Viewpoint: GPs should be prepared to see patients coming into surgery about a persistent cough

Leicestershire GP Dr Pawan Randev on the benefits of the DH's Be Clear on Cancer campaign.

Dr Pawan Randev fronts the DH’s Be Clear on Cancer advertising campaign.
Dr Pawan Randev fronts the DH’s Be Clear on Cancer advertising campaign.

Eight months ago, the DH ran a pilot awareness campaign in the East and West Midlands. Under the Be Clear on Cancer banner, the campaign aimed to encourage anyone, especially over 55s, showing the key signs of lung cancer – namely a persistent cough for three weeks or more – to book an appointment with their GP. The results were very positive and last month the campaign rolled out on a national basis.

‘Right sort’ of patients

There’s been some criticism by GPs saying that the campaign is driving the worried well into surgery but, I have to say, that is not my experience at all. My surgery in North West Leicestershire fell into the pilot area and I can honestly say we weren’t overwhelmed. DH data show that during the eight weeks that the pilot ran in the Midlands, practices saw an average of just 2.4 extra patients per week.

The patients I was seeing were right to book an appointment with me. I didn’t have anyone coming to me for inappropriate reasons. When they reported a cough for three weeks or more, I had the opportunity to examine and reassure them, refer them for an X-ray to investigate whether it could be lung cancer, or find out whether there was another reason for their symptoms.

The results from across the region reflect that the ‘right sort’ of patients were prompted to visit their GP; the regional pilots showed a 23% increase in the number of people who visited their GP with relevant symptoms and an increase in referrals for chest X-rays and chest CT scans compared with the same period the previous year.

Advertising campaign motivates patients

I found that the advertising campaign gave those who had been worried about a cough or another symptom the confidence to come in to surgery; it showed sympathetic GPs who wanted to see their patients.

Often, prior to the adverts, those who were the most worried about coming were smokers who would normally dismiss a cough as 'only a smoker’s cough' and wouldn’t think to come to surgery for fear of being reprimanded about their habits.  When smokers did come in I found it gave me an opportunity to talk to them about smoking cessation at a time when they were aware of the impact that smoking was having on their health.

Although the pilot campaign only ran for eight weeks, the impact it had has been a lasting one. It didn’t just reach those who had a cough or another symptom. I found that the 'health-responsible' family member, often the wife or adult daughter, took on the messages and encouraged others in the family to visit me if they were worried.

The national campaign rolled out in May has had a similar impact and I note that the number of patients booking appointments in my practice about a persistent cough hasn’t increased dramatically. 

We’re all too aware that one-year survival rates for cancer in this country are poor, and that we lag behind many countries including Australia, Canada and Sweden.

Statistics show that in England only 25% of people with lung cancer will survive for at least a year after receiving a diagnosis. Just 7% will survive for at least five years.  However, survival rates can vary widely depending on how far the cancer has spread at the time of the diagnosis.

One of the reasons for such low survival rates is that people aren’t clear on what the signs of the disease are and they tend to present to GPs too late; DH research prior to the campaign showed that one in 10 people knew that a persistent cough for three weeks or more could be a symptom of lung cancer, much lower than for symptoms of other forms of cancer such as breast, testicular or skin cancer.

The Be Clear on Cancer campaign – which aims to raise awareness of the symptoms - is therefore playing, an essential role in the government’s commitment to significantly improve cancer survival.

It’s not just low awareness of symptoms that is holding people back; we know that patients are often worried about wasting their GP’s time with something they think might be a trivial health concern. 

Being able to evaluate, reassure and investigate appropriately is part of our role as GPs so we should support symptom awareness campaigns. 

  • Dr Pawan Randev is a GP in Measham and works for North West London Cancer Network. He also fronts the DH’s Be Clear on Cancer advertising campaign.

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