Figures released by Public Health England (PHE) reveal that around 10,200 people in England die from oesophago-gastric (OG) cancers every year (1): this equates to 28 people each day. Early diagnosis of oesophago-gastric cancers is crucial: around 67% of those diagnosed at the earliest stage survive for at least five years compared with 3% for those diagnosed at a late stage. (2)
To help improve public awareness of the symptoms of OG cancers, PHE is running the Be Clear on Cancer oesophago-gastric cancer campaign nationally from 26 January – 22 February 2015. The campaign is aimed at men and women over 50, with the primary message being “Heartburn most days for three weeks or more could be a sign of cancer – tell your doctor”. There is also a secondary message highlighting dysphagia as a symptom – “food sticking when you swallow could be a sign of cancer – tell your doctor”.
The decision to run the campaign nationally follows encouraging results from a pilot which ran in the North East and North Cumbria region from February to March 2014, where research showed a significant uplift post-campaign in spontaneous awareness of oesophago-gastric cancer symptoms (that is, heartburn and food sticking). (3) In terms of clinical outcomes, early analysis shows:
- A significant uplift of 29 percentage points, in the proportion of upper GI cancers diagnosed via a two-week wait (2WW) referral, among those aged 60–69. This is encouraging as we know one year survival is worse for those diagnosed via emergency presentation compared with those diagnosed via 2WW referral. We also know older people are more likely to present via emergency presentation.
- A 52% increase in urgent GP referrals for suspected upper gastrointestinal (GI) cancers, compared with a 17% increase in the control areas. (4)
- Preliminary data from a sample of 50 practices in the regional pilot area in early 2014 demonstrated a 46% increase in GP visits regarding oesophago-gastric cancer symptoms mentioned in the campaign. This equates to an additional 0.6 appointments per practice per week.
- Regarding endoscopy, the average increase per week was 16 additional gastroscopies as a delayed effect of the pilot from March 2014 until August 2014. The range across the nine NHS trusts in the pilot area went from one additional gastroscopy per week up to 23 additional gastroscopies.
In addition early indications suggest an increase in the number of Barrett’s Oesophagus cases diagnosed in a sample of hospital trusts. Between 1 in 200 and 1 in 1,000 people who have Barrett’s Oesophagus will develop oesophageal cancer therefore identifying this condition can increase the chance of detecting some oesophageal cancers early.
To help local teams to prepare, NHS Trusts, Clinical Commissioning Groups and Strategic Clinical Networks were notified about the campaign in September 2014, with further information about the campaign, together with learnings from the regional pilot, sent via a briefing sheet in October 2014. In addition, three events took place in December. This provided information about the campaign and learnings from the regional and local pilots gave perspectives from a number of different healthcare professionals and offered the opportunity to ask questions of an expert panel.
The Be Clear on Cancer oesophago-gastric cancer campaign targets the age group most at risk of developing OG cancers, the over 50s. To help manage the potential impact, particularly on endoscopy services, advertising will run for four weeks rather than the usual six for national campaigns. The campaign includes partnership and digital activity targeted at those who regularly buy heartburn medication.
Commenting on the impact of the regional pilot, Anjan Dhar, Senior Lecturer in Gastroenterology, Consultant Gastroenterologist, County Durham, said:
“In Durham, we certainly felt the impact of the regional pilot campaign on endoscopy services. Although it was a challenge it wasn’t insurmountable. We worked with our GP partners to implement a temporary secondary care pathway and added extra endoscopy lists during weekends. This is a fantastic opportunity to make a real impact in improving survival rates for these cancers.”
Professor Kevin Fenton, National Director of Health and Wellbeing at Public Health England explains the importance of this awareness activity:
“The initial results of the regional pilot are starting to show the potential advantage of this Be Clear on Cancer oesophago-gastric campaign. Evaluation results to date show an increase in cancers diagnosed via the two-week wait referral route following a number of the Be Clear on Cancer campaigns. These campaigns give the potential for more diagnoses and better outcomes for cancer.”
Sean Duffy, National Clinical Director for Cancer at NHS England said:
“Early diagnosis of cancer is absolutely critical to improving survival. Part of this is helping people understand what symptoms to look out for, which is why campaigns like this are so important. Patients with possible early signs and symptoms should visit their GP so where necessary they can be referred for tests, and treatment can start quickly. Early diagnosis is a key focus for us and will form part of the NHS’s new five year strategy for cancer, currently being developed by an independent taskforce.”
The campaign key messages will be promoted through television, radio, digital and out of home advertising, together with face to face events in venues such as shopping centres. Further information for healthcare professionals, including a video showing the experience of healthcare professionals involved in the regional pilot, is available at naedi.org/beclearoncancer/oesphago-gastric.
- Deaths data supplied by Public Health England’s West Midlands Knowledge and Intelligence Team based on Office for National Statistics data.
- Survival is relative period survival supplied by Public Health England’s West Midlands Knowledge and Intelligence Team based on National Cancer Registration Service data. One-year relative survival is based upon staged 2003-2012 diagnoses and five-year relative survival is based upon staged 1999-2008 diagnoses.
- TNS BMRB on behalf of Public Health England post-OG campaign survey of 300 adults aged over 50 interviewed face to face in the North East region, 12-25 March 2014. Significant uplift based on all who had seen any publicity recently about the symptoms of cancer.
- Data from the National Cancer Waiting Times (CWT) Monitoring Dataset provided by NHS England and accessed via Public Health England’s Knowledge and Intelligence Team (East Midlands).
- Data supplied by Mayden, specialists in healthcare information technology, http://www.mayden.co.uk/.
- All data from Diagnostics Monthly Waiting Times and Activity Reporting Data (DM01).
- Data supplied by individual NHS trusts who participated in the regional pilot (Northern England SCN area, Feb–Mar 2014).
- Hvid-Jensen F et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. New England Journal of Medicine 2011;365:1375–83 and Yousef F et al. The incidence of esophageal cancer and high-grade dysplasia in Barrett’s esophagus: a systematic review and meta-analysis. American Journal of Epidemiology 2008;168:237–49.