Network Level Cancer Awareness Report. Prepared by Public Knowledge June 2011

Transcription

1 Network Level Awareness Report Prepared by Public Knowledge June 2011

2 Index Slide numbers Executive Summary... 3 Background... 4 The Awareness Measure... 5 Methodology and Sample Demographics, smoking and personal experience of cancer the signs and symptoms of cancer Help seeking behaviour the risks of cancer The number of people who develop cancer Most common cancers screening Communication preferences Recommendations NHS County Durham and Darlington Interventions... 35

3 Executive Summary cancer signs and symptoms Respondents served by the North of England Network were significantly less likely to mention many of the most common symptoms of cancer both spontaneously and when prompted in comparison to the national baseline. In addition, just over a fifth of the sample (21%) were unable to name any signs or symptoms of cancer spontaneously. Respondents from NHS Cumbria tended to be more likely to mention many of the most common symptoms. Respondents in the North East are less likely to say they would contact a doctor to discuss possible signs/symptoms of cancer within a week than observed within the national data set. Network level respondents would also wait longest before contacting their doctor with a persistent cough or hoarseness and are most likely to delay visiting doctor because of fear over what the doctor might find. cancer risks Respondents in the North East were also significantly less likely to name the most common causes of cancer when compared to the national baseline, both spontaneously and when prompted. However Network respondents were significantly less likely to give the response don t know when asked about risk factors compared to the national baseline. The number of people who develop cancer 17% of both the national and the Network samples correctly stated that people out of 100 develop cancer in their lifetime, however there was a greater tendency to overestimate within the Network sample. Within the Network 64% said at any age when asked about the age people are most likely to develop cancer. The most common cancers in men and women Breast cancer was correctly mentioned by the largest proportion of the Network sample as the most common cancer in women, however only 26% and 19% respectively named the second and third most common cancers in women, lung and colorectal cancer. Lung and prostate cancer were correctly recalled of the most common cancers in men within both the national baseline and Network sample. NHS Screening There are no differences in awareness of breast, cervical and bowel cancer between the national and the Network data. the breast and cervical cancer screening programme is relatively high across the region, with the exception of breast cancer screening awareness in NHS Tees and NHS South of Tyne and Wear. the bowel cancer screening programme is consistently lower at both the national and Network level although NHS County Durham and Darlington s pre to post stage data does indicate a significant increase in awareness.

4 Background One in three people in the UK develop cancer across the course of their lives and around one in four people who develop cancer will die as a result. Statistics have also shown that there is a considerable gap between survival and mortality rates in England as compared to Europe. In 2007 the Department of Health launched the Reform Strategy which outlined actions to improve UK wide cancer services within the NHS and reduce inequalities in incidence, access to services and outcomes. Further to this, in January 2011 the coalition government published Improving Outcomes: A Strategy for which outlined how the Government, NHS and public can prevent cancer, improve the quality and efficiency of cancer services, and achieve outcomes that will rival the best in Europe.

5 The Awareness Measure Raising awareness of cancer within the general population is crucial given that one of the main factors associated with a delay in seeking help for cancer is a failure to recognise early cancer symptoms. To aid this process the Awareness Measure (CAM) was developed by Research UK, University College London, King s College London and the University of Oxford in This validated set of questions has been extensively used nationally to assess awareness of the warning signs and symptoms of cancer, knowledge of the types and incidence of cancer, awareness of the screening programmes for bowel, breast and cervical cancer, health seeking behaviours and barriers to seeking GP consultations. In 2010 a second, amended version of the CAM was also released. Data from all CAM projects is uploaded into the CAM Archive in order to provide a national benchmark which can be used to track developments in knowledge and awareness. The data discussed in this report was collected using a combination of version 1 and version 2 of the CAM.

6 Methodology The North of England Network (NECN) serves 5 localities: County Durham and Darlington, North of Tyne, South of Tyne and Wear, Tees and North Cumbria. NHS County Durham and Darlington used a pilot version of the CAM to assess cancer awareness in a large sample of their general population in Results from this pilot survey and surveys conducted in other areas were assessed and the NECN Local Awareness and Early Diagnosis Steering Group decided that further CAMs conducted in the NECN should be concentrated on the 10% most deprived population in their area. This report compares baseline levels of cancer awareness within the 5 NHS areas served by the North of England Network to a Network level total using merged data. NHS Cumbria NHS Tees NHS North of Tyne NHS South of Tyne NHS County Durham and Darlington Pre Network level data NHS County Durham and Darlington Post In early 2011 post stage data was collected from County Durham and Darlington following the implementation of a targeted social marketing campaign. This data is included for comparative purposes but has been excluded from the baseline Network level total. Awareness in these areas is then also compared to a total national baseline created by merging all datasets available within the CAM Archive up to June Please note that individual reports are available for each of the NHS areas served by the North of England Network where further information can be found if required.

7 Network Sample All data within the Network sample was collected using a face-to-face methodology, with the exception of a proportion of data from NHS Cumbria which was collected via a telephone methodology. The table below shows the proportion of data collected in each NHS area. In total the Network sample consists of 10,053 responses. This is compared to the national baseline which consists of 32,615 responses. Dotted Eyes Crown copyright and/or database right All rights reserved. Licence number

8 Primary Demographics The Network level data is fairly well matched to the National data, although in the national data there is a greater gender skew towards women and a higher proportion of BME respondents. Quotas were imposed on data from each of the NHS areas to ensure a representative sample. Data from NHS Cumbria is drawn from a sample that is notably older than the other areas while data from NHS Tees and NHS North of Tyne contains a higher proportion of BME groups. * BME British Minority Ethnic

9 Secondary Demographics 40% of the Network sample reported having no formal qualifications Respondents in NHS Tees (46%) and NHS North of Tyne (48%) were most likely to report having no formal qualifications. Only 7% of the Network sample reported having a degree or higher degree which is considerably lower than the UK average of almost 20%.* The most common qualifications held by respondents in the Network sample were GCSEs (29%). 62% of the Network sample were coded into socio-economic grades D and E** Only 4% of the Network sample were coded into socio-economic grades A and B. The majority (62%) were coded into grades D and E with similar levels of D and E respondents interviewed across the three areas where socio-economic grade was recorded (NHS Tees, NHS North of Tyne and NHS South of Tyne and Wear). 18% of the Network sample reported unemployment Unemployment in the Network sample was significantly higher than the current national average of 7.7%.*** A quarter of the Network sample were employed full-time. Unemployment was highest in the NHS Tees (22%), NHS North of Tyne (25%) and NHS South of Tyne and Wear (28%) subsamples. 36% of the Network sample rent from a local housing authority or housing association Respondents in the NHS Tees (44%), NHS North of Tyne (53%) and NHS South of Tyne and Wear (58%) subsamples were significantly more likely to rent from a local housing authority or housing association, whilst those from NHS Cumbria (61%) and NHS County Durham and Darlington (54%) were more likely to own their property outright or have their own mortgage. * ** Socio-economic grade was only collected in NHS Tees, NHS North of Tyne and NHS South of Tyne and Wear A- Higher managerial, administrative, professional, B - Intermediate managerial, administrative, professional, C1- Supervisory, clerical, junior managerial, C2 - Skilled manual workers, D- Semiskilled and unskilled manual workers, E - Casual labourers, pensioners, unemployed. *** According to the Office of National Statistics and based on data collected January to March 2011:

10 Smoking National Total 35% Network Total 40% NHS Cumbria 27% NHS Tees 43% NHS North of Tyne 39% NHS South of Tyne and Wear 47% NHS County Durham and Darlington Post 30% 40% of the Network sample reported that they currently smoke which is considerably higher than the national average of 21%.* Respondents in the NHS South of Tyne and Wear subsample were significantly more likely to report smoking (47%) and respondents in NHS Cumbria were significantly less likely to (27%). * Based on data collected for the Office of National Statistics 2009: Q. Do you currently smoke any cigarettes at all? Base: National Total (9,563), Network Total (10,053), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Post (1,590)

11 Personal Experience of Most respondents have some personal experience of cancer, most commonly within a close family member In addition 5% of respondents have themselves suffered from cancer With the exception of NHS Tees, North of England Network respondents were significantly less likely to say they had no personal experience of cancer compared to the national data Q. Have you, your family or close friends had cancer? Base: National Total (32615), Network Total (10,053), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1590)

12 s Top 10 spontaneously mentioned symptoms A lump or swelling was the most commonly mentioned symptom with 55% of the national sample and 53% of the Network sample giving this response. Respondents in the Network sample were significantly less likely to mention many of the most common symptoms of cancer when compared to the national baseline. Within the Network sample, respondents from NHS Cumbria were significantly more likely to mention many of the most common symptoms. 71% 57% 55% 53% 50% 51% 50% In total, 21% of the Network sample were unable to name any signs or symptoms of cancer. Respondents from the NHS Tees and NHS North of Tyne subsamples were significantly more likely to give the response don t know, as were males (26%), BME respondents (35%), those aged years (32%), those classified as socio-economic grade E (25%), the unemployed (28%), smokers (24%) and those with no formal educational qualifications (23%). Smaller proportions of the Network sample (1-2%) also mentioned a number of other symptoms specified in the CAM code frames including loss of appetite (2%), a sore that does not heal (1%), feeling weak (1%), bruising (1%), difficulty swallowing (1%) and blurred vision (0%). 25% 26% 22% 23% 23% 23% 19% 20% 20% 17% 18% 19% 19% 16% 15% 16% 15% 13% 14% 15% 12% 14% 10% 11% 11% 8% 8% 9% 8% 9% 8% 9% 7% 7% 4% 21% 14% 9% 7% 7% 4% 5% 10% 8% 5% 5% 6% 7% 4% 4% 4% 5% 6% 4% 5% 3% 3% 3% 4% 4% 2% 2% 3% 1% 1% 0% 1% 1% 1% 1% 25% 23% 21% 21% 19% 20% 10% National Total Network Total NHS Cumbria NHS Tees NHS North of Tyne NHS South of Tyne and Wear NHS County Durham and Darlington Post * Pre stage data for NHS County Durham and Darlington was processed before the availability of the CAM toolkit and consequently this data is not comparative and has been excluded. Q. There are many warning signs and symptoms of caner. Please name as many as you can think of. Base: National Total (26,522), Network Total (3,960), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Post (1,590)

13 s Top 10 spontaneously mentioned symptoms - County Durham and Darlington Pre and Post Invervention* Post stage respondents were somewhat more likely to spontaneously mention lumps, weight loss and changes to moles, skin or rashes, but they were significantly more likely to mention bleeding and pain than pre stage respondents. However, despite some positive increases in spontaneous awareness, post stage respondents were significantly more likely to be unable to spontaneously mention any symptoms of cancer (15% pre stage, 20% post stage). * Pre stage data for NHS County Durham and Darlington was processed before the availability of the CAM toolkit and consequently this data is not comparative. Therefore post stage data has been grouped into code frames similar to the pre stage in order that pre and post stage spontaneous symptoms can be compared. Q. There are many warning signs and symptoms of caner. Please name as many as you can think of. Base: NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590)

14 s Prompted Yes responses Respondents in the Network sample were most likely to agree that unexplained lumps or swellings (95%) were a warning sign of cancer. 92% of the sample also agree that a change in the appearance of a mole could be a symptom of cancer, despite the fact that only 7% mentioned this symptom spontaneously in the previous question. Respondents were least likely to agree that a persistent cough or hoarseness could be a sign of cancer (66%) and agreement with this symptom was particularly low in the NHS Tees subsample (59%). When compared to the national baseline, Network respondents were significantly more likely to say don t know when asked about most of the symptoms listed. Those in the NHS Tees subsample were least likely to agree that many of the symptoms listed could be a sign of cancer, as were younger respondents, males, BME respondents, the unemployed and those classified as socio-economic grade E. Q. Do you think that xxx could be a sign of cancer? Base: National Total (32,615), Network Total (10,053), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590)

15 s Spontaneous and Prompted Signs and - Mean Scores This slide presents the mean number of signs of symptoms of cancer recalled by respondents spontaneously and agreed to be signs/symptoms when prompted (out of a possible total of 9). National Total Network Total NHS Cumbria NHS Tees NHS North of Tyne NHS South of Tyne and Wear NHS County Durham and Darlington Pre NHS County Durham and Darlington Post Spontaneous signs/symptoms No data* 1.84 Prompted signs/symptoms The mean number of symptoms spontaneously mentioned by the Network sample (1.72) is notably lower than the national baseline of 2.14, however in terms of prompted awareness there is less variation between the national baseline and Network sample. As shown, respondents in NHS Cumbria recalled the most symptoms both spontaneously and when prompted, whilst those in NHS Tees recalled the fewest symptoms both spontaneously and prompted. * Pre stage data for NHS County Durham and Darlington was processed before the availability of the CAM toolkit and consequently this data is not comparative Q. There are many warning signs and symptoms of caner. Please name as many as you can think of. Q. Do you think that xxx could be a sign of cancer? Base: Detailed on previous slides

16 s Length of wait before contacting a doctor to discuss symptoms - Network vs. National Within a week More than a week Don't know/never National Network National Network National Network Bleeding 86% 84% 12% 14% 1% 3% Symptom that might be cancer 83% 80% 15% 16% 2% 3% Lump/swelling 81% 79% 16% 17% 2% 3% Change in the appearance of a mole 75% 72% 21% 23% 2% 4% Pain 72% 70% 24% 25% 3% 5% Difficulty swallowing 75% 68% 21% 24% 4% 7% Change in bowel/bladder habits 64% 60% 31% 34% 3% 6% Sore that doesn t not heal 62% 60% 33% 33% 3% 7% Weight loss 51% 51% 44% 41% 6% 7% Cough/hoarseness 51% 45% 42% 44% 6% 10% With the exception of weight loss, Network level respondents are less likely to say that they would contact a doctor within a week than observed within the national data. This is reflected in consistent increases in the number of Network level respondents who give the answer don t know or never in comparison to the national benchmark. It is particularly striking that 10% of network respondents say don t know or never when asked how long they would wait to contact a doctor in relation to a cough or hoarseness Q. If you noticed any of the following unexplained symptoms how soon would you contact your doctor to make an appointment to discuss it? Base: National Total (32,013), Network Total (9,451). This data excludes NHS Cumbria where data was collected using v2 of the CAM in a different format..

17 s Length of wait before contacting a doctor to discuss symptoms - Never and Don t Know responses in males and females 4% An unexplained bleeding 3% 4% A symptom that might be a sign of cancer 3% 5% An unexplained lump/swelling 1% 7% A change in the appearance of a mole 3% 6% An unexplained pain 3% 8% A persistent difficulty swallowing 6% Males are significantly more likely to give the response don t know or never when asked how soon they would contact a doctor to discuss symptoms when compared to women 6% A change in bowel/bladder habits 5% 8% A sore that doesn t heal 5% 8% An unexplained weight loss 7% 12% A persistent cough or hoarseness 8% Q. If you noticed any of the following unexplained symptoms how soon would you contact your doctor to make an appointment to discuss it? Base: Network Total (9,451). This data excludes NHS Cumbria where data was collected using v2 of the CAM in a different format..

18 s Length of wait before visiting a doctor to discuss symptoms mean number of days With the exception of unexplained weight loss and a change in the appearance of a mole, Network respondents would wait longer than the national average before contacting a doctor. Network respondents would wait the shortest time for an unexplained bleeding (7.2 days) and a symptom they thought might be a sign of cancer (8.3 days). A persistent cough or hoarseness (18.6 days) and unexplained weight loss (18.2) were the symptoms that Network respondents would leave for the longest before contacting a doctor. Respondents from the NHS South of Tyne and Wear and County Durham and Darlington subsamples were likely to wait longer than respondents from other areas within the Network. Females and older respondents (55 years +) would generally initiate contact with a doctor sooner on average than other respondents. Q. If you noticed any of the following unexplained symptoms how soon would you contact your doctor to make an appointment to discuss it? Base: National Total (32,013), Network Total (9,451), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590). This data excludes NHS Cumbria.

19 s Reasons why respondents put off visiting a doctor yes, often and yes, sometimes responses only National Data Network Data NHS Cumbria NHS Tees NHS North of Tyne NHS South of Tyne and Wear NHS County Durham and Darlington Pre NHS County Durham and Darlington Post I would be worried about what the doctor might find 31% 37% 43% 39% 25% 39% 39% 25% I would be too scared 23% 24% 32% 24% 20% 29% 24% 23% It would be difficult to make an appointment with my doctor I would be worried about wasting the doctor s time 25% 24% 26% 27% 18% 19% 26% 27% 22% 21% 19% 23% 10% 23% 23% 22% I would be too embarrassed 16% 17% 14% 18% 12% 20% 19% 15% I would be too busy to make time to go to the doctor I have too many other things to worry about 16% 13% 12% 12% 6% 11% 16% 15% 15% 13% 10% 14% 7% 14% 15% 13% My doctor would be difficult to talk to 10% 11% 8% 9% 7% 12% 11% 10% I wouldn t feel confident talking about my symptom with the doctor 9% 10% 8% 9% 6% 14% 9% 9% It would be difficult for me to arrange transport to the doctor s surgery 5% 4% 5% 4% 2% 5% 5% 4% The national and Network data indicate that respondents were more likely to put off visiting a doctor due to worries about what the doctor might find (31% national and 37% Network). Respondents within the Network were significantly more likely to give this response compared to the national baseline and responses were particularly high in NHS Cumbria (43%), Tees (39%), South of Tyne and Wear (39%) and County Durham and Darlington Pre Stage (29%). Almost a quarter of the Network sample (24%) also said they would be put off by difficulties making an appointment and a fifth (21%) said they would often or sometimes put off visiting the doctor because of worries about wasting the doctors time. It is evident that these barriers need to be addressed in order to promote early presentation. Q. Could you say if any of these might put you off going to the doctor? Base: National Total (32,615), Network Total (10,053), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590).

20 s Top 10 spontaneously mentioned factors that may cause cancer The most commonly named risk factor, smoking, was mentioned by 71% of both the national baseline and Network sample. This was followed by drinking alcohol which was mentioned by 28% of the national baseline and 27% of the Network sample. Respondents in NHS Cumbria, South of Tyne and County Durham and Darlington Post Stage were significantly more likely to mention drinking alcohol as a risk factor. With the exception of smoking and drinking alcohol, Network respondents were significantly less likely to mention all of the CAM specified code frames when compared to the national baseline. However Network respondents were significantly less likely to give the response don t know (9%) compared to 12% of the national baseline. Respondents with no formal qualifications were significantly more likely to be unable to name any risk factors (12%) as were those classified as socio-economic grade E (12%). * Pre stage data for NHS County Durham and Darlington was processed before the availability of the CAM toolkit and consequently this data is not comparative and has been excluded. Q. What things do you think affect a person s chance of getting cancer? Base: National Total (26,522), Network Total (3,960), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Post (1,590).

21 s Top 10 spontaneously mentioned risks - County Durham and Darlington Pre and Post Both pre and post stage respondents in NHS County Durham and Darlington were most likely to spontaneously mention smoking as a risk (67% pre, 68% post), however there was no significant increase in mentions of smoking pre to post. However post stage respondents were significantly more likely to spontaneously mention drinking alcohol at the post stage (20% pre, 34% post) in addition to getting sunburnt (10% pre, 14% post), lack of exercise (5% pre, 6% post), chance (4% pre, 8% post) and pollution/environment (4% pre, 6% post). At the post stage respondents were also less likely to give the response don t know (11% pre, 8% post), suggesting that knowledge of risk factors is increasing. * Pre stage data for NHS County Durham and Darlington was processed before the availability of the CAM toolkit and consequently this data is not comparative. Therefore post stage data has been grouped into code frames similar to the pre stage in order that pre and post stage spontaneous risks can be compared. Q. What things do you think affect a person s chance of getting cancer? Base: NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590)

22 s Prompted awareness of factors which may increase the chances of developing cancer Respondents in the Network sample were most likely to agree that smoking (91%) and exposure to another person s cigarette smoke (83%) could increase the chances of developing cancer. Agreement levels were lowest within the Network sample for healthy lifestyle related risk factors including physical activity, eating fruit and vegetables and eating red or processed meat. When compared to the national baseline, Network respondents were less likely to agree that most symptoms listed could increase the chances of developing cancer. Levels of agreement appear to vary across the Network sample, however there are some positive increases in agreement between the pre and post County Durham and Darlington samples, in particular those relating to alcohol consumption, infection with HPV, exercise, consumption of fruit and vegetables, and consumption of red meat. Within the Network sample, younger respondents (15-24 years) were significantly more likely to give the response not sure when asked about each of the symptoms listed. Q. How much do you agree that each of these can increase the chances of getting cancer? Base: National Total (32,615), Network Total (10,053), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590).

23 s Average number of symptoms spontaneously mentioned and prompted agreement This slide presents the mean number of causes of cancer recalled by respondents spontaneously and agreed to causes of cancer when prompted (out of a possible total of 11). National Total Network Total NHS Cumbria NHS Tees NHS North of Tyne NHS South of Tyne and Wear NHS County Durham and Darlington Pre NHS County Durham and Darlington Post Spontaneous causes No data 2.22 Prompted causes The mean number of risks spontaneously mentioned by the Network sample (1.94) was again notably lower than the national baseline (2.55) and prompted agreement was also lower within the Network sample (5.49 Network, 6.08 National). Again respondents in NHS Cumbria recalled the most causes both spontaneously and when prompted. Respondents from NHS North of Tyne spontaneously recalled the fewest causes (1.74), but respondents from NHS Tees agreed with the fewest causes when prompted. * Pre stage data for NHS County Durham and Darlington was processed before the availability of the CAM toolkit and consequently this data is not comparative Q. What things do you think affect a person s chance of getting cancer? Q. How much do you agree that each of these can increase the chances of getting cancer? Base: Detailed on previous slides

24 s Factors Contributing to Incidence of in the UK Respondents ranked 5 factors according to how much they contribute to cancer incidence in the UK where 1 is most important and 5 is least important Chance and aging are approximately on a par as least important Least important Lifestyle is considered most important Most important * This question is excluded from v2 of the CAM and was not asked in NHS Cumbria Q. Please put the following things in order of how much you think they contribute to caner in the UK. Base: National Total (32,013), Network Total (9,451), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590).

25 s Expectation of the number of people developing cancer in their lifetime Respondents were shown a picture of 100 people and asked how many out of 100 would develop cancer during their lifetime. One in three will develop cancer at some point during their lives. 53% of the national sample and 44% of the Network sample said 0-30 people out of 100 would develop cancer in their lifetime 17% of the national and Network samples correctly stated that people out of 100 would develop cancer in their lifetime 27% the national sample and 36% of the Network sample said more than 41 people out of 100 would develop cancer in their lifetime Q. How many people out of 100 will develop cancer over the course of their life? Base: National Total (28,601), Network Total (9,451).

26 s Expectation of the age people develop cancer Respondents were asked at what age people are most likely to develop cancer. The risk of developing cancer is closely related to increasing age and therefore, according to the CAM toolkit, people are most likely to develop cancer at 80 years old and above. The majority of respondents at the Network and individual area levels think that people are most likely to develop cancer at any age. Respondents from NHS Cumbria were most likely to give the response at any age (81%). Only 1% of the Network sample correctly stated that people are most likely to develop cancer at 80 years old and above. Responses to this question indicate that many respondents do not connect the development of cancer with the increase of age. Network Data 4% said years Network Data 17% said years Network Data 10% said years Network Data 1% said 80 years and above Network Data 64% said At any age Network Data 5% said Don t know * A slightly modified version of this question was asked in NHS Tees and North of Tyne therefore responses from NHS Cumbria and South of Tyne and Wear have been grouped in order to be comparative Q. Who is most likely to develop cancer? Base: Network (3,960), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1445), NHS South of Tyne and Wear (1,328).

27 s Most common cancers in women combined mentions The three most common cancers in women are breast, lung and colorectal. Respondents in both the national baseline and Network sample correctly named breast cancer as the most common cancer in women (94% national, 95% Network) and mentions of breast cancer were relatively high across the Network. Cervical cancer was named the second most common cancer in women in both the national baseline and Network sample, however respondents in the Network sample were significantly more likely to name cervical cancer when compared to the national baseline. Mentions of cervical cancer were particularly high at the NHS County Durham and Darlington pre stage (67%), but at the post stage respondents were notably less likely to mention cervical cancer c (52%). Within the Network sample only 26% and 19% respectively named the e second and third most common cancers in women, lung and colorectal cancer. Respondents in the Network sample were significantly icantly less likely to mention lung cancer (26%) when compared to the national sample (28%). Respondents in NHS South of Tyne and a Wear were significantly less likely to mention lung cancer (21%), whilst those in NHS Tees were less likely to mention colorectal cancer (13%). Pre stage respondents in NHS County Durham and Darlington displayed low awareness of colorectal cancer (17%) ) however at the post stage mentions had risen to 24%. Q. What do you think is the first/second/third most common type of cancer in women? Base: National Total (32,615), Network Total (10,053), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590).

28 s Most common cancers in men combined mentions The most common cancers in men are prostate, lung and colorectal. Lung and prostate cancer were the most commonly recalled cancers in men within both the national baseline and Network sample. Mentions of both lung and prostate cancer vary across the Network with awareness particularly high in NHS Cumbria and awareness significantly lower amongst respondents from NHS Tees. Network level respondents were significantly more likely to mention colorectal and testicular cancer when compared to the national baseline and the NHS County Durham and Darlington pre and post data indicates a positive increase in mentions of colorectal cancer as the most common cancer in men (40% pre, 52% post). It is interesting that respondents within the national baseline and Network sample are much more likely to think that males will contract both lung (60% national, 59% Network) and colorectal cancer (42% national, 44% Network) than women (28% national, 26% Network for lung and 18% national and 19% Network for colorectal). Q. What do you think is the first/second/third most common cancer in men? Base: National Total (32,615), Network Total (10,053), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590)

29 s Programmes Breast Screening Cervical Screening Bowel Screening cervical cancer screening is consistently high across the Network with no fewer than 71% of the samples in each Network area aware of this screening programme. breast cancer screening was more varied across the Network with those in Cumbria and North of Tyne significantly more likely to be aware. Unsurprisingly, awareness of the bowel cancer screening programme was consistently lower at the national and Network level. Within the Network awareness is significantly higher in NHS Cumbria, North of Tyne and South of Tyne and Wear. Furthermore, pre to post awareness of bowel cancer screening in County Durham and Darlington rose by 10%. Q. Is there an NHS breast/cervical/bowel cancer screening programme? Base: National Total (32,615), Network Total (10,053), NHS Cumbria (602), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328), NHS County Durham and Darlington Pre (6,093), NHS County Durham and Darlington Post (1,590)

30 s Age of first invitation for Programmes* Presented is the proportion of respondents who CORRECTLY attribute the age of invitation to each of the NHS cancer screening programmes Breast Screening (50-54 years) Cervical Screening (25-29 years) Bowel Screening (60-64 years) Correct attribution of the age of invitation increases notably in County Durham and Darlington Pre to Post for breast and bowel * Age of first invitation was only asked to those who were aware of the screening programme Q. At what age do you think people are first invited to breast/cervical/bowel cancer screening? Base: Varies by area and screening programme.

31 s Experience of screening programmes* Breast Screening Female respondents aged 50 years and over were asked specifically about breast cancer screening attendance. In total 79% of those in the target age range could recall receiving an invitation to attend breast cancer screening (Network level). Recall was highest amongst respondents from NHS North of Tyne (83%). 95% of respondents who could recall receiving an invitation said they had attended, with those in the North of Tyne sample significantly more likely to say they had attended. In total 34% of the those who had attended screening said they had done so within the last year. Cervical Screening Female respondents aged years were asked about cervical cancer screening attendance. Of the total Network sample, 86% of those in the target audience recalled receiving an invitation to attend cervical cancer screening. Invitation recall was highest in NHS North of Tyne (88%) but not significantly higher than other areas. According to respondent answers, screening attendance is high with 94% of those who could recall receiving an invitation saying they had attended. Again, reported attendance was highest in NHS North of Tyne. Just under a third of those who said they had attended have done so within the last year (30%). Bowel Screening Both male and female respondents aged 60 years and over were asked about bowel cancer screening. At the Network level, 55% of those in the target age range said they recall receiving an invitation to complete a bowel cancer screening kit. Recall was highest in NHS South of Tyne and Wear (60%). Of those who recall receiving an invitation, 81% report that they have completed a screening kit. Respondents from the North of Tyne sample were significantly more likely to report having completed a screening kit (86%). More than half of those who reported completing a kit said they had done so within the last year (52%). Additionally, respondents who had not completed a kit were asked why this was using an open question. Many respondents reported that they did not complete a bowel cancer screening kit because they did not like the idea of it. Others reported that it is embarrassing and/or confusing. * Questions on screening attendance are an addition to the validated CAM and were only asked in NHS Tees, North of Tyne, South of Tyne and Wear and as part of NHS County Durham and Darlington s post stage Q. Have you ever received an invitation to breast/cervical/bowel cancer screening? Q. Have you ever attended/completed breast/cervical/bowel cancer screening? When did you last attend breast/cervical/bowel cancer screening?- Base: Varies by area and question.

32 s Communication Preferences The largest proportion of the Network sample (45%) said that they would prefer to be kept up to date with information about the NHS and its services via the television. Preference for this method of communication was highest in NHS South of Tyne and Wear (55%) and lowest in NHS North of Tyne (36%). 39% of the Network sample said they would prefer to be kept up to date through information in doctor s waiting rooms. Respondents in NHS North of Tyne (41%)and South of Tyne and Wear.(43%) were significantly more likely to select this option.. More than a third of the Network sample (34%) said they would prefer to be kept informed through leaflets/flyers. More than two-fifths of the Network sample (23%) would prefer communications via newsletters. Respondents in NHS Tees were significantly more likely to select this option (27%) and respondents in NHS South of Tyne and Wear were significantly less likely to (21%) Over two-fifths of the sample (22%) also indicated a preference for communications via posters/billboards. Preference for this communications method was highest in NHS South of Tyne and Wear were a quarter of the sample selected this option (25%). * preferences is an addition to the validated CAM and is only asked in NHS Tees, NHS North of Tyne and NHS South of Tyne Q. How would you prefer to be kept up to date with information about the NHS and the services offered? Base: Network Total (3,358), NHS Tees (585), NHS North of Tyne (1,445), NHS South of Tyne and Wear (1,328).

33 Recommendations Improve awareness of the symptoms of cancer Network level respondents show low levels of awareness of the most common signs and symptoms of cancer spontaneously. Even when prompted there are relatively low levels of agreement that some symptoms, could be a sign of cancer particularly a cough or hoarseness and a sore that does not heal. Social marketing is needed to raise awareness of common signs and symptoms of cancer, ideally in relation to the most common cancers in the region. Encourage help seeking behaviour and overcome barriers Network level respondents wait longer than average before contacting a doctor to discuss the signs and symptoms of cancer. There is a need to decrease this length of wait and to break down barriers that prevent respondents from initiating contact with a doctor, particularly emotional barriers such as being worried about what the doctor might find, or being scared or embarrassed, and worries about wasting the doctors time. Social marketing material designed to address barriers and promote the importance of earlier presentation would be beneficial and doctors appointments also need to be easier to make. Improve awareness of the most common types of cancer Respondents show low levels of awareness of the most common types of cancer, particularly cancer in women where there is a tendency to over emphasize the incidence of cervical cancer in place of lung and bowel. Given the high incidence levels of bowel and lung cancer regionally, it would be beneficial to increase awareness of these cancers in both men and women. It would also be beneficial to attempt to increase bowel cancer screening take up by tackling the issues people have with completing the kit.

34 Please note that individual reports are available for each of the NHS areas served by the North of England Network where further information can be found if required. FOR MORE INFORMATION PLEASE CONTACT DR NICKY TURNILL The Mill, Hexham Business Park, Burn Lane, Hexham, Northumberland, NE46 3RU T: F: E: E: W:

35 NHS County Durham and Darlington Interventions Overview of NHS County Durham and Darlington interventions Talking About Project Launched: 2008 with countywide expansion in December 2009 Target: Mainly deprived areas Aim: Increase awareness of the signs and symptoms of specific cancers (bowel, breast, lung and cervical) Method: Peer education programme with development of training course. Delivered through community workshops (workplaces, community centres) and information stalls (public events, high footfall public spaces). Other Developments Data availability and service developments Cervical Screening Aim: Interventions aimed at encouraging GP practices to review their screening rates and to try innovative methods and raise rates during 2009/10. Encourage GP Practices to target <29 year olds, as group with low screening rates. Methods: Text messaging (in Consett found reduced DNAs) FAQs and better appointment invites. Women sent appointment time instead of a request for them to make an appointment. More opportunistic screening. Seeing same staff member each visit. Bowel Screening Methods: At launch of the programme regional awareness campaign undertaken. Since the launch regional work to increase awareness of the programme has continued with public posters. Local marketing campaign starting July 2011 already piloted during 2011 in Spennymoor and Ferryhill. Social Marketing Be Clear on 2011: Targeting several cancers through local and regional media campaigns. Race for Life: Aimed at promoting awareness of all cancers. Regional media campaign. Northern Echo 2011: Regular features including case studies and information on signs and symptoms.