PhD candidates

List of current theses

The art of oncology: communicating survival expectancy to patients with cancer
Quality of life and arm symptoms following axillary surgery for breast cancer
Costs and effectiveness of anticancer treatments
Exploring barriers to radiotherapy utilisation
Microvascular complications of diabetes
The effects of fenofibrate on various cell functions 
Studies of cardiovascular disease and its treatment
Costs of premature mortality in Australia
The Freedom Poverty Measure: a multidimensional measure of poverty for Australia 
Observed and latent measures for global health-related quality of life assessment

List of recent submissions

Studies of diagnostic test accuracy and clinical trials of treatment effectiveness
Predicting individual survival and the benefits of treatment for cancer patients
Patients' and clinicians' preferences for chemotherapy: what makes it worthwhile? 
Statistical methods addressing biases and inefficiencies in the design and analysis of clinical trials

Current theses

Thesis title: The art of oncology: communicating survival expectancy to patients with cancer

PhD candidate: Belinda Kiely

Supervisor: Martin Stockler

Summary: Belinda's goal is improving communication of life expectancy to patients in a way that is realistic but maintains hope. Median survival is the measure that most cancer professionals are familiar with, but for patients the median is unnecessarily discouraging and frequently misinterpreted. Many interpret the median as a limit and do not realise that 50% of individuals live longer. Belinda and her colleagues have suggested framing information in terms of the chance of surviving rather than the chance of dying, as a way of conveying hope. They also suggest using multiples and fractions of the median to present typical, best-case and worst-case scenarios to patients rather than just a single estimate of the median.

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Thesis title: The costs and effectiveness of anticancer treatments

PhD candidate: Deme Karikios

Supervisor: Martin Stockler

Summary: The aims of these projects are to assess the cost-effectiveness of new anticancer drugs and identify their determinants. Specific objectives include: to systematically review recent evidence about the costs and cost-effectiveness of anticancer drugs; and to survey medical oncologists to determine their views on how treatment costs affect decision making, and how problems associated with the increasing costs of treatment may be resolved. Another key objective is to perform cost-effectiveness analyses of expensive anticancer treatments, based on individual patient data from randomised trials conducted by the CTC. This includes the MAX trial of bevacizumab plus capecitabine in advanced colorectal cancer, and the ANZ0001 trial of capecitabine versus CMF in advanced breast cancer.

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Thesis title: Quality of life and arm symptoms following axillary surgery for breast cancer

PhD candidate: Michaella Smith

Supervisor: Martin Stockler

Summary: The aims of this project are to determine how best to measure, express, analyse and compare the effects of different operations on how women feel and progress after surgery for early breast cancer. This will be achieved by analysing longitudinal data on arm symptoms, functions, disabilities, body image and other aspects of quality of life, collected on 1088 women who participated in the RACS SNAC trial. The data also include arm measurements completed by doctors or nurses. Exploration, analysis and synthesis of these measures will provide important information about the effects of axillary clearance and sentinel node biopsy in early breast cancer. It will also generate new knowledge on how to design future studies comparing operations; especially how best to measure, express and compare their effects on patient-rated outcomes.

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Thesis title: Exploring barriers to radiotherapy utilisation

PhD candidate: Puma Sunderasan

Supervisor: Martin Stockler

Summary: The objectives of Puma's thesis projects are to: determine current radiotherapy (RT) utilisation rates in NSW; explore barriers to RT utilisation from the perspective of consumers (patients and carers) and their referring physicians; define the components of RT-related 'service inconvenienced'; and begin the development of a valid and reliable health-related quality of life tool that can accurately quantify RT-related inconvenience.

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Thesis title: Microvascular complications of diabetes

PhD candidate: Ru-Dee Ting

Supervisor: Anthony Keech

Summary: Ru-Dee's PhD is focused on microvascular complications in diabetes, and how they are treated with the drug fenofibrate (which reduces high cholesterol and triglyceride levels). The research is split into clinical and basic science parts. The clinical part is based on the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study and examines various markers which might predict renal disease, the effect that fenofibrate has on renal disease and the effect that has on the kidneys. The basic science part concentrates on elucidating how fenofibrate mediates beneficial effects on the kidneys. This seems to involve multiple pathways and is not as straightforward as was initially thought.

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Thesis title: The effects of fenofibrate on various cell functions

PhD candidate: Kushwin Rajamani

Supervisor: Anthony Keech

Summary: Diabetes is a systemic condition with various destructive effects on blood vessels and nerves. Patients are at risk of leg ulcers because of poor circulation and poor sensation. If the ulcers fail to heal properly, there is risk of infection leading to osteomyelitis (inflammation of the bone) or gangrene of the foot, which may require amputation of the toes or foot. An analysis of the FIELD trial showed that fenofibrate treatment reduces amputations. As part of his PhD project Kushwin is studying the effects of fenofibrate on various cell functions in an attempt to elucidate the mechanisms of this effect in laboratory mice with diabetes.

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Thesis title: Studies of cardiovascular disease and its treatment

PhD candidate: Jordan Fulcher

Supervisor: Anthony Keech

Summary: The NHMRC Clinical Trials Centre has gathered individual patient data on more than 169 000 patients participating in randomised trials of statin treatment. Jordan is currently undertaking systematic reviews of the large data sets to explore the effects of lipid-lowering treatment by gender, age and long-term follow-up, with a view to further investigate biological mechanisms for statin efficacy and safety in various populations.

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Thesis title: Costs of premature mortality in Australia

PhD candidate: Hannah Verry

Supervisor: Deborah Schofield

Summary: Decisions to publicly fund effective health interventions in Australia are generally based on costs that occur in the health sector alone. But premature mortality also reduces household income, savings and superannuation, tax revenue and economic productivity. Hannah's research will highlight the costs of premature mortality to individuals and society as a whole, which may have significant implications for how decision makers choose to allocate scarce resources. Hannah hopes her work will provide a valid method of incorporating societal costs into economic evaluations of health interventions and also that it will highlight the economic benefits of disease prevention.

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Thesis title: The Freedom Poverty Measure: a multidimensional measure of poverty for Australia

PhD candidate: Emily Callander

Supervisor: Deborah Schofield

Summary: Poverty is about having low living standards; however within Australia its measurement has traditionally focused only on an individual's income. Health and education are two additional requirements for adequate living standards and for basic functioning within modern society, but they have traditionally been ignored by measures of poverty. Emily's thesis develops a new measure of poverty for Australia - the Freedom Poverty Measure - which measures an individual's income, health and education attainment in order to determine their poverty status.

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Thesis title: Observed and latent measures for global health-related quality of life assessment

PhD candidate: Annette Kifley

Supervisor: Val Gebski

Summary: Evaluation of health-related quality of life (QOL) outcomes is now a key objective of many clinical studies. These evaluations typically involve assessing the overall balance of positive and negative impacts of conditions and treatments on different dimensions of QOL and health. Single summary measures are often unsatisfying in this context, but they are frequently required and used. An additional issue for statistical analysis of QOL data is that nonstandard response distributions are frequently encountered. This thesis explores latent variable modelling techniques that summarise information from health-related QOL assessments, and regression modelling techniques suitable for handling observed global QOL variables. The work will be useful for QOL evaluations aimed at pharmacoeconomic or individual clinical decision making, and in obtaining summary QOL measures for use in quality-adjusted survival analysis.

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Recent submissions

Thesis title: Studies of diagnostic test accuracy and clinical trials of treatment effectiveness

PhD candidate: Lukas Staub

Supervisor/s: John Simes, Sally Lord

Summary: Demonstrating how new tests affect treatment selection and subsequent outcomes will lead to improved patient health and more efficient use of health expenditures. After completing his PhD Lukas hopes to continue to develop and publish these ideas in order to improve the evidence base on which clinicians make decisions about the use of medical tests in everyday practice.

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Thesis title: Predicting individual survival and the benefits of treatment for cancer patients

PhD candidate: Chee Lee

Supervisor: John Simes

Summary: It is possible to individualise cancer treatment by identifying biomarkers that signal that a patient will benefit from treatment. Clearly this is good for patient quality of life, and Chee's quest is to find more treatments that suit each individual cancer patient, replacing the scattershot approach of one chemotherapy regimen for all. Having access to tumour tissues donated by patients as part of a particular clinical trial enables researchers to focus on determining where and why the drug worked. Ultimately this data can enable clinicians to determine if there is anything they can do to improve the situation of an individual patient. The laboratory and data collection for this research are conducted elsewhere; data are then analysed and managed within the CTC.

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Thesis title: Patients' and clinicians' preferences for chemotherapy: what makes it worthwhile?

PhD candidate: Prunella Blinman

Supervisor: Martin Stockler

Summary: Chemotherapy for cancer can improve cure rates, survival time and cancer-related symptoms; but it has significant adverse effects. Prunella's thesis reports the results of studies conducted to determine which benefits were sufficient to make chemotherapy for potentially curable colorectal cancer and lung cancer worthwhile, as judged by patients with cancer and their doctors.

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Thesis title: Statistical methods addressing biases and inefficiencies in the design and analysis of clinical trials

PhD candidate: Manjula Schou

Supervisor: Ian Marschner

Summary: Manjula's research project is studying a suite of problems concerning statistical methodology that can be used to address common biases and inefficiencies in the design and analysis of randomised studies, particularly clinical trials. Clinical trials methodology is one of the most important applications of statistics, and although it has been a widely studied area, many clinical trials are designed and analysed in either suboptimal or biased ways. The proposed research is seeking to address this in the following areas: adaptive methods involving analysis or modification of ongoing studies; subgroup analysis with particular reference to interpretation of heterogeneity in multinational studies; efficient study design in multi-arm trials; and study design methods that anticipate dropouts.

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