To PhD or not to PhD: did Shakespeare die of cancer?

Matthew Smith from the UK describes his research and shares his advice for a successful first year of PhD study

That is the question. Shakespeare, the renowned 17th century writer, died unexpectedly after a merry meeting with his writing fellows. Four centuries later, explanations on the cause of his death are still being formulated – the latest of which is a rare cancer of the tear duct known as Mikulicz Syndrome. But can the length of his survival give some indication as to whether he had this disease?

I am a biostatistician, having started my career by graduating from an undergraduate degree in in mathematics from Nottingham in 2015, which allowed a smooth transition to study the MSc Medical Statistics at LSHTM. Before starting the MSc, I spent a year as a General Surgery assistant at the Royal Hampshire County Hospital in Winchester, which enabled a greater understanding of the clinical, and patient-level, aspects to public health.

I initiated my PhD at LSHTM in September 2017 with the Cancer Survival Group, in the Department of Non-Communicable Disease Epidemiology. My objective is to broaden and deepen my understanding of the survival of patients with different types of cancer: particularly non-Hodgkin lymphoma. Interestingly, recent research has shown that those burdened are now more likely to beat their cancer. As part of my research, I am using advanced statistical methods to investigate the effects arising from a range of risk factors on the chances of survival from cancer. It was hypothesised that the comorbidity status of a patient accounted for some of the variability in survival between patients; however, we are adapting the hypothesis to suggest the disparities in survival outcomes are more likely due to the interaction between the patient characteristics and the health care system.

This PhD, along with other international research, is a stepping stone along the pathway of fighting cancer. My long-term goal is to establish clear and patient-centred treatment pathways that will enable all cancer patients to receive their optimal treatment and therefore experience their optimal survival outcome. When I complete my PhD, I plan to remain at LSHTM and build on the strong foundations that have been made through collaborations whilst integrating with universal health care systems, such as the National Health Service, to enhance services and achieve greater outcomes for cancer patients.

The first year of my PhD, via a literature review, involved strengthening my understanding of the current research and knowledge in my area. It is during this time that most students begin to develop their main research question; and build a report of the current knowledge and where the potential gaps in the research are. Towards the later stages of the first year each student will formally present their progress during an ‘upgrading process’, which is open for anyone to attend. This can be a daunting affair for most students; it was soothing to hear from a previous PhD student that although this is a formal examination it is an opportunity to gain crucial advice from experienced researchers in your area.

Building rapport with your supervisors helps enormously towards achieving your PhD objectives. I have a very good relationship with my both of my supervisors: Dr Edmund-Njeru Njagi and Professor Bernard Rachet. Your supervisors will be well practiced in balancing between allowing you space to develop your independent research skills and ensuring you are on track to complete your PhD. I meet with my supervisors once every two or four weeks, who openly engage with my questions and offer suitable, invaluable advice. Additional to your supervisors, you will have the prospect of establishing your advisory panel, who are usually subject-specific researchers that also give valued advice.

A strategy for my first year revolved around a clear timeline, which was established very early after beginning the research: this too can be difficult to follow. You may come across hurdles that hinder your planned progression; however, the timeline is guidance, and adaptable, and you can treat it as motivation. Logically, your literature review will highlight the general end-goal of your PhD; as you advance, you will anticipate what is achievable given the time available to you.

LSHTM is active in their support for student development: both academically and socially. There may be a high work load, but it is important to seize opportunities outside of your working routine. For example, I would not have understood a particular characteristic of a cancer cell if I had not attended a transferable skills workshop – something I did not expect! Other opportunities could be to lead a practical session for the master’s students who are learning your research area. I have developed useful friendships through attending optional MSc modules, and reinforced my skills through the transferable skills workshops.

Further to my studies, I am a member of the Centre for Statistical Methodology, and I hold a seat within the Students’ Representative Council (SRC) as Vice President, Research Degrees. There are a number of Centres within LSHTM ranging from infectious diseases to non-communicable diseases, through to mathematics and statistics: you can join more than one Centre, but it is worthwhile joining at least one. Each Centre will host their own events for all members to attend; for example, the event could be a lecture by a leading researcher in that field. Being a part of the SRC means you are responsible for voicing the research degree students; a particular highlight of this role was the ability to affect positive change in the experience of the research degree students at LSHTM.

The most influential piece of advice I have received is to be holistic but have depth: I would recommend this to any PhD student. In the first year, you will settle into a rhythm of your daily activities and understand your area in greater detail through literature reviews. Your research topic may change as you acquire knowledge, and you will may need to adapt your research question accordingly. The upgrading process will then be an opportunity to show what is the current awareness to your chosen field, where you plan to take the research, and what you want to find out. To achieve this: follow through with your timeline, communicate with your supervisors, collaborate with other leading researchers in your area, attend lectures (if only moderately related to your topic), and allow yourself to socialise and sink into the diverse culture here at LSHTM!

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