Cancer: Why extra GP visits triggered by the Be Clear on Cancer campaign are worth it

The latest Be Clear on Cancer campaign will push some patients through GP practices' doors at a time when services are already stretched. But the campaign can be a springboard for longer-term improvements that help detect cancer early, argue Manchester GP Dr Nigel Guest and national clinical director for cancer at NHS England Professor Chris Harrison.

Dr Nigel Guest
Dr Nigel Guest

This month saw the launch of the latest Be Clear on Cancer campaign and some of our GP surgeries may have started to feel the impact of these adverts already. Many of us will be familiar with the adverts about the three-week persistent cough because these first appeared on our TV screens in 2012.

In addition, this time Public Health England (PHE) has included a message about inappropriate breathlessness – defined as getting out of breath doing the things you used to be able to do. This was piloted in the East of England and is now being run in tandem with the three-week cough adverts. It is hoped this duo will reach out to members of the public who may have undiagnosed COPD, lung cancer or heart disease – as well as a host of other respiratory conditions that may present with these symptoms.

Between us, our experience spans over 25 years in public health and 30 years in general practice and during that time we have seen many positive developments, but we still have a long way to go when it comes to improving lung cancer outcomes.

Cancer outcomes

The title of our plan to radically reform public services in Greater Manchester is 'Taking charge of our health and social care'. To some it may seem that a campaign run by a central team at PHE is at odds with this approach. A disconnect that isn’t enabling us to ‘take charge’ - but we disagree.

The campaign focus on a particular type of cancer encourages us to review and consider clinical pathways and reassess models of care – we appreciate that transformations of this nature can’t always happen quickly, but the Be Clear on Cancer campaigns can help to act as a catalyst for change. The campaigns are an opportunity for us to shine the spotlight on areas where we may have public health challenges – in Trafford CCG our lung cancer incidence rate is above the national average and we are joined in the higher ranks by many of our colleagues in neighbouring north of England towns and cities -  therefore raising awareness of the symptoms associated with lung cancer and other respiratory conditions is welcomed. But most of all, the campaigns provide us with an opportunity to improve things for our patients.

We know from the first national lung cancer campaign that ran in England that more cancers were diagnosed in the months surrounding the activity compared with the same months in the previous year (approximately 700 more), that there was an increase in the proportion of earlier stage diagnoses (equivalent to around 400 additional cases) and most importantly, that around 300 more people received surgical interventions as a first treatment for lung cancer – the best chance we have at seeing an improvement in longer-term outcomes for lung cancer patients. Analysis and evaluation of metrics related to the second and third national lung campaigns is ongoing.

GP workload

The results of the previous campaigns in combination with other improvements can make the difference between us lagging behind the best in Europe and becoming one of the best in Europe. In Manchester – through the ACE programme - we are looking at ways in which we can streamline the lung cancer pathway. We are seeing firsthand the impact of new treatment options. At The Christie - the largest single-site cancer centre in Europe - we have been successfully using SABR (stereotactic ablative radiotherapy) to treat early lung cancers for several years.

Working with the Royal Marsden and University College London Hospitals, The Greater Manchester Cancer Vanguard is looking at the full patient experience; from prevention to end-of-life care, across all key providers in public health, the NHS and wider social care services. As more people survive a cancer diagnosis, we need to ensure we are all equipped to manage the ongoing care and needs of the patient. It is going to take a multifaceted approach to see the shift we need in lung cancer outcomes and Be Clear on Cancer is a valuable part of that.

Yes, the Be Clear on Cancer campaign will push more people through our surgery doors with persistent coughs and inappropriate breathlessness. Following the first national lung cancer campaign, analysis of data from 486 GP practices showed that there was around a 63% increase in the number of patients aged 50+ presenting with a cough (when comparing with the same time previous year) the equivalent of around three additional visits per practice, per week.

And yes, resources may already be stretched in some areas, but we need to think differently about how we manage things – we have found that by working with the full primary care team including pharmacists, health care assistants, practice and community based nurses; these campaigns can be successfully managed at a local level.

Although we may not have found a cure for all lung cancers, if detected early we can dramatically improve the number of years patients live and with a good quality of life. From a Manchester perspective, we want to embrace the Be Clear on Cancer campaigns and not view them in isolation, but use them as a springboard. We want to stop seeing them as a short-term campaign, and instead think about the opportunities that they present to help us transform the way we diagnose, treat and support cancer patients in our communities.

Dr Nigel Guest is a GP based in Timperley, Manchester, chief clinical officer at Trafford CCG and a member of the Manchester Cancer board; and Professor Chris Harrison is medical director (strategy) at The Christie NHS and national clinical director for cancer at NHS England.

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