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National bowel cancer awareness campaign 'failed to improve patient outcomes'

The Government’s national bowel cancer awareness campaign has not led to an improvement in patient outcomes, despite prompting a big increase in the number of patients with symptoms going to the GP, according to a study at one NHS trust.

Researchers from Mid Yorkshire Hospitals NHS Trust said the awareness campaign resulted in the number of two-week-wait referrals to their colorectal unit increasing by half, but that colorectal cancer (CRC) detection rates did not change and most patients still presented with late-stage disease.

The team called for a rethink of future awareness campaigns because colorectal units could not cope with the increased number of referrals.

The bowel cancer awareness campaign was the launchpad for the Government’s Be Clear on Cancer awareness campaigns, which aim to improve early diagnosis of cancer by raising awareness of symptoms amongst the public and encouraging people to see their GP earlier.

The publicity campaign involves adverts in public places and in local newspapers and advises people to visit the GP ‘if you’ve had blood in your poo or looser poo for the last three weeks’.

The first national campaign was launched at the end of January 2012 despite concerns from GP experts it would overwhelm diagnostic services and lead to delays. Subsequent results emerging from pilots suggested the campaign would not necessarily improve cancer detection rates.

Dr Tak Khong and colleagues from Pinderfields Hospital in Wakefield looked at the effect of the national bowel cancer awareness campaigns run between February and the end of March 2012 and between September and the end of October 2013.

Compared with corresponding 2011 figures, there was a 55-60% increase in referrals through the two-week-wait route during the two periods of the bowel awareness campaign.

The number of CRC diagnoses did go up in line with the increase in two-week-wait referrals during each campaign period, from less than 30 cases to nearly 50 cases in the first and from 20 to 35 cases in the second period.

However, the authors said the detection rate was unchanged, with the proportion of positive diagnoses remaining low in each campaign period at 5.6% and 6.1%, respectively.

And there was no change in the stage at which cancer was diagnosed as a result of the campaign, with over 50% of patients diagnosed with stage 3 and 4 disease in both the February to April periods, and 60% in the September to October period of 2011 compared with 40% in the same two months in 2011.

One-year survival of patients diagnosed with CRC also did not differ between patients diagnosed as a result of the campaign and those diagnosed in 2011.

The researchers, who presented their findings at the recent British Society for Gastroenterology annual conference, concluded: ‘The UK bowel awareness campaign has increased public awareness of CRC and prompted symptomatic individuals to seek medical attention.

‘However, increased two-week-wait referrals has not translated to better outcomes for patients, partly due to late presentation.’

Dr Khong and colleagues said better risk assessment tools were needed to identify ‘those most at risk of CRC who would benefit from urgent diagnosis and treatment’. 

Otherwise, they added, ‘future national public health campaigns would undoubtedly mount further pressures on stressed colorectal units which are currently working at their limits’.

Dr Mike Cohen, a member of the steering group of the Primary Care Society for Gastroenterology and medical director of Prime Endoscopy Bristol, said the awareness campaign had resulted in a significant increase in two-week-wait referrals, while a significant proportion of patients who turn out to have cancer would not meet the two-week-wait criteria.

Dr Cohen said: ‘There are a lot of people with early disease who do not fulfil the two-week-wait pathway, who are being diagnosed on the non-two-week-wait route now.

‘All this is happening at a time when bowel scope flexible sigmoidoscopy screening is being introduced for those at 55 years of age leading to a big demand on already stretched services.’

Dr John O’Malley, a GPSI in gastroenterology and GP in Stockport, said: ‘GPs are doing a great job, they are trying to get the two-week-wait referrals in.

‘The problem is that’s not translating into [improved outcomes] so whether that’s because the guidelines are not good enough or the pathways need to be looked at is a moot point.’

Cancer Research UK, which has taken over the evaluation of the Be Clear on Cancer national campaigns, said the findings ‘were not surprising’ as the impact of the campaign would vary in different areas.

Dr Sara Hiom, Cancer Research UK’s director of early diagnosis, said: ‘This audit is the latest in a number of local studies confirming that there are variations across England in the impact of these campaigns, so these findings aren’t surprising.’

‘We’ve helped evaluate these pilots on a national and local level because ongoing evaluation is vital if we are to understand the impact of each campaign on local services and cancer outcomes.’

Gut 2014; 63: A241-2

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Readers' comments (5)

  • Vinci Ho

    The problem is cancer higher up in the colon is more occult e.g. caracal cancer and will not be easily detected by just 'blood in the poo or loose poo'.
    Otherwise, I can see the 'wise men' in NHSE will ask people to take aspirin everyday to prevent colon cancer after reading the astrology.......

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  • Vinci Ho

    Correction
    ....e.g. Caecal cancer

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  • No the problem is that secondary can't manage the demand,it has nothing to with primary career gps apart from its a nice way to blame gps. It's very childish actually, the way nhs is working. Frankly they should just let patient self refer using the simple 2 week rule tick box criteria. Would reduce everyone's workload.

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  • Just Your Average Joe

    Campaigns are ill thought out.

    If you have a cough for >3 weeks panic and see your GP.

    no mention of age, or if cold then no need etc, so hundreds of inappropriate worried well swamp GP practices in cold season with children with viral illness worried about lung cancer.

    TWR guidance is cough over 6 weeks needs CXR, which is highly appropriate but not specific to Lung cancer.

    Therefore campaign should have been 'Over 40 and had a cough for over 6 weeks without a recent cold' esp if smoker go see your GP.

    Then a little more targeted and you get improved care and outcomes while preventing huge wastes of time and money.

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  • Just Your Average Joe

    Therefore campaign should have been 'Over 40 and had a cough for over 6 weeks' esp if smoker and without a recent cold go see your GP.

    Feel free to fine tune and use!

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