with the Information Commissioner’s Office. You can find its registration number is Z7513362 and its entry on the ICO website.
LSHTM handles any data used in the SORT study in accordance with data protection laws and its own internal policies and procedures. Read LSHTM’s Data Protection Policy.
The SORT study uses data provided by patients and collected by the NHS England as part of their care and support. All the data we receive from NHS England are pseudonymized - this means that individuals cannot be identified in the data and the researchers working with the data have no way of identifying any specific individual. We receive it under a data sharing agreement, and access is restricted in line with the ICON Data Management and Security Policy.
Additionally, we will receive information about people who participate in the qualitative aspect of our study (patient and carer interviews). Their information is governed by LSHTM’s Research Participant Privacy notice. There is no way to link the information or identity of the qualitative participants to the data we receive from NHS England.
Finally, we will receive information about people who participate in Patient and Public Involvement (PPI) Panel which provides input and support to the study. Their information is governed by LSHTM’s Data Protection Policy.
Ethical approval
All of our research using data about patients is approved by the Research Ethics Committee of the NHS Health Research Authority. In addition, the SORT study is approved by the LSHTM Ethics Committee.
Contact details
If you want further information about how LSHTM uses personal information, please see www.lshtm.ac.uk/dpo or contact dpo@lshtm.ac.uk.
If you have questions about the SORT study, please contact the Co-Principal Investigators Prof. Richard Grieve at Richard.Grieve@lshtm.ac.uk or Dr David Lugo Palacios at David.Lugo-Palacios@lshtm.ac.uk.