Living Well After Head and Neck Cancer Research Group
Our research group aims to optimise functional outcomes and quality of life in head and neck cancer, with strong collaborations regionally, nationally and internationally. Our programme covers a range of topics and issues, from diagnosis to end of life, from the perspective of patients and carers.
This work spans qualitative, quantitative and mixed methods, using designs including systematic reviews, feasibility and pilot studies to randomised control trials. We are closely aligned with Liverpool Head and Neck Centre’s Patient Forum, Patient & Public Research Groups | Liverpool Head & Neck Centre who provide a strong foundation and partnership, informing research development to dissemination. Our group has representation across healthcare disciplines (Head and Neck Surgeons, Oncologists, Nurses, Allied Healthcare Professionals), academics (Exercise Physiologists, Behavioural Scientists), methodologists, PhD candidates and early-career researchers.
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Prehabilitation and enhanced recovery
Prehabilitation can improve quality of life and reduce treatment complications in cancer care. Integrating prehabilitation into routine HNC care poses huge challenges, due to the nature of symptoms and side-effects, a limited time-frame before the onset of treatment, and a complex care pathway. Our focus is on developing and evaluating prehabilitation and enhanced recovery interventions, to improve patients’ physical and psychological well-being. Hear more about our work here.
Patient reported measures
Information on the impact of head and neck cancer and its treatment taken from patients’ and carers’ perspectives are crucial for accurate information provision, decision-making, directing consultations, robust research end-points and informing guidelines. Our work includes developing patient-reported measures and symptom indices, re-purposing and testing existing measures for different populations and integrating them into clinical care for patient benefit. We are optimizing and evaluating mechanisms to enhance completion of measures, including digital platforms.
Support and rehabilitation
Head and neck cancer and its treatment can have a huge impact on patients’ and carers’ daily lives, affecting functions such as breathing, communication, swallowing and activity, with multiple symptoms including pain, fatigue and altered appearance. Physical, emotional, social, and financial concerns are common, impacting on quality of life, and influencing treatment.
Quality of Life
Quality of life is a fundamental consideration following the diagnosis of head and neck cancer. Its measurement as an outcome helps refine treatments. Its inclusion in clinical practice allows for targeted intervention. Individual and holistic care is enhanced through the use of the Patient Concerns Inventory and the number of concerns correlates with quality of life. Our research focus on aspects of validation, refinement, utility, implementation and dissemination.
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If you are interested in getting involved in research we would love to hear from you.
Please get in touch with Michelle Lawton michelle.lawton@liverpool.ac.uk
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Our group is currently accepting PhD applications from suitable candidates with identified funding, with topics aligned with our research focus. Further details can be found here How to apply | Postgraduate research | University of Liverpool
Nurses and Allied Healthcare Professionals seeking NIHR Integrated Clinical Academic funding from pre to post doctoral level Research career funding programmes | NIHR are also welcomed.
RESEARCH
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Professor Jo Patterson Inaugural 12 June 2025
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Functional Outcomes in Head and Neck Cancer - Prof Jo Patterson
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The Patient Concerns Inventory (PCI-HN) is a condition specific prompt list. The concept stems from the literature on the value of question prompt lists in oncology, however as an item the approach has a simplicity which enables its integration into routine care. The PCI-HN was developed as a tool to help overcome some of the difficulties inherent in Health-Related-Quality-of-Life (HRQOL) questionnaires, notably the limited number of issues, the wording, the reliance on Likert scoring as an outcome and the patient questionnaire burden.
The PCI-HN was developed through patient focus groups and first published in 2009 [1]. It is a tool for use in post treatment consultations to help patients raise issue that otherwise, though important, can be missed. It compromises of a list of 56 items and covers physical, treatment, social care, psychological and spiritual aspects. In addition, the PCI-HN lists 18 allied professionals and asks patients to select any that they would like to talk with in clinic or by referral. A systematic review and content comparison of unmet needs self-report measures used in patients with head and neck cancer favoured the PCI compared to 13 other tools [2]. There is also a PCI-HN with specific items appropriate for use at the time of diagnosis of head and neck cancer [3]. The PCI is a free to use resource.
There have been numerous papers on the PCI and these support the premise that:
· It is feasible in routine patient care
· It is appreciated by patients
· It is a tool that helps the ‘hard to reach’ such as elderly and those from low socioeconomic backgrounds.
· It facilitates the ‘conversation’ around potential unmet needs
· Its frequent use provides multiple opportunities for intervention
· It had stratified and make more appropriate the referrals to disciplines (targeted signposting)
· A realisation of the common issues serves as drivers for change reflecting patient experience
· A randomised trial (RCT) provides evidence of benefit as a low-cost intervention which improves patients quality of life
· The PCI approach has been developed in other cancers and long-term conditions such as neuro-oncology, burns, rheumatology, stroke
1.Rogers SN, El-Sheikha J, Lowe D. The development of a PatientsConcerns Inventory (PCI) to help reveal patients concerns in thehead and neck clinic. Oral Oncol 2009. Jul;45(7):555-61. doi:10.1016/j.
2.Shunmugasundaram C, Rutherford C, Butow PN, Sundaresan P, DhillonHM. Content comparison of unmet needs self-report measures used inpatients with head and neck cancer: A systematic review. Psychooncology2019. Dec;28(12):2295-2306.
3.Byrne MJ, Rogers SN (2017) Service evaluation of patients’ views on the Patients’ Concerns Inventory (at diagnosis). Br J Oral Maxillofac Surg 55(7):714–716.
You can access the PCI-HNC here: Patient Concern Inventory | Liverpool Head & Neck Centre
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This feasibility study is funded by the NIHR Research for Patient Benefit and aims to understand and evaluate head and neck cancer (HaNC) patients’ engagement in physical exercise. The vast majority of HaNC patients have low levels of physical activity, associated with substantial treatment side-effects. The project will develop a collaborative, flexible, patient-centred personalised programme, with tools to support HaNC-specific barriers to exercise, and test whether this is feasible and acceptable. 35 HaNC patients will be recruited across Liverpool and Sunderland. Physiotherapists will work with local Cancer Exercise Specialists to devise a personalised exercise programme, using support tools to overcome HaNC-specific barriers, with weekly virtual support. We will assess; rates of uptake, retention and exercise completion; patient reported symptoms and QOL; physical fitness. We will interview patients and healthcare professionals. Our study will determine whether further research into personalised exercise programmes is feasible and worthwhile.
Our team includes
Professor Jo Patterson, Speech & Language Therapist, University of Liverpool
Val Bryant PPI representative
Professor Adrian Midgley, Clinical Exercise Physiologist and certified Cancer Exercise Specialist
Dr Andy Levy, Reader and Chartered Exercise Psychologist, Edge Hill University
Professor Simon Rogers, Consultant HNC Surgeon, Edge Hill University
Mr Mike Nugent, Consultant HNC Surgeon, South Tyneside and Sunderland NHS Foundation Trust
Mr Andrew Schache, Consultant HNC Surgeon and Reader at University of Liverpool
Ruth Price, Specialist HNC Physiotherapist, University of Liverpool Hospitals Foundation Trust
Dr Brooker, Academic Clinical Oncologist, Clatterbridge Cancer Centre, Liverpool
Dr Steven Lane Medical Statistician, University of Liverpool
Professor Bridget Young, Qualitative Methodologist, University of Liverpool
Collaborator: Dr Gillian Prue Queens University Belfast, Chair of the NCRI Acute Care and Toxicities Workstream and member of the Living With and Beyond Cancer Group
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In healthcare, the 'head and neck' region includes the nose, mouth, throat, voice box, thyroid and salivary glands. Many patients present to their GP with symptoms affecting these areas, including hoarse voice, throat discomfort, neck lumps, mouth ulcers and difficulty swallowing. In some patients, these symptoms will be caused by a 'head and neck cancer', and so they may be referred to the hospital for an urgent specialist opinion. In the last year in England, 228,482 patients were referred with suspected head and neck cancer, making it the fifth largest group of suspected cancer referrals.
After specialist assessment, the vast majority (95%) of these patients can be reassured that they are cancer-free, but about 5% of patients will be diagnosed with cancer. In referral pathways for some other suspected cancers (e.g., prostate and lung), a scan may be arranged before the patient is seen in clinic to help reach the diagnosis sooner, and reduce any anxiety that the patient may experience in this period. However, due to the various types of cancer seen within the head and neck, no single laboratory test, imaging investigation or diagnostic procedure is suitable to assess all the referrals we receive. Around one third of patients referred with suspected head and neck cancer will undergo some form of investigation but the information in the referral is often not enough to decide who may need an investigation, or which type they may need.
We will work with patients and other interested parties to develop and implement a new pathway for suspected head and neck cancer referrals, based around the patient and their symptoms. In the new pathway, the hospital will make contact with the patient soon after receipt of the referral. Patients, with the help of their family and/or carers, will be asked to complete an electronic questionnaire about their symptoms using a smartphone, tablet, computer or automated phone call. Building on our previous work, we will develop a risk stratification system for head and neck cancer and based on thousands of new referrals who will be assessed as part of our development and feasibility work. The hospital specialist will then review all the information from the symptom questionnaire and the patient’s individualised risk score to advise the most appropriate management, before the patient comes to hospital. Using this system, higher-risk patients may have targeted investigations arranged directly, before being seen in clinic, and lower-risk patients may avoid unnecessary investigations and hospital appointments before being reassured. We will compare this new pathway to the existing system to ensure it is safe in identifying just as many cases of cancer, while also leading to faster diagnosis, reducing patient anxiety and using healthcare resources more efficiently.
For more information see EVEREST-HN | The Royal Marsden
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Background: The NIHR funded EVEREST-HN research programme aims to improve the way that the NHS assesses more than 200,000 people per year who are suspected of having Head and Neck cancer. Our research team are refining tools (that use patient reported problems with voice and swallowing) to identify those who likely have Head and Neck cancer. If a GP suspects their patient might have cancer, they refer them to a clinic led by a specialist in Head and Neck (H&N) cancer. In the future, the patients will be asked by health practitioners to complete a questionnaire through an NHS website or through a telephone service. This questionnaire will be automatically processed to alert the H&N clinic if the patient is at ‘high risk’ of having cancer.
Our questionnaire also identifies those at a low risk of cancer. Probably as many as 97 of 100 people referred to the H&N clinic do not have cancer. Although low risk, this group still require specialist assessment and treatment. We think a new Speech and Language Therapist (SLT) led clinic could be a helpful solution. These therapists are highly skilled at assessing and treating problems with voice and swallowing.
Study aims: to develop a model of how SLT clinics should be set up. This will include defining:
What specific clinical skills the SLTs need and how patients are assessed
To do this, we will: Look at how similar clinics in other specialities work, including how they decide what skills are essential. Analyse the ways that medical specialists conduct H&N consultations to produce an assessment procedure used in ‘usual care’. We will then: Share the skills list and assessment procedure with experts in the field. Ask the experts to agree a final list of essential skills and assessment procedures. Future work: Beyond this proposal, we will need to do more research to check whether the new SLT clinic works to help diagnose and treat patients' voice and swallowing problems.
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The study aims to improve the experiences of patients with incurable head and neck cancer (IHNC) by finding out the most pressing issues for them and developing solutions to improve these.
How will we do this?
1. A series of up to three interviews, over an 8-month period, with incurable head and neck cancer patients and their families, along with group discussions with healthcare workers involved in head and neck cancer care. These will explore how patients’ needs and use of healthcare change over time.
2. Using interview and group discussion findings, we will hold a series of workshops with patients, families, clinical service leaders, and healthcare workers. We will identify priorities and develop ways to improve care experiences.
The study was awarded funding from the NIHR Research for Patient Benefit programme.
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Background
In the UK, approximately 6,000 people receive radiotherapy each year for head and neck cancers. This treatment usually takes place in daily sessions lasting around 10-15 minutes, and it is essential that patients do not miss any appointments. To ensure precise targeting of radiation while sparing healthy tissues, patients must remain completely still during daily treatment. Currently, rigid, custom-made thermoplastic masks are employed to limit movement, but these are tight and uncomfortable. Patients with head and neck cancer who are receiving radiotherapy often feel a lot of anxiety, especially because of the immobilization masks they have to wear. The mask is a rigid plastic device that helps keep patients still during treatment, but it can be quite uncomfortable, and this discomfort often increases as treatment goes on. These masks can make some patients feel claustrophobic and very uncomfortable. Studies show that up to 40% of patients ndergoing radiotherapy experience anxiety and some patients need to take breaks from treatment or use medication to help calm their nerves.
Aim(s)
The primary aim of this project is to reduce anxiety for radiotherapy patients with head and neck cancer by using virtual reality (VR) technology during treatment while anxiety while ensuring patients remain motionless. This system is intended to improve patient comfort and psychological well-being during treatment sessions.
Design and Methods
To ensure safety, the system will undergo comprehensive testing to make sure it works in a radiation treatment room and also to check that it does not interfere with the radiation dose delivered during treatment. The next phase involves evaluating the experience of using VR by asking healthy volunteers from the local community to have simulated CT scans; one using the traditional fitted mask and the other using the new VR system. Following each session, volunteers will complete anxiety surveys and have their heart rates monitored to assess how the experience affected them. Additionally, their head positions will be tracked using a laser system to check that they did not move during the session After experiencing both systems, volunteers will have short interviews to compare their experiences and share their feelings about each method. This feedback will help researchers determine whether the VR system reduces anxiety compared to the normal mask.
Patient and Public Involvement
The design of this project has been informed by a local patient-led research group and a patient group specializing in head and neck cancers. This collaboration will continue throughout the project, providing input on hardware and software design, user evaluations, and sharing results.
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We aim to improve support services for people diagnosed with head and neck cancer (HNC). The number of people treated for HNC is increasing. About a third have anxiety or depression (also known as emotional distress) which is bad enough to require professional support. Emotional distress reduces quality of life and can make living with symptoms of HNC worse. Many have long-term and complex difficulties with altered appearance, speaking, eating, and drinking difficulties, leaving them very isolated. Some people with HNC do not wish to engage with professional services to help reduce emotional distress. A wider range of care and support must be available. Peer support is one option; it involves people with a similar condition providing social, emotional, or practical support to others. This form of support has been beneficial in other cancer groups. Peer support could improve mental health, provide access to help closer to home and reduce healthcare use. Little is known about the best way to set up a peer support service. Multiple perspectives are required including HNC patients, local and national healthcare providers, social care providers, and cancer charities. Developing a better understanding of how to design and organise a peer support service is the primary aim of this project.
How will we do this?
There are two main parts to our work, occurring over 15-months within North-West England. First, we will gain idea from patients and people working in healthcare. Interviews will highlight issues and attitudes towards the development and implementation of a peer support service. We will recruit from places with high poverty, diverse ethnicity, and varying distance from specialist cancer centres. We will conduct three workshops with patients, healthcare and social care staff, and cancer charities, to put all the information together and develop a peer support intervention for future testing. We anticipate the intervention will address issues such as identifying and training peers, enabling access, understanding who peer support is likely to benefit and how to reach people who are isolated.
Patient Involvement
Our established HNC Patient Forum identified peer support as a research priority. Members described benefit from meeting other patients, some preferring this to talking to professionals. However, they recognised that peer support access is variable and limited. They identified multiple problems such as matching patients, and peer supporter training. The Forum has guided our plan. We have an experienced PPI representative on the project. He has advised on the proposal and will chair regular PPI meetings. They will help develop information resources, comment on findings and help with sharing our findings.
To find out more, please contact:
Prof Jo Patterson joanne.patterson@liverpool.ac.uk.
Our Research Group
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Dr Michelle Lawton
HEE/NIHR Advanced Clinical & Practitioner Academic Fellow
Michelle is a Clinical Academic Speech and Language Therapist, specialising in dysphagia (swallowing difficulties), working across the University of Liverpool and Mid Cheshire NHS Trust. She is currently undertaking an NIHR Advanced Fellowship, developing and evaluating the feasibility of a novel intervention to improve swallow function for people following head and neck cancer, in addition to working clinically as an Advanced Clinical Specialist in head and neck oncology. She is passionate about developing innovative technologies through research to improve patient outcomes.
Michelle received her undergraduate degree in Speech Pathology and Therapy from Manchester Metropolitan University (BSc (Hons): first) in 2003. She went on to complete a PhD at the University of Manchester, winning a Stroke Association postgraduate Fellowship in 2013. As part of her PhD, Michelle developed a psychometric scale to measure the impact of developing a positive therapeutic alliance in aphasia rehabilitation, which is now being translated internationally. Following her PhD, she secured an NIHR postdoctoral bridging Fellowship in 2021 and Advanced Fellowship in 2023.
Michelle has over 20 years of clinical experience in assessment and management of dysphagia and communication impairment arising from multiple aetiologies. Her clinical and research interests include: prehabilitation, outcome measurement, instrumental assessment, respiratory disorders, psychosocial adjustment and novel swallow interventions. She has presented nationally and internationally and taught at undergraduate and postgraduate level. She is mentor for research-active healthcare professionals and a supervisor for pre-doctoral and doctoral students.
Michelle leads the ‘Improving Outcomes in Head and Neck Cancer’ research seminars at the Liverpool Head and Neck Centre. She is a mentor and research champion for The Royal College of Speech and Language Therapists and a steering group member of the Council of Allied Health Professions Research (CAHPR).
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Professor Simon N Rogers
Consultant Oral and Maxillofacial Surgeon
Simon worked as Consultant Surgeon at the Liverpool Head and Neck Centre with special interest in oncology and microvascular free tissue reconstruction between January 1999 to April 2022. From 2007 he had a funded secondment as professorial in the Faculty of Health, Social Care and Medicine at Edge Hill University.
He has published extensively with over 450 peer review papers and numerous book chapters. The main focus has been on the subject of patient reported outcome and quality of life. He was instrumental in the development of the UW-QOLv4 which was published in 2002. This questionnaire is one of the most commonly reported QOL questionnaires used in head and neck cancer. http://www.handle-on-qol.com/Index.aspx
As the Chief Investigator, he has seen the successful completed a NIHR funded trial: ‘Improving quality of life through the routine use of the Patient Concerns Inventory for head and neck cancer patients: a cluster preference randomized controlled trial (NCT03086629). This trial produced 13 peer review publications.
Simon chaired the NHS England Quality of Life Metric Steering Group for many years. The Group successfully delivered full national roll-out in October 2021.This initiative is part of the ‘Achieving World-Class Cancer Outcomes: a strategy for England’.
From May 2022 Simon was appointed as a full-time consultant in the Department of Oral and Maxillofacial Surgery, at Wirral University Teaching Hospital. In October 2022 he was appointed as Clinical Lead for Research and Innovation at the Trust.
Simon remains research active through his links with the Liverpool Head and Neck Centre. He contributes to the Living Well After Head and Neck Cancer Research group.
https://www.researchgate.net/profile/Simon-Rogers-2
7,774 Research Interest Score, 17,122 Citations, 70 h-index (ORCID identifier: 0000-0002-5989-6142).
In 2024 Simon was awarded The Down Surgical Prize: The Down Surgical Prize is the most prestigious award given by the British Association of Oral and Maxillofacial Surgeons for excellence and outstanding contribution. The prize and Medal awarded annually, which will be considered a high honour, to be awarded to a person or persons who are adjudged to have made a major contribution to Oral and Maxillofacial Surgery in the widest sense.
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Dr Gemma Cherry
Clinical psychologist/ Senior Lecturer
Gemma is an academic clinical psychologist who combines a clinical role (psycho-oncology) at the Royal Liverpool University Hospital with a substantive post as a Senior Lecturer in Clinical Psychology at the University of Liverpool.
As well as working on the doctoral training programme helping to train clinical psychologists, she conducts research designed to improve the experiences of patients with physical health difficulties (particularly cancer). Her research focuses on understanding why some people experience psychological distress after a diagnosis of cancer or physical health difficulty, and on developing and testing interventions to reduce psychological distress in this context. She also has an interest in clinical decision-making and clinical communication, and lead several studies focused on improving these aspects of care. I work closely with the Liverpool Head and Neck Centre on a range of studies, including:
an NIHR-funded trial (the ACTIOHN study) examining the feasibility of a tailored exercise programme for patients with head and neck cancer (qualitative lead)
studies designed to improve swallowing and lymphoedema outcomes for patients (including leading the qualitative aspect of feasibility studies and co-supervising the development and validation of a lymphoedema quality of life scale)
studies examining treatment decision-making for older adults with advanced cancer and their carers
I am passionate about improving the experiences and well-being of those affected by cancer in our region and am also working closely with the LHNC team to progress grant applications to this end.
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Dr Pete Bridge
Senior Lecturer in Radiotherapy and Oncology
Pete is a senior lecturer in Radiotherapy and Oncology at the University of Liverpool where he teaches radiotherapy planning, physics and research skills. Prior to this, he worked as a senior lecturer and undergraduate course coordinator at Queensland University of Technology in Brisbane, Australia. Pete’s research interests lie in the role of technology for radiotherapy education and clinical practice and particularly the use of virtual reality.
He conducted the first evaluation of a virtual linear accelerator educational resource prior to its commercialisation as VERT (Virtual Environment for Radiotherapy Training) and led a funded project to develop and evaluate a medical imaging 3D immersive educational environment. He has published on a wide range of educational innovations ranging from VR applications to engaging patients to provide student feedback. He co-authored the “CT Anatomy for Radiotherapy” textbook, is the Editor in Chief for the Journal of Radiotherapy in Practice and is one of the editors of the 9th edition of Walter and Miller’s Textbook of Radiotherapy.
He has recently developed and evaluated a VR environment for supporting mental wellbeing for students and is currently co-leading an NIHR-funded project exploring the use of VR during head and neck radiotherapy. In his spare time he enjoys mountains, mud and good beer.
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Dr Hannah Doughty
Lecturer in Psychology
Dr Hannah Doughty is a mixed methods researcher who is currently working as a Lecturer in Psychology at Liverpool John Moores University. She holds a First-Class Honours (BSc) degree in Applied Psychology awarded by LJMU in 2015 and a PhD in Health Psychology, awarded by the University of Liverpool in 2024. Her PhD applied behaviour change theory to explore the barriers to, and facilitators of, physical activity promotion and participation for people living with and beyond head and neck cancer. For over a decade, she has worked across academic and NHS settings including The Clatterbridge Cancer Centre in health-related research, with a strong focus on improving the quality of life for people affected by head and neck cancer. She is an active member of the Research Centre in Brain and Behaviour and the Institute for Health Research at LJMU, where she Co-Leads the Cancer Specialist Interest Group.
Hannah’s research interests are focussed on improving the quality of life of individuals living with and beyond cancer and other long-term conditions. She applies behavioural science to understand and address unmet needs, particularly in underserved cancer cohorts. Her interests include:
The psychological impact of cancer
Health-related behaviour change
Palliative and supportive care needs in head and neck cancer
Patient and public involvement in health research
Patient-centred care, service design and delivery
The use of qualitative methods to inform the design and delivery of clinical services and trials.
She has led research focused on improving psychological wellbeing, quality of life and physical activity engagement for those living with and beyond head and neck cancer, and she has contributed to work exploring the palliative care needs of people with advanced head and neck cancer. In addition, she has co-designed a book exploring patient experiences of radiotherapy for gynaecological cancer, which was shortlisted for the Excellence in Research Award by North West Cancer Research.
PhD Students
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Laura-Jayne Watson
NIHR Doctoral Clinical & Practitioner Academic Fellow
Find out more
Laura-Jayne's doctoral thesis aims to better understand what care people with a laryngectomy and their families need at home.
Research Question:
What are the healthcare needs of laryngectomy patients and their families following discharge after surgery and how can these be incorporated into a prototype education and training package for use by community healthcare professionals?
Research Objectives:
1. To identify and critically review available laryngectomy education and training packages (ETP)
2. To explore patient and family members experiences and needs from community healthcare services following laryngectomy
3. To co-design a prototype laryngectomy ETP for community healthcare professionals
Methods:
There will be three work-streams in this research:
· Work-stream 1: Environmental scan of available laryngectomy ETP’s
· Work-stream 2: Semi-structured qualitative interviews with laryngectomy patients and family members
· Work-stream 3: Co-design workshops with patients, families and healthcare professionals to design a prototype ETP
Two simultaneous groups will run alongside the research: patient-advisory group and healthcare professional stakeholder advisory group. Both groups will review findings from the environmental scan and semi-structured interviews to shape the co-design phase and ensure the research stays grounded in patient experience and service needs.
Supervisors: Professor Jo Patterson,
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Linda Cantwell
Doctoral Candidate
Linda is an advanced practitioner dietitian with over 12 years clinical experience, specialising in home enteral feed and head and neck cancer. She has developed a research interest in prehabilitation in head and neck cancer. In 2020 she secured an NIHR pre-clinical academic fellowship and completed a systematic review to investigate the current landscape of nutritional prehabilitation in head and neck cancer.
In January 2025 she will commence an NIHR Doctoral Clinical Academic Fellowship in collaboration with the University of Liverpool and the Liverpool Head and Neck Centre. The aim of her research is to develop, implement and investigate the feasibility of a Co-produced nutritional prEhabilitation iN Head And Neck CancEr intervention for patients treated with radical radiotherapy (+/- chemotherapy) (Co- ENHANCE).
She is also chair of the British Dietitian Association (BDA) specialist group Parenteral and Enteral Nutrition Group (PENG) and represent PENG on the British Association of Parenteral and Enteral (BAPEN) council.
Supervisors: Jo Patterson
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Sarah Stephens
Doctoral Candidate
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Sarah’s research aims to explore how transoral surgery affects swallowing and communication in the first six weeks following surgery for cancer of the oropharynx (part of the throat directly behind the mouth that helps you speak and swallow).
Sarah’s research will provide:
In depth analysis of early post operative changes to function (speech and swallowing) which will allow clinicians to delineate which patients benefit functionally from transoral surgery thereby facilitating the complex treatment decision-making process
Evidence on the impact of surgical technique (transoral laser microsurgery vs transoral robotic surgery) which will guide policy and clinical decision making
Greater understanding of functional changes which will improve pre-treatment education, thus reducing anxiety and engagement (patients and carers) in the post-operative period.
Qualitative data to enhance the understanding of oropharyngeal dysfunction, highlighting the timing and nature of functional problems, alongside patient and carer priorities. This will optimise care pathways and efficient clinical management. It will also enhance understanding of patient experience of functional assessments and data collection processes.
a set of core outcome measures, which has been identified by an international panel of experts (clinicians and patients), aiming to reduce heterogeneity in future research data, allowing for comparisons amongst observational studies, strengthening the evidence available to clinicians.
Supervisors: Professor Jo Patterson,
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Shamah Alnahham
Doctoral Candidate
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Shamah’s research aims to evaluate the diagnostic accuracy of screening tests for detecting aspiration in patients with head and neck cancers. Throughout thesis, Shamah presents three different studies. An initial systematic review will be conducted to assess the diagnostic accuracy of swallowing screening tools for detecting aspiration among head and neck cancer patients. Using existing data, the second study will evaluate the diagnostic accuracy of the 100mL Water Swallow Test for detecting aspiration will be compared with videofluoroscopic swallowing evaluations for patients with HPV+ Head & Neck Cancer. The final study will use a modified water swallow test to screen people treated for head and neck cancer for aspiration.
Supervisors: Joanne Patterson, Michelle Lawton, Jenan Altamimi, Andrew Schache
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Alison Smith
NIHR Doctoral Clinical & Practitioner Academic Fellow
Alison’s doctoral thesis aims to provide an example of how patients receiving treatment for HNL have an improved quality of life and better chances of swallowing a normal texture of diet without needing to eat softer foods or rely on high calorie alternatives like drinks or liquid food through feeding tubes in the stomach. Ideas of what could be done to improve patient care and help to better manage HNL will be discussed. Together, refinement of a personalised treatment programme will be agreed. The agreed solution will then be tested with HNC patients to get their view.
Research Question:
Is Complete Decongestive Therapy (CDT) a feasible and acceptable intervention for patients with head & neck lymphoedema (HNL) following treatment for head and neck cancer (HNC)?
Research Objectives:
1. To identify and critically review the content and relevance of the literature on HNL interventions and their impact on dysphagia outcomes, retention and adherence.
2. Co-Production: Identification of solutions to acceptability, refining the intervention, and materials used with patient and AHP stakeholder workshops, along with a principal patient co-creator.
3. To deliver a co-produced individualised CDT intervention to HaNC patients with HNL and evaluate its acceptability and feasibility
Methods:
There will be three work-streams in this research:
Work-stream 1: A Systematic Review
A search of any research that has used CDT to treat HNL to understand if this type of treatment has previously been practical to HNC patients receiving it, and if it improved their swallowing function.· Work-stream 2: Co production
Three workshops of people who have had HNC, their partners/carers and HNC health professionals. People will be invited nationally and called ‘coproduction participants’. Participants will be asked to share challenges and thoughts on the treatment programme itself. Any changes to the treatment programme and therapy resources will be made once agreed.
Work-stream 3: Feasibility study
This will test if personalised CDT is a practical and acceptable treatment for HNL to improve swallowing. Afterwards, participants will be invited to take part in a short interview to share their views on the treatment.
Supervisors: Professor Jo Patterson, Dr Gemma Cherry, Mr Jason Fleming
Research Staff
Strategic Advisory Board Member
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Dr Kate Hutcheson
Deputy Director
Dr. Kate Hutcheson is a Professor and Deputy Director of Clinical Research in the Department of Head and Neck Surgery with dual appointment in the Division of Radiation Oncology at the University of Texas MD Anderson Cancer Center. She serves as Section Chief and Research Director for the Section of Speech Pathology and Audiology. Dr. Hutcheson is a certified speech-language pathologist, a Board Certified Specialist in Swallowing and Swallowing Disorders (BCS-S), and holds a Doctorate Degree in Epidemiology. She maintains an active clinical practice and research program. She has authored over 120 journal articles with funding support from the National Institutes of Health, Patient Centered Outcomes Research Institute, the MD Anderson Institutional Research Grant Award program, and the CPRIT UT Health Innovation Training Program. She is an accomplished clinician and educator who lectures nationally and internationally on radiation associated dysphagia and head and neck cancer rehabilitation.
Honorary Members
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Dr Roganie Govender
Consultant Clinical-Academic SLT - Associate Professor, UCL Head & Neck Academic Centre
Roganie is a consultant speech and language therapist and clinical-academic at University College London Hospital and an Associate Professor at the University College London Head and Neck Academic Centre. She is currently an AHP representative on the British Association of Head and Neck Oncology Council, co-research lead for the RCSLT Head and Neck CEN, and UK representative on the research board of the European Society of Swallowing Disorders (ESSD).
Roganie undertook her honours and master’s degrees in South Africa where she qualified as a speech pathologist and audiologist working at the Chris Hani Baragwanath Hospital in Soweto and the Johannesburg General Hospital prior to re-locating to the UK. She has more than 30 years of experience as a clinician, predominantly in the field of ENT and head and neck cancer focussing on dysphagia. Alongside clinical work, Roganie has been the recipient of multiple NIHR awards which have enabled her to develop as a researcher. These include a NIHR doctoral fellowship (CDRF), clinical lectureship and post-doctoral funding. Most recently she was awarded a Senior Clinical and Practitioner Research Award where she will work closely with researchers both in Liverpool and London collaborating on and facilitating multicentre research in head and neck pre/rehabilitation across the country. Having obtained her PhD in behavioural science and health at UCL and had training in applied health research, Roganie is ideally placed to apply these skills to her clinical research interests. Roganie was the chief investigator for SIP SMART, an SLT-led, pilot multicentre clinical trial on dysphagia prehabilitation for people with head and neck cancer. Roganie has published widely in her field, presented her work nationally and internationally and is actively involved in postgraduate teaching and research supervision alongside several professional committee roles.
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Dr Soultana Papadopoulou
Assistant Professor, Department of Speech and Language Therapy, University of Ioannina
Dr. Soultana Papadopoulou, PhD (Medical School, University of Ioannina, 2014), serves as Assistant Professor in the Department of Speech and Language Therapy at the University of Ioannina.
Her scholarship is devoted to the multifaceted study of dysphagia in both neurodevelopmental and medical contexts, with particular emphasis on the rigorous detection, comprehensive assessment, and targeted intervention of feeding and swallowing disorders, as well as the meticulous adaptation and validation of clinical screening instruments for Greek-speaking dysphagic populations.
Her research portfolio encompasses randomized clinical trials, systematic reviews, and authoritative chapters in international edited volumes, alongside numerous peer-reviewed articles that advance novel interventional paradigms.
She has supervised a breadth of clinical and pedagogical investigations in language development, dysphagia, and special education, contributed teaching in Erasmus exchanges, and engages actively in scientific and administrative committees. Through these endeavors, she fosters interdisciplinary dialogue and propels an integrated, lifespan-oriented understanding and management of dysphagia across diverse pathological cohorts.
Collaborators
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Professor Adrian Midgely
Professor of Clinical Exercise Physiology, Edge Hill University
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Biography
Adrian has been a member of the sport and exercise science programme team within the Department of Sport and Physical Activity since October 2012. He was previously a lecturer at the University of Hull at which he completed his PhD in exercise physiology. He currently leads BSc Sport and Exercise Science modules in exercise and health and in clinical exercise physiology. In addition to his academic qualifications in sport and exercise science, Adrian holds many vocational qualifications in health and fitness, including specialist qualifications in cancer, cardiovascular disease, obesity and diabetes, exercise referral, older adults, pre- and postnatal exercise, corrective exercise, and management of low back pain He is the Designated Individual for human tissue compliance within the University, and sits on the central university ethics committee.
Research Interests
Adrian’s is probably best known for his research into the measurement and development of cardiorespiratory fitness. He also has a strong interest in factors that explain exercise tolerance during maximal exercise. His current research focuses on exercise testing and prescription in clinical populations, such as those with head and neck cancer, cardiac disease, and pulmonary disease.
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Professor Chris Ward
Professor of Respiratory Physiology, Newcastle University
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Chris has made significant contributions to respiratory physiology over 35 years, publishing over 300 papers. His work focuses on human lung injury, remodeling, comorbidity, and treatment effects. Funded by organizations like NHMRC, MRC, and Wellcome, his research has practical implications. The Ward lab’s pioneering work on neutrophilic airway pathophysiology and differentiated airway epithelium has impacted lung research including COVID discovery research.
Supervision and Collaboration: Chris has supervised 15 PhD students in the UK, fostering effective working relationships. His postdocs have transitioned to clinician scientist roles, and overseas students have become PIs and associate professors.
Impact and Engagement: Chris actively engages with patients, initiating a fibrotic lung disease user group. His research has influenced clinical practice, including lung transplantation and CF clinics. His overseas students have applied their training in COPD prognostication and infectious diseases. His commitment to broader societal benefit extends to teaching and linking NHS and University colleagues.
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Professor Heather Starmer, Stanford Medicine
Clinical Professor and Director of the Head and Neck Cancer Speech and Swallowing Rehabilitation Center
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Heather Starmer is a Clinical Professor and Director of the Head and Neck Cancer Speech and Swallowing Rehabilitation Center. She is a Board Certified Specialist in Swallowing and Swallowing Disorders. in 2023 she was awarded the prestigious Fellow designation by the American Speech Language and Hearing Association (ASHA).
Prior to joining the faculty at Stanford University, Professor Starmer served as the lead of the head and neck cancer rehabilitation program at Johns Hopkins University.
She has pursued doctoral studies at the University of Liverpool with completion of her PhD in Applied Health Research in 2024. Her doctoral dissertation focused on the assessment of head and neck lymphedema with a particular emphasis on the patient experience and quality of life.
Professor Starmer specialises in the rehabilitation of speech, voice, and swallowing in patients with head and neck cancer. She has particular interest in prevention of communication and swallowing disorders associated with radiation and chemotherapy. She has a strong interest in head and neck cancer survivorship and helping patients to accomplish their personal goals and to optimize their quality of life long term.
Professor Starmer's academic goals include improving communication and swallowing outcomes following a diagnosis of head and neck cancer through clinical research. She was a key member of a collaborative research group at Johns Hopkins resulting in multiple publications and presentations on strategies to minimize speech and swallowing difficulties. Recent advances in pain management during radiation therapy developed by this research collaborative have already shown great promise in protecting patients from potential swallowing difficulties during and after their cancer treatment. She works closely with colleagues in surgery, radiation oncology, and medical oncology to tackle the often difficult problems encountered by patients with head and neck cancer. She has particular interest in investigating the role of innovative surgical techniques such as Transoral Robotic Surgery (TORS) in minimizing long term functional deficits. She regularly collaborates with colleagues around the globe to develop innovative solutions to challenges encountered by head and neck care teams and the patients they serve. -
Professor Mike Drinnan
Professor of Digital Healthcare Interventions, Teeside University
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Mike joined Teesside University in November 2023 after a long career in the North-East NHS, leading groups that specialise in physiological measurement and in medical device development, regulation and assessment.
Mike’s academic activities have been linked with his NHS role in developing novel med-tech, and also with the training of healthcare professionals, notably through the UK's Scientist Training Programme (STP).
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David Hamilton
consultant ENT, head, neck and thyroid surgeon
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David (known as “Winnie) is a consultant ENT, head, neck and thyroid surgeon at the Freeman Hospital in Newcastle. His clinical work centres on developing safe processes of care, reducing inequality and developing the roles of Allied Healthcare Professionals and trainee surgeons. He is currently the Health & Care Research Director for the North East and North Cumbria RRDN.
His research interests are broad but his main focus is on optimising patient centred outcomes in head and neck cancer. He has expertise in shared decision making and informed consent and co-led the development of the Royal College of Surgeons of Edinburgh “Informed Consent: Sharing the Decision” ICONS course. He is also the chief investigator for the Laryngeal Cancer Cohort (LARCH) which runs across the Northern Head and Neck Cancer Alliance
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Dr Catriona Mayland
Senior Clinical Lecturer, University of Sheffield
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Catriona joined the University of Sheffield in 2018 after obtaining a Yorkshire Cancer Research (YCR) ‘CONNECTS’ Senior Clinical Research Fellowship. She is also an Honorary Consultant in Palliative Medicine at Sheffield Teaching Hospitals NHS Foundation Trust.
Catriona was awarded my Doctor of Medicine (MD) degree from the University of Liverpool in 2010. Her MD evaluated quality of care for dying patients and their families (last days of life) as perceived by bereaved relatives. From this work, she developed and validated the international ‘Care Of the Dying Evaluation’ (CODETM) tool.
Catriona’s belief that palliative care should help address injustices and inequities drives her research interests. These include complex cancer groups e.g., head and neck cancer, mesothelioma, and improving access and integration of palliative care, including bereavement support, through inclusive methodology.
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Linda Sharp
TBA
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Dr Andy Levy
Programme Leader: BSc (Hons) Sport & Exercise Psychology
Andy is a Reader in Psychology at Edge Hill University’s Department of Psychology, He is a Chartered Psychologist, and an Associate Fellow of the British Psychological Society. His research sits at the intersection of social and health psychology, with a strong focus on predicting, understanding, and changing lifestyle behaviours. Andy works collaboratively within multidisciplinary teams to address complex health challenges through behavioural science. He has a particular interest in designing and implementing interventions that support the promotion, prevention, and self-management of health-related behaviours. A growing area of his work centres on understanding behaviour change in people living with and beyond head and neck cancer, with a specific emphasis on increasing physical activity. Andy is especially interested in how behaviour change theory can be effectively applied by healthcare professionals and patient groups in both clinical and community settings to support sustainable lifestyle changes that improve recovery and long-term outcomes.
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Jo Trask
Head of Health Inequalities and patient engagement at Cheshire and Merseyside Cancer Alliance
Jo Trask, Head of Health Inequalities and patient engagement at Cheshire and Merseyside Cancer Alliance has over 30 years of experience in inequity.
Jo specialises in development of staff to tackle health inequalities, cancer pathways and inequity, and involving diverse patient representation in all work. With a background in the third sector and NHS, supporting people we hear from least, Jo has helped a wide range of organisations to embrace the challenge of tackling health inequality, encouraging active approaches across systems.
Jo works widely across the UK to support cancer services working towards equity
Patient and Public Involvement
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Val Byrant
Lead of HNC patients called CHANGE who support studies, promoting the patient voice.
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Val spent 37 years in education before retiring in 2010 after undergoing Chemo/radiotherapy for Head and Neck Cancer ( HNC). The effects of this mean she is reliant on PEG feeding for most of her nutrition.
After taking part in a study into Altered Eating Val became involved in research. She is currently a co applicant on 5 studies and has co authored several papers.
In 2017 she was presented with a Giving Voice award on behalf of the RCSLT.
In 2022 she became the first Patient President at the Swallows International Conference.
In May 2023 she was awarded Honorary Life Membership of BAHNO.
She leads a small group of HNC patients called CHANGE who support studies, promoting the patient voice.
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Vince Killen
Vice-Chair and Secretary of the HaNC PPI Research Forum
Vince is a head and neck cancer patient, who was initially diagnosed in 2005 and subsequently with osteoradionecrosis in 2016.
He is Vice-Chair and Secretary of the HaNC PPI Research Forum Patient & Public Research Groups | Liverpool Head & Neck Centre a group of Cheshire and Merseyside patients and carers who support research into head and neck cancer, primarily undertaken by the Liverpool Head and Neck Centre.
Vince is retired and was formerly a Director of the Shop Direct/Littlewoods Group and a Trustee of the Liverpool Everyman/Playhouse Theatres.
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Chris Elkington
Chair of Head and Neck Cancer UK
Christopher John (Chris) Elkington
F.M.S; M.C.I.Mgt
Married, Father and Grandfather
Lincolnshire born and bred, currently living in Suffolk
Retired CEO of a consortium of Local Authorities
Former Chair of Parish Council, School Governors, Admissions and Exclusions Panels, Scouts and a myriad of small groups
Head and Neck Cancer Survivor – currently 13+ years
Current Chair of Head and Neck Cancer UK (HANCUK). www.hancuk.org
Director, Trustee and Company Secretary of multi-national professional Institute
Founder and current Trustee of Lincoln City Football Club former players association
Former Independent member of Standards Committees of two Local Authorities
Passionate about raising awareness of Head and Neck Cancer (by any means) inc
Radio, TV, presentations to clinicians, students , pharma companies & professional bodies and lobbying MP’s. ministers and decision makers
Participating in, and sometimes leading, PPI groups in a variety of research projects, particularly advocating for the use of non- clinical language in patient facing documents.
Alumni
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Emily Pearson
Doctoral Candidate
Understanding emotional challenges after treatment for head and neck cancer.
A head and neck cancer diagnosis can have a threat to life and treatments can be invasive and life changing. Treatment regimens can impair physical and psychological well-being caused by facial disfigurement and / or disability, such as difficulties speaking, breathing, or swallowing. Therefore, difficulties with emotional distress such as depression, anxiety and cancer-related post-traumatic stress symptoms can occur. Studies have suggested that people with HNC have increased risk of emotional distress and suicidal tendencies in comparison with other tumour types as well as being four times higher than the general population.
Research exploring psychological mechanisms that underpin the development of emotional difficulties and keep them going is limited within HNC. This cross-sectional study will investigate the role of metacognitive beliefs and self-compassion in the development and maintenance of anxiety, depression, and cancer-related post-traumatic stress. The study will collect questionnaire measures at one time point and will use quantitative methods to analyse the data. Participants will be able to complete the measures using an online link or using paper and pen.
The study is being conducted as partial completion of the Doctorate in Clinical Psychology at the University of Liverpool and has been designed in conjunction with the Aintree Patient and Participation Involvement group at the HNC unit at Aintree Hospital. The findings will be published in a peer reviewed journal and will help us understand psychological interventions for people with HNC and how we can help minimise distress following treatments