Reader/Principal Researcher in Primary Care Cancer Research

MA, MB BChir, DCH, DRCOG, MSc, MD, FRCGP

Honorary Clinical Associate Professor

General Practice & Primary Care Academic Centre, University of Melbourne, Victoria 3053, Australia

Email: fmw22@medschl.cam.ac.uk

Tel: 01223 762514

Background and Research Interests

Fiona leads the Cancer Group in the Primary Care Unit, Department of Public Health and Primary Care, at the University of Cambridge. The Cancer Group’s objective is to deliver world-class research focusing on the cancer pathway, from prevention, screening, early detection and diagnostics to post-treatment care; we also focus on translating genetics advances into primary care. Her research expertise lies across the primary care research spectrum and includes randomised controlled trials, cohort studies and systematic reviews; she has a particular interest in patient experiences and qualitative and mixed methods approaches.

She has won research grants totalling more than £25 million in the UK and AU$5 million in Australia, and published over 180 peer reviewed articles including in Nature, Lancet, BMJ and JAMA. Fiona co-leads the CanTest Collaborative, Cancer Research UK’s first Catalyst award, aiming to accelerate progress towards improving cancer outcomes by focussing on the transformative implementation in primary care of tests to support early detection of cancer. She is also co-investigator on the £5m NIHR Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, led by Prof Stephen Duffy (QMUL).

Current UK leadership roles include membership of Cancer Research UK’s Early Detection Committee and Cambridge Cancer Centre’s Early Detection Committee. Her international work is marked by an honorary academic role at the University of Melbourne, Australia, where she contributes to parallel programmes of work on improving outcomes for cancer patients. She also co-leads research in South Africa and Uganda, and contribute to research in Europe (Denmark, the Netherlands) and the US. Her educational and capacity building work is marked by the setting up and delivery of the CanTest International School in Cancer Detection Research in Primary Care, and her role as Training Lead for Cambridge in the NIHR School for Primary Care Research.

Selected Recent Key Publications

Fitzgerald RC, di Pietro M, O’Donovan M, Maroni R, Muldrew B, Debiram-Beecham I, Gehrung M, Offman J, Tripathi M, Smith SG. Aigret B, Walter FM, Rubin G, the BEST3 Trial Team, Sasieni P. Cytosponge-trefoil factor 3 versus usual care to identify Barrett’s oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial. The Lancet 2020. doi: 10.1016/S0140-6736(20)31099-0

Helsper CW, Campbell C, Emery J, Neal RD, Li L, Rubin G, van Weert H, Vedsted P, Walter FM, Weller D, Nekhlyudov L. Cancer has not gone away: A primary care perspective to support a balanced approach for timely cancer diagnosis during COVID‐19. Euro J Cancer Care 2020. doi: 1111/ecc.13290

Rafi I, Crinson I, Dawes M, Rafi D, Pirmohamed M, Walter FM. The implementation of pharmacogenomics into UK General Practice: a qualitative study exploring barriers, challenges and opportunities. J Comm Genetics 2020, doi: 10.1007/s12687-020-00468-2

Van Melle M, IS Yep Manzano S, Wilson H, Hamilton W, Walter FM, Bailey SER. Faecal immunochemical test to triage patients with abdominal symptoms for suspected colorectal cancer in primary care: review of international use and guidelines. Family Practice 2020, doi: 10.1093/fampra/cmaa043

Zhou Y, Abel GA, Hamilton W, Singh H, Walter FM, Lyratzopoulos G. Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: A longitudinal data-linkage study using primary care electronic health records. Cancer Epidemiol 2020, doi: 10.1016/j.canep.2020.101703

Archer S, Babb de Villiers C, Scheibl F, Carver T, Hartley S, Lee A, Cunningham AP, Easton DF, McIntosh JG, Emery J, Tischkowitz M, Antoniou AC, Walter FM. Evaluating clinician acceptability of the prototype CanRisk tool for predicting risk of breast and ovarian cancer: a multi-methods study. PLOS One 2020, 6;15(3):e0229999. doi: 10.1371/journal.pone.0229999

Walter FM & Emery JD. Further evaluation is required for smartphone-aided diagnosis of skin cancer. Lancet Digital Health 2020,  doi: 10.1016/S2589-7500(20)30021-2

Walter FM, Pannebakker MP, Barclay ME, Mills K, Saunders CL, Murchie P, Corrie P, Hall P, Burrows N, Emery JD. Effect of a Skin Self-monitoring Smartphone Application on Time to Physician Consultation Among Patients With Possible Melanoma: A Phase 2 Randomized Clinical Trial. JAMA Netw Open 2020, 3(2):e200001. doi: 10.1001/jamanetworkopen.2020.0001

Saunders C, Kilian B, Thompson D, McGeogh L, Griffin SJ, Antoniou CA, Emery J, Walter FM, Usher-Smith JA. External validation of risk prediction models incorporating common genetic variants for incident colorectal cancer using UK Biobank. Cancer Prev Res 2020. doi: 10.1158/1940-6207.CAPR-19-0521

Habgood E, Walter FM, O’Hare E, McIntosh J, McCormack C, Emery JD. Using an electronic self-completion tool to identify patients at increased risk of melanoma in Australian primary care. Aust J of Derm 2020. doi: 10.1111/ajd.13244.

Freeman K, Dinnes J, Chuchu N, Takwoingi Y, Bayliss SE, Matin RN, Jain A, Walter FM, Williams HC, Deeks, JJ. Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies. Brit Med J 2020,368:m127. doi: 10.1136/bmj.m127

Thorneloe RJ, Hall L, Walter FM, Side L, Lloyd KE, Smith SG, on behalf of the ENGAGE investigators. Knowledge of Potential Harms and Benefits of Tamoxifen among Women Considering Breast Cancer Preventive Therapy. Cancer Prev Res 2020. doi: 10.1158/1940-6207.CAPR-19-0424

Humphrys E, Walter FM, Rubin G, Emery JD, Johnson M, Richards A, Fitzgerald RC, Viswanath YKS, Burt J. Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study. Br J Gen Pract Open, 2020. doi: 10.3399/bjgpopen20X101001

Jones OT, Ranmuthu C, Hall PN, Funston G, Walter FM. Recognising skin cancer in primary care. Adv Ther 2019. doi: 10.1007/s12325-019-01130-1

Funston G, Melle MV, Baun MLL, Jenson H, Helsper C, Emery J, Crosbie EJ, Thompson M, Hamilton W, Walter FM. Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines. BMC Cancer 2019: 19, 1028. doi: 10.1186/s12885-019-6211-2

Merriel SWD, Hardy V, Thompson M, Walter FM, Hamilton W. Patient-Centered Outcomes From Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: A Systematic Review. J Am Coll Radiology 2019. doi: 10.1016/j.jacr.2019.08.031

Zhou Y, van Melle M, Singh H, Hamilton W, Lyratzopoulos G, Walter FM. Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review. BMJ Open 2019, 9:e029143. doi: 10.1136/bmjopen-2019-029143

Jones OT, Jurascheck L, Hickman S, van Melle M, Burrows N, Hall P, Emery JD, Walter FM. Dermoscopy for melanoma detection and triage in primary care: a systematic review. BMJ Open 2019;9:e027529. doi: 10.1136/bmjopen-2018-027529

Banks I, Weller D, Ungan M, Selby P, Aapro M, Beishon M, Bolt M, Bonanno F, Champeix C, Dégi C, Eneqvist LJ, Kazmierska J, Kolacinska A, Malas S, Moine S, Pavlic D, Price R, Walter FM, Wyld L. ECCO Essential Requirements for Quality Cancer Care: Primary care. Critical Reviews in Oncology/Hematology 2019 17. doi: 10.1016/j.critrevonc.2019.07.007

Moodley J, Scott SE, Mwaka AD, Constant D, Githaiga JN, Stewart TS, Payne A, Cairncross L, Somdyala N, Walter FM. Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer. PLoS ONE 2019, 14(8): e0220545. doi: 10.1371/journal.pone.0220545

Renzi C, Kaushal A, Emery J, Hamilton W, Neal RD, Rachet B, Rubin G, Singh H, Walter FM, de Wit NJ, Lyratzopoulos G. Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms. Nat Rev Clin Oncol 2019. doi: 10.1038/s41571-019-0249-6

Amelung D, Whitaker KL, Lennard D, Ogden M, Sheringham J, Zhou Y, Walter FM, Singh H, Vincent C, Black G. Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study. BMJ Qual Saf 2019. doi: 10.1136/bmjqs-2019-009485

McGeoch L, Saunders CL, Griffin SJ, Emery J, Walter FM, Thompson D, Antoniou AC, Usher-Smith JA. Risk prediction models for colorectal cancer incorporating common genetic variants: a systematic review. Cancer Epidemiol Biomarkers Prev 2019. doi: 10.1158/1055-9965.EPI-19-0059

Githaiga JN, Walter FM, Scott SE, Mwaka AD, Moodley J. Symptom awareness measures for breast and cervical cancer in Sub-Saharan Africa: a scoping review. South African Journal of Oncology 2019;3:a78. doi: 10.4102/sajo.v3i0.78

Murchie P, Masthoff J, Walter FM, Rahman K, Allan J, Burrows N, Proby C, Lee AJ, Johnson M, Durrani A, Depasquale I, Brant W, Neilson A, Meredith F, Treweek S, Hall S, McDonald A. Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma. Trials 2019, 20:318. doi: 10.1186/s13063-019-3453-x

Zhou Y, Funston G, Lyratzopoulos G, Walter FM. Improving the Timely Detection of Bladder and Kidney Cancer in Primary Care. Adv Ther 2019, 36(7): 1778-1785. doi: 10.1007/s12325-019-00966-x

Jones OT, Jurascheck L, Utukuri M, Pannebakker M, Emery J, Walter FM. Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology. J Eur Acad Dermatol Venereol 2019. doi: 10.1111/jdv.15614

Scott SE, Penfold C, Saji S, Curtis S, Watts C, Hamilton W, Joannides A, Walter FM. ‘It was nothing that you would think was anything’: Qualitative analysis of appraisal and help seeking preceding brain cancer diagnosis. PLoS ONE 2019; 14(3):e0213599.  doi: 10.1371/journal.pone.0213599

Sage WA, Fernandez-Mendez R, Crofton A, Gifford M, Bannykh A, Chrysaphinis, Tingley E, Bulbeck H, Brahmbhatt M, Pickard J, Walter FM, Brodbelt A, Price SJ, Joannides AJ. Defining unmet clinical need across the pathway of brain tumor care: a patient and carer perspective. Cancer Manage Res 2019, 19;11 2189-2202. doi: 10.2147/CMAR.S175886

Kummer S, Walter FM, Chilcot J, Emery J, Sutton S, Scott S. Do cognitive heuristics underpin symptom appraisal for symptoms of cancer?: A secondary qualitative analysis across seven cancers. Psychooncology 2019, 28(5):1041-1047. doi: 10.1002/pon.5049

Walter FM, Thompson MJ, Wellwood I, Abel GA, Hamilton W, Johnson M, Lyratzopoulos G, Messenger M, Neal R, Rubin G, Singh H, Spencer A, Sutton S, Vedsted P, Emery JD. The CanTest Framework for evaluating diagnostic strategies for early detection of cancer in primary care. BMC Cancer 2019, 19:586. doi: 10.1186/s12885-019-5746-6

Pannebakker MM, Mills K, Johnson M, Emery JD, Walter FM. Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation. Brit J Gen Pract Open 2019, 3 (1). doi: 10.3399/bjgpopen18X101635

Walter FM, Joannides A, Penfold C, Saji S, Johnson M, Watts C, Brodbelt A, Jenkinson MD, Price SJ, Hamilton W, Scott SE. Missed opportunities for diagnosing brain tumours in primary care? Findings from a qualitative study. Brit J Gen Pract 2019,. pii: bjgp19X701861. doi: 10.3399/bjgp19X701861

Barclay ME, Lyratzopoulos G, Walter FM, Jefferies S, Peake MD, Rintoul RC. Incidence of second and higher order smoking-related primary cancers following lung cancer: a population-based cohort study. Thorax 2019, pii: thoraxjnl-2018-212456. doi: 10.1136/thoraxjnl-2018-212456

Lee A, Mavaddat N, Wilcox AN, Cunningham A, Carver T, Hartley S, Babb de Villiers C, Izquierdo A, Simard J, Schmidt MK,  Walter FM, Garcia-Closas M, Tischkowitz M, Pharoah P, Easton DF, Antoniou AC. BOADICEA: a comprehensive breast cancer risk prediction model incorporating genetic and non-genetic risk factors. Genet Med 2019. doi: 10.1038/s41436-018-0406-9

Emery JD, Murray SR, Walter FM, Martin A, Goodall S, Campbell SC, Mazza D, Habgood E, Kutzer Y, Barnes D, Murchie P. The CHEST Australia Trial: a randomised controlled trial of an intervention to reduce time to consult with symptoms of lung cancer. Thorax 2019. thoraxjnl-2018-212506v1-thoraxjnl-2018-212506

Dinnes J, Deeks JJ, Chuchu N, Ferrante di Ruffano L, Matin RN, Thomson DR, Wong KY, Aldridge RB, Abbott R, Fawzy M, Bayliss SE, Grainge MJ, Takwoingi Y, Davenport C, Godfrey K, Walter FM, Williams HC, Cochrane Skin Cancer Diagnostic Test Accuracy Group. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst Rev 2018, CD011902. doi: 10.1002/14651858.CD011902.pub2

Chuchu N, Takwoingi Y, Dinnes J, Matin RN, Bassett O, Moreau J, Bayliss SE, Davenport C, Godfrey K, Jain A, Walter FM, Deeks JJ, Williams HC, Cochrane Skin Cancer Diagnostic Test Accuracy Group. Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma. Cochrane Database Syst Rev 2018, CD013192. doi: 10.1002/14651858.CD013192

Humphrys E, Burt J, Rubin G, Emery JD, Walter FM. The influence of health literacy on the timely diagnosis of symptomatic cancer: a systematic review. Euro J Cancer Care 2018, e12920. doi: 10.1111/ecc.12920

Wilson E, Usher-Smith J, Emery JD, Corrie P, Walter FM. A modelling study of the cost-effectiveness of a risk stratified screening programme for melanoma in the UK. Value Health 2018; 21:8:658-668. doi: 10.1016/j.jval.2017.11.009

Rubin G, Walter FM, Emery J, de Wit N. Re-imagining the diagnostic pathway for gastro-intestinal cancer. Nat Rev Gastro Hepat 2018, 5(3):181-188. doi: 10.1038/ nrgastro.2018.1

Emery JD, Gray V, Walter FM, Cheetham S, Croager EJ, Slevin T, Saunders C, Threlfall T, Auret K, Nowak AK, Geelhoed E, Bulsara M, Holman CDJ. The Improving Rural Cancer Outcomes (IRCO) Trial: a cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia. Br J Cancer 2018, 118(6):e8. doi: 10.1038/ bjc.2017.457

Stewart TS, Moodley J, Walter FM. Population risk factors for late-stage presentation of cervical cancer in sub-Saharan Africa. Cancer Epidemiol 2018, 53:81-92. doi: 10.1016/j.canep.2018.01.014

Usher-Smith JA, Harshfield A, Saunders CL, Sharp SJ, Emery J, Walter FM, Muir K, Griffin SJ. External validation of risk prediction models for incident colorectal cancer using UK Biobank. Br J Cancer 2018, 118(5):750-759. doi: 10.1038/bjc.2017.463

Koo MM, Hamilton W, Walter FM, Rubin GP, Lyratzopoulos G. Symptom signatures and diagnostic timeliness in cancer patients: a review of current evidence. Neoplasia 2018, 20(2):165-174. doi: 10.1016/j.neo.2017.11.005

Zhou Y, Mendonca SC, Abel GA, Hamilton W, Walter FM, Johnson S, Shelton J, McPhail S, Elliss-Brookes L, Lyratzopoulos, G. Variation in ‘fast-track’ referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670,000 patients with cancers of 35 different sites. Br J Cancer 2018, 118(1):24-31. doi: 10.1038/bjc.2017.381

Emery JD, Gray V, Walter FM, et al. The Improving Rural Cancer Outcomes (IRCO) Trial: a cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia. Br J Cancer 2017. doi: 10.1038/bjc.2017.310

Usher-Smith JA, Kassianos A, Emery JD, Abel GA, Teoh Z, Hall S, Neal RD, Murchie P, Walter FM. Identifying people at higher risk of melanoma across the UK: a primary care based electronic survey. Brit J Dermatol 2017, 176(4):939-948. doi: 10.1111/bjd.15181

Zhou Y, Abel GA, Hamilton W, Pritchard-Jones K, Gross CP, Walter FM, Renzi C, Johnson S, McPhail S, Elliss-Brookes L, Lyratzopoulos G. Diagnosis of cancer as an emergency: a critical review of current evidence. Nat Rev Clin Oncol 2017, 14(1):45-56. doi: 10.1038/nrclinonc.2016.155

Walter FM, Mills K, Mendonca S, Abel G, Basu B, Carroll N, Hamilton W, Rubin GP, Emery JD. Symptoms and patient factors associated with diagnostic intervals for pancreatic cancer (SYMPTOM pancreatic study): a prospective cohort study. Lancet Gastroenterol Hepatol 2016, (4):298-306. doi: 10.1016/S2468-1253(16)30079-6

Walter FM, Emery JD, Mendonca S, Hall N, Morris HC, Mills K, Dobson C, Bankhead C, Johnson M, Abel G,  Rutter M, Hamilton W, Rubin GP. Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study. Brit J Cancer 2016, 115(5):533-541. doi: 10.1038/bjc.2016.221

Hamilton W, Walter FM, Rubin G, Neal RD. Improving early diagnosis of symptomatic cancer. Nat Rev Clin Oncol 2016, 13(12):740-749. doi: 10.1038/nrclinonc.2016.109

Usher-Smith JA, Emery J, Hamilton W, Griffin S, Walter FM. Risk prediction tools for cancer in primary care. Br J Cancer 2015, 113(12):1645-50. doi: 10.1038/bjc.2015.409

Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, et al. First symptoms and other factors associated with time to presentation and diagnosis and stage at diagnosis of lung cancer: a prospective cohort study. Br J Cancer 2015; 112 Suppl:S6-S13. doi: 10.1038/bjc.2015.30

Rubin G, Berendsen A, Crawford SM, … Walter FM et al. The expanding role of primary care in cancer control. Lancet Oncol 2015, 16(12):1231-72. doi: 10.1016/S1470-2045(15)00205-3