Raising awareness of cancer symptoms. Amanda Boughey, Cancer Research UK September 2015

Transcription

1 Raising awareness of cancer symptoms Amanda Boughey, Cancer Research UK September

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3 Early Diagnosis diagnosing more cancers earlier would be good for patients and the UK

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5 Early Diagnosis diagnosing more cancers earlier would be good for patients and the UK variation

6 Source: NCIN (2012)

7 Geographical variation Proportion of new cancers where the stage is known, diagnosed as early stage (stages 1&2) Source: PHE. Accessed May Source:

8 ICBP Module 1 - survival differences AUS CAN SWE NOR DEN UK Colorectal Cancer 1yr Relative Survival AUS SWE CAN NOR DEN UK SWE CAN AUS NOR DEN UK Lung Cancer 1yr Relative Survival SWE CAN AUS NOR DEN UK NOR CAN AUS DEN UK Breast Cancer 1yr Relative Survival Ovarian Cancer 1yr Relative Survival Coleman MP, Forman D, Bryant H et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden and the UK, (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. The Lancet 2011, 377:

9 Early Diagnosis diagnosing more cancers earlier would be good for patients and the UK variation It s complex!

10 Early Diagnosis is a complex, multifaceted challenge The updated NAEDI hypothesis Hiom et al. (2015) Diagnosing cancer earlier: reviewing the evidence for improving cancer survival. BJC

11 ICBP module 2 - Awareness and beliefs HYPOTHESIS Lower survival rates in Denmark and UK are explained in part by lower cancer awareness and more negative beliefs about cancer HEADLINE FINDINGS Not supported in all jurisdictions Generally positive attitudes and beliefs about cancer in all jurisdictions Low awareness of increasing risk with age But, in the UK, people more likely to identify barriers to seeing their GP

12 Inequalities in early diagnosis GENDER AGE SOCIOECONOMIC FACTORS ETHNICITY

13 Early Diagnosis diagnosing more cancers earlier would be good for patients and the UK variation It s complex! The principles underlying earlier cancer diagnosis would also benefit outcomes in other diseases

14 Premature mortality in the UK 6 The 10 most common causes of death in 2011 FUNDRAISING ACTIVITIES Cancer is the leading cause of death from illness in every age group (except men aged 15-24) Qtr 1 Qtr 2 Qtr 3 Qtr 4 Sponsorship Collecting Door-to-door Original Data Sources: Office for National Statistics

15 15 Monday, September 28, 2015 View <Headers and Footers> to alter this text

16 The journey in England 2008/9/ onwards 16

17 An awareness campaign Clarity on SYMPTOMS Clarity on ACTION Clarity on BENEFIT By showing real-life GPs, the ads help to reassure people that their doctor really does want to listen.

18 How many subtle messages can you squash in to 33 seconds? 18

19 Video clip of Cancer Research UK TV advert

20 Video clip of Cancer Research UK TV advert

21 Web banners Other items included: - Information leaflet - Branded pharmacy bags - Pull up banners for use at events Posters for local team to edit Symptom cards NHS choices content

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23 Planning for the increase in demand for services

24 How are campaigns evaluated?

25 Results public awareness public awareness of lung cancer symptoms e.g. Prompted awareness of cough for 3+ weeks 40% Percent of respondents 35% 30% 25% 20% 15% 10% 5% 19% * 34% 22% 20% 18% * 33% Pre-campaign Post-Campaign 0% Pilot area Control area Regional campaign National campaign * = significantly different to pre-campaign No. of respondents: Regional 450, National 1,100

26 Results public awareness NET - MENTIONS OF COUGH RELATED TO CAMPAIGN % Cough / hoarseness Shortness of breath Coughing up blood Persistent / prolonged cough Breathing problems Weight loss Pain Tiredness / fatigue Generally unwell Coughing up phlegm Don t know Question: There are many signs and symptoms of lung cancer. Please write in as many as you are aware of Base:1153/1121 pre/post Chart reproduced by CRUK 66 Pre Post Key campaign symptom Population aged 55+. Data source: TNS

27 Results GP attendance to cancers diagnosed Percent change between campaign/control months and previous time period: 70% 60% 50% 40% 30% 20% 10% 0% -10% -20% * * * * * * * Not available Control area /time period Campaign area /time period Regional National Regional National Regional National Regional National * GP attendance Urgent GP referrals GP-referred chest * x-rays Cases diagnosed * *= significant change = significant difference to control * * * people with a cough going to see their GP urgent GP referrals for suspected lung cancer GP-referred chest X-rays number of lung cancers diagnosed (NLCA data)

28 Results stage and treatment (NLCA data) Evidence of a stage shift at diagnosis Percentage point change between 2011 & * Stage I Stage II Stage III Stage IV proportion of non small cell lung cancers diagnosed at stage I (p<0.001) proportion diagnosed at stage IV (p<0.001) No change for the control period (p=0.404 & p=0.244) Increase in surgical resection rate 2.3 percentage point increase in proportion receiving resection (p<0.001) No evidence of increase for the control (p=0.425) * Control (Feb- April) Campaign (May-July) * = significant change

29 Results crude survival (NLCA) One-year age-standardised crude survival Regional campaign only: Increase of 4 percentage points in the pilot area (p=0.024) Increase of 2 percentage points in the control area (p=0.034) But no evidence of a difference in magnitude (p=0.425)

30 But is it cost effective?

31 That advert would only work in England..

32 NI creative testing BCOC Positives and Negatives / Improvements See when I came in I thought no I wouldn t go and see the doctor with a cough, after that I think maybe F, Belfast, smoker It would make me go if the cough was regular M, Lisburn, smoker Many a time I ve said to myself oh I m not going to go, they re too busy for me there are people sicker than me. So make it that the doctor says we re better talking to you now than down the line. Or something like better safe than sorry M, Newry, smoker The only thing it s not getting across is that a small cough could still be a bad cough M, Newry, smoker We don t have those sort of blue buses so it looks weird F, Belfast, smoker

33 NI creative testing Smokers and Non-Smokers Non-smokers gave no indication that the creative was not equally aimed at them. Smokers expect to be criticised and respond particularly intensely to the negative tone of annoying cough. Smokers often expect a hard time or unequal treatment from the GP, so robust reassurance that GPs want to see people is important. Smokers look for any opportunity to feel less stigmatised. Gravitate to messages that say anyone can get lung cancer. But this is more about feeling a bit better than influence on actual behaviour. Majority of smokers agree no mention of smoking is the right strategy.

34 A few personal reflections on the 4 years Be Clear on Cancer has: moved from fear and dread to expecting campaigns and planning around them acted as a catalyst for change brought primary and secondary care together kept the momentum going on early diagnosis The challenges remain: do we fully understand the impact? what about the other chronic conditions that may be picked up? what about the less common cancers and those that don't have clear symptoms? how do we prevent the campaign becoming wallpaper? Key learning: committed partners and local NHS teams recognise limitations but don t let it stop momentum be brave My personal favourite

35 Growing recognition of the importance of early diagnosis % strongly disagree Going to my GP with a symptom of [x] cancer makes no difference to my changes of surviving cancer Most cancer treatment is terrible; it is even worse than death 0 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Bowel national W1 Lung national W1 Bowel national W2 Lung national W2 BiP national W1 Breast national W1 Source: TNS BMRB tracking

36 Worth a read Diagnosing cancer earlier: reviewing the evidence for improving cancer survival Ironmonger, L. et al. (2014) An evaluation of the impact of large scale interventions to raise public awareness of a lung cancer symptom. Br J Cancer

37 I was lucky. If I had not read that in the paper, I would ve been none the wiser. Kenneth Dorling, Leeds. Walk in chest X-ray And with all the numbers, stats, facts and figures, we must not lose sight of... My husband heard the Be Clear on Cancer advert on the radio and he insisted that I should go to the GP Joy Sowerby, aged 52. Diagnosed with stomach cancer

38 THANK YOU!