Cancer awareness campaign fails to improve diagnosis rates

A DH-backed cancer awareness campaign failed to detect more cases or improve recognition of symptoms, casting doubt over whether a recent £8.5m bowel cancer campaign was worthwhile.

Lung cancer: the DH awarded 109 PCTs between £22,750 and £100,000 each to develop awareness campaigns for breast, bowel and lung cancers (Photograph: SPL)
Lung cancer: the DH awarded 109 PCTs between £22,750 and £100,000 each to develop awareness campaigns for breast, bowel and lung cancers (Photograph: SPL)

The £9m project, which ran in 2010/11 and covered a quarter of England's population, encouraged patients to visit their GP if they had symptoms of cancer.

But a DH report found it had no impact on people's awareness of common symptoms.

The number of two-week wait referrals from GPs and subsequent diagnoses increased by the same amount in areas with active campaigns as control areas.

Yorkshire GP Dr Nick Summerton, a DH cancer adviser, said: 'To be frank, I thought the campaign was, at best, naive and poorly planned. I also suspect it generated considerably more patient anxiety than earlier cancer diagnoses.'

He said the campaign tried to raise public awareness of too many symptoms, which often present as vague and undifferentiated anyway.

'The money could have been much better spent on low-dose CT scans and widening access to flexible sigmoidoscopy,' he said.

Campaign backed by £9m
Organisers completed an analysis of the negative pilot results in October 2011, the report said. Yet, three months later ministers launched an £8.5m bowel cancer awareness campaign in January that used the same promotional material as these pilots.

The project, organised by the National Awareness and Early Diagnosis Initiative, a partnership between the DH, the National Cancer Action Team and Cancer Research UK, was backed by £9m of funding.

The DH awarded 109 PCTs between £22,750 and £100,000 each to develop awareness campaigns for breast, bowel and lung cancers.

Organisers tracked two-week wait referrals, screening uptake, public awareness and the numbers of cancers detected, among other measures.

To improve awareness, PCTs used slogans such as ‘Be Clear on Cancer’, ‘Cough Cough’ and ‘Don’t be a Cancer Chancer’ on posters, fliers, media advertising and in organised community events.

NHS managers discussed the campaign with local GPs and pharmacists and improved GP direct access to scans such as chest X-Ray.

No impact on cancer awareness
During the campaign, urgent GP referrals for suspected lung cancers rose 9% compared with the previous year. But referrals also increased 7% in PCTs that did not run campaigns. This reflected a national trend of increasing referrals at this time.

The report said not all results were published when the report was written. Benefits were seen in some areas but not in others.

Nevertheless, researchers concluded that the results overall 'suggest that the increase seen at the project level could be simply due to a general trend of more people being referred through this pathway, rather than due to the project activity itself'.

Similarly, there was no overall difference in diagnosis rates between campaign areas and controls. Just 28 extra cancers were detected across 19 project areas.

For bowel cancer, campaign areas saw a 16% increase in urgent GP referrals but this was the same as in control areas. Nor were there differences in diagnosis rates, which rose by around 1.3%.

Researchers said: 'Thus, the increase cannot necessarily be attributed to the local projects.'

Campaigns worked well in some areas, with 24% more people in Warwickshire saying they would be likely to visit their GP with a symptom they thought could be cancer.

But in most areas there was no change in awareness.

Researchers said that, overall, results 'have not shown significant changes in unprompted or prompted awareness of cancer signs and symptoms when comparing pre- and post-intervention surveys from those projects'.

GPs 'cynical' about pilot
During the programme organisers met with 'a degree of cynicism about whether this work will translate into both cost efficiencies and improved survival' from clinicians.

The report also reveals the impact of the NHS reorganisation on efforts to improve cancer awareness. One pilot participant described: 'Many practices raised the issue of doing "more" referrals when they felt they were being told to do "less" activity. Whether perception, reality or misinterpretation it was a common theme.'

Organisers will continue to analyse the project as more data become available to find out the most effective way of raising public awareness and increasing GP referrals.

A DH spokesperson said: 'The results from the surveys gathered were varied across the projects, with some reporting positive findings.

'The Be Clear on Cancer campaigns have helped to raise awareness of the key symptoms of these cancers and have changed people's behaviour with more patients that have the relevant symptoms going to their GP.

'This has resulted in more patients being referred by their GP for tests and this is the first essential step in moving towards earlier diagnosis.

'We knew from the start that this was not a one-off campaign and have anticipated the need for it to last a number of years to get full impact. We expect to see a clearer picture emerging when we conduct further analysis.'

Dr Jodie Moffat, Cancer Research UK's senior health information manager, said the report was the first of a number of analyses of the pilots.

'This will help us learn as much as we can about the impact these activities can yield. Already we know that some of the pilots reported positive changes in key areas, and one of the tasks now is to explore this further.'

She added that the project would provide evidence of what works in promoting earlier diagnosis of cancer.

'With the changing landscape, it is vital that awareness and earlier diagnosis of cancer do not slip off the agenda. Improving outcomes for cancer patients and addressing the differences in cancer survival that exist between the UK and comparable countries must continue.'

The national Be Clear On Cancer campaign ran for nine weeks from the end of January, through television, radio and newspaper adverts, and cost £8.5m.

The public were advised to speak to their GP as soon as possible if they have had blood in their 'poo' or looser stools for three weeks or more.

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