Gjerloev, Amalia Wittendorf; (2024) Insights into cancer care with operational research: modelling pathways from first referral to treatment start with discrete event simulation. Doctoral thesis (Ph.D), UCL (University College London).

Text Gjerloev_10202528_thesis.pdf Access restricted to UCL open access staff until 1 January 2026. Download (78MB)

Abstract

Many European healthcare systems are finding it increasingly challenging to meet the growing demands of older and sicker populations. The Covid-19 pandemic exacerbated this, particularly in the UK, where the National Health Service (NHS) had little spare capacity and suspended many routine services. Cancer services were notably impacted, resulting in long waiting times and difficulties in meeting national performance targets. Within this context, I created a discrete event simulation tool that analyses patient flow through a cancer care pathway from initial referral to first treatment to support operational decisions aimed at improving service performance. I present a systematic review of how simulation techniques have been used to analyse and inform operational decisions in cancer services and a literature review on the use of design of experiments techniques with discrete event simulation models. These insights guided my work with University College London Hospital (UCLH) and the Royal Free Hospital (RFH) in analysing cancer care pathways. The configurable discrete event simulation tool was developed to help cancer services address bottlenecks and make informed resource management decisions around. Designed for use by hospital analysts, the tool is tailored for application to cancer care pathways and includes several features unique to NHS cancer services. It is available for download by healthcare analysts and researchers. I applied the tool to two case studies: the lung cancer pathway at UCLH and the breast cancer pathway at RFH. In both cases, I parameterised and used the simulation tool to provide insights about the operational performance of the pathways, and offered feedback on potential service changes to assist decision-making in cancer services. Finally, I discuss the successes and challenges of applying the tool to different cancer pathways across multiple London hospitals, detailing the consultancy steps taken and the implications of the application within the context of the literature.

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