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Surgery Or RadioTherapy for early-stage cancer: Providing evidence on the effectiveness and cost-effectiveness of surgery versus radiotherapy for early-stage cancers to inform policy which can improve outcomes for all

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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).

Study design

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.  

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Overview SORT 2 columns
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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: 

  1. the effect of having radiotherapy rather than surgery on patient’s outcomes
  2. the NHS costs of radiotherapy compared to curative surgery
  3. 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.

Project team
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LSHTM team
Prof Ajay Aggarwal


Prof Cancer Services & Systems Research


Assistant Professor


Professor of Cancer Epidemiology
Dr David Lugo Palacios

Lugo Palacios

Assistant Professor in Health Economics
Prof Ellen Nolte


Professor of HS and Systems Research

Eva Kagenaar

Research Fellow


Research Fellow

Paula Fry

Project Coordinator


Professor of Health Economics Methodolog


Associate Professor
Dr Suping Ling


Assistant Professor in Epidemiology
Ms Yuki Alencar


Research Group Manager
Co-applicants (external)

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
Study design
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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.

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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.

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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 or contact

If you have questions about the SORT study, please contact the Co-Principal Investigators Prof. Richard Grieve at or Dr David Lugo Palacios at