Module 2. Dr Anna Gavin Mr Conan Donnelly Dr Michael Donnelly Dr David Donnelly

Size: px

Start display at page:

Download "Module 2. Dr Anna Gavin Mr Conan Donnelly Dr Michael Donnelly Dr David Donnelly"

Eustace Percival George
5 years ago
Views:

1 Module 2 Dr Anna Gavin Mr Conan Donnelly Dr Michael Donnelly Dr David Donnelly

population-based cancer registration Universal

2 Norway Canada N.Ireland (Alberta, British Columbia, Wales Sweden England Denmark Manitoba and Ontario) Key selection criteria: Long-standing, high quality, population-based cancer registration Universal access to and broadly comparable spend on health care & Willingness to participate New South Wales Victoria

3 Extent of current differences in survival and how has this changed between 1995 and 2007? Can we explain international differences in survival? 4 Cancer Types Breast Colorectal lung Ovary

Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C,

Marrett L, Gjerstorff ML, Johannesen TB, Adolfsson J, Lambe M,

Richards MA, and the ICBP Module 1 Working Group (2011) Cancer

UK, 1995 2007 (the International Cancer Benchmarking

4 Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, Nur U, Tracey E, Coory M, Hatcher J, McGahan CE, Turner D, Marrett L, Gjerstorff ML, Johannesen TB, Adolfsson J, Lambe M, Lawrence G, Meechan D, Morris EJ, Middleton R, Steward J, Richards MA, and the ICBP Module 1 Working Group (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data Lancet, vol 377, pp

5 Breast Colorectal Ovarian Lung

7 Cancer Survival Diagnosis and treatment delay Treatment quality Screening availability & uptake Patient awareness of symptoms & care seeking GP / PCP beliefs and behaviours Diagnostic availability Treatment delay 1 Core benchmarking: Using routine cancer registry data investigate differences in survival and potential causes of differences including stage at diagnosis, treatment and pathways to diagnosis 5 2 Population awareness / beliefs: A survey of population awareness and beliefs 3 GP/PCP beliefs and behaviours: In depth surveys with GPs to understand referral delays Diagnostic and treatment delay: An audit of delays in diagnosis and treatment ofpatients Treatment high resolution study: Compare the extent to which evidence based treatment is applied 4

Hypothesis: Denmark and UK would have lower cancer awareness and more

Sweden Measure: Awareness and Beliefs about Cancer (ABC) measure built

aged 50+ using computer assisted telephone interviews, conducted by Ipsos

8 Hypothesis: Denmark and UK would have lower cancer awareness and more negative beliefs about cancer outcomes than Australia, Canada, Norway, Sweden Measure: Awareness and Beliefs about Cancer (ABC) measure built across the partnership Method: Population-based surveys of men and women aged 50+ using computer assisted telephone interviews, conducted by Ipsos MORI When: Fieldwork May to September 2011: 19,079 interviews completed (2,307 in NI)

9 N. Ireland - 2,307 adults age 50+ from 23,541 eligible telephone numbers

10 Awareness of symptoms of cancer NI (n=2,307) Unexplained lump or swelling Persistent unexplained pain Unexplained bleeding Persistent cough or hoarseness 0% 10% Percentage of respondents 20% 30% 40% 50% 60% 70% 70% 80% 75% 90% 89% 100% 97% Symptom awareness generally high in Northern Ireland Lower awareness of unexplained night sweats, unexplained tiredness, persistent hoarseness / coughing Change in bowel or bladder habits Persistent difficulty in swallowing 86% 82% 96% High awareness of lumps, moles and weight loss as symptoms Change in a moles appearance Sore that does not heal Unexplained night sweats 23% 72% Lower awareness among men, those with lower educational attainment and older people Unexplained weight loss Unexplained tiredness 65% 92% Most people with these symptoms will not have a diagnosis of cancer

11 Awareness of symptoms by gender (n=2,307) 1.Male 2.Female Unexplained lump or swelling 96% 97% Persistent unexplained pain 76% 2 73% Unexplained bleeding 85% 92% 1 Persistent cough or hoarseness 64% 74% 1 Change in bowel or bladder habits 85% 87% Persistent difficulty in swallowing 78% 86% 1 Change in a moles appearance 95% 97% 1 Sore that does not heal 69% 75% 1 Unexplained night sweats 22% 23% Unexplained weight loss 93% 91% Unexplained tiredness 63% 66% Total responses (weighted) 1,061 1,246 (1/2 = significant at 95% CI) Generally females more aware than males -except for pain

12 Awareness of symptoms of cancer by age (n=2,302) Unexplained lump or swelling 98% 4 97% 97% 94% Persistent unexplained pain 75% 75% 74% 71% Unexplained bleeding 90% 4 90% 4 91% 4 82% Persistent cough or hoarseness 69% 70% 74% 65% Change in bowel or bladder habits 89% 3,4 87% 4 82% 80% Persistent difficulty in swallowing 82% 84% 83% 78% Change in a moles appearance 97% 4 97% 4 95% 92% Sore that does not heal 69% 74% 75% 72% Unexplained night sweats 21% 24% 22% 24% Unexplained weight loss 94% 3,4 93% 4 90% 85% Unexplained tiredness 65% 64% 63% 65% Total responses (weighted) (3/4 = significant at 95%) Generally younger more aware than older

13 Awareness of symptoms of cancer by marital status (n=2,295) 1. Single 2. Married/ Partnered 3. Separated/ Divorced 4. Widowed Unexplained lump or swelling 98% 97% 94% 95% Persistent unexplained pain 77% 75% 71% 73% Unexplained bleeding 88% 90% 91% 87% Persistent cough or hoarseness 67% 71% 66% 66% Change in bowel or bladder habits 88% 87% 4 81% 81% Persistent difficulty in swallowing 83% 82% 79% 85% Change in a moles appearance 92% 98% 1,4 98% 94% Sore that does not heal 72% 72% 67% 74% Unexplained night sweats 26% 22% 21% 24% Unexplained weight loss 90% 93% 4 89% 89% Unexplained tiredness 60% 65% 64% 64% Total responses (weighted) 250 1, Little variation Change in moles/bowel habit higher awareness if married/partnered (adjusted for age)

14 Awareness of symptoms of cancer by highest educational attainment (n=2,274) 1.Primary 2.Lower secondary 3.Upper secondary 4.Nondegree tertiary 5.Degree level tertiary 6.Other Unexplained lump or swelling 95% 99% 1 99% 99% 98% 100% Persistent unexplained pain 69% 76% 78% 74% 84% 1,4 71% Unexplained bleeding 86% 91% 92% 94% 1 92% 1 90% Persistent cough or hoarseness 64% 74% 1 70% 67% 78% 1,4 72% Change in bowel or bladder habits 82% 88% 87% 88% 91% 1 87% Persistent difficulty in swallowing 80% 83% 84% 82% 85% 89% Change in a moles appearance 94% 98% 1 97% 98% 98% 1 100% Sore that does not heal 73% 72% 73% 67% 73% 72% Unexplained night sweats 22% 20% 22% 24% 27% 20% Unexplained weight loss 89% 93% 94% 95% 1 94% 1 89% Unexplained tiredness 58% 69% 1 69% 65% 70% 1 70% Total responses (weighted) Increased awareness with increased education

15 Awareness of symptoms of cancer by history of cancer (self/friend/relative) (n=2,301) 1.Yes 2.No Unexplained lump or swelling 97% 96% Persistent unexplained pain 75% 73% Unexplained bleeding 89% 89% Persistent cough or hoarseness 71% 2 66% Change in bowel or bladder habits 86% 85% Persistent difficulty in swallowing 84% 2 78% Change in a moles appearance 97% 2 95% Sore that does not heal 72% 72% Unexplained night sweats 23% 21% Unexplained weight loss 92% 90% Unexplained tiredness 66% 2 59% Total responses (weighted) 1, History of cancer - raised awareness for cough/hoarseness/swallowing/moles/tiredness

16 Barriers to symptomatic Too busy Worried what doctor might find worried about wasting doctors Too embarrassed Wouldn't want to know if had cancer Difficult to see a doctor presentation - NI People aged more likely to report barriers especially being too busy, too embarrassed, worried about wasting doctors time Single people report more barriers especially being too busy, too embarrassed and worried about what the doctor might find People with primary education much more likely to report they wouldn t want to know they had cancer 0% 10% 20% 30% 40%

17 Barriers to symptomatic presentation compared Consistently lower reporting of barriers in Scandinavia, Australia and Canada compared to UK UK inc NI more likely to identify wasting a doctors time as a barrier 5 0 Embarrassment Particularly likely to be reported in NI I would be too embarrased Embarrassment particularly low in Scandinavia I would be worried about wasting the doctors time

18 Cancer Beliefs Compared Disagree with the statement: "Cancer diagnosis is a death sentence" Fatalism about cancer may cause patients to be dismissal about the importance of early diagnosis NI People less likely to disagree with the statement Cancer is a death sentence Further understanding of this issue is required 64 UK England NI Wales Denmark Norway Sweden Australia NSW Victoria Canada People with lower educational attainment and those with no experience of cancer more likely to believe cancer is a death sentence

19 Cancer Beliefs Compared Generally positive beliefs about cancer with the majority of people agreeing cancer can be cured NI compares favourably against Australia, Canada and Denmark Within NI married people and people with higher educational attainment more likely to agree that cancer patients cancer patients can expect to continue with normal activities 84 UK England NI Wales Denmark Norway Sweden Australia NSW Victoria Canada Agree cancer can often be cured

20 Barriers to presentation UK more likely to report being worried about what the doctor might find Significantly fewer reporting being too busy to see the doctor in Scandinavia Little difference in this item between the UK, Canada and Australia 0 worried about what the doctor might find too busy to go to the doctor

21 High level of awareness, more so where there had been initiatives eg. sunbeds Higher in women than men, except pain Higher in younger (50-70yrs) than older Higher in higher educational attainment Higher in partnered for bowel/bladder/moles Little difference history of cancer except cough/hoarseness/swallowing /tiredness

22 What can we conclude? Cancer awareness is generally very good in NI Could be better in some population some groups the same groups that are of higher cancer risk! NI public more likely to report barriers to presentation Beliefs about cancer outcomes more negative in NI Further research required to investigate relationships between awareness, beliefs and barriers Limited in what we can say in the contribution to cancer survival

23 Can we rely on this research? Questionnaire validated Reliability testing performed Forward / backward translation performed Single international survey provider Weighted results Survey lacks theoretical basis Surveyed population isn t skewed to cancer incidence population Cross-sectional approach can offer little to answer questions of cancer survival

THE INTERNATIONAL CANCER BENCHMARKING PARTNERSHIP: GLOBAL LEARNING FROM OUR RESULTS Harpal Kumar, Chief Executive, Cancer Research UK UICC World

THE INTERNATIONAL CANCER BENCHMARKING PARTNERSHIP: GLOBAL LEARNING FROM OUR RESULTS Harpal Kumar, Chief Executive, Cancer Research UK UICC World Cancer Congress, 5 December 2014 Melbourne, Australia Outline