Cancer Early Diagnosis Campaigns

Objectives

The strategic aim is to help halve, by 2014/15, the gap between cancer survival in England and survival in the best European countries, with an estimated benefit of 5,000 additional lives saved each year.[1]The principal route is earlier diagnosis, supported by sustained public awareness, earlier presentation to general practice, effective screening, and improved diagnosis for people with symptoms.[1][2]

• Raise awareness of possible cancer symptoms and encourage people to seek prompt advice from their general practitioner.[1]
• Embed early-diagnosis messages through continuing public-awareness campaigns rather than relying solely on one-off activity.[2]
• Reduce late diagnosis through national and regional campaigns addressing bowel cancer, blood in urine, breast cancer symptoms among women aged over 70, ovarian cancer, and broader combinations of symptoms.[2]
• Strengthen the capacity to investigate symptomatic patients, including diagnostic and endoscopy services needed when campaigns increase referrals.[1][2]
• Assess whether campaigns generate appropriate help-seeking and diagnostic activity by monitoring urgent suspected-colorectal-cancer referrals, endoscopy volumes, waiting times, age profiles and regional variation.[1]

The evidence base cited for the 2012 bowel cancer activity indicates that awareness campaigns can increase urgent referrals and diagnostic procedures.[1]During the February and March 2012 campaign period, urgent two-week-wait referrals increased, including by around 50% in areas that had not previously participated in pilot campaigns; the East of England recorded a 48% increase, while the South West recorded 5.5%.[1]Most additional referrals, 80%, involved people aged 50 and over.[1]Colonoscopy and flexible-sigmoidoscopy activity increased significantly, although there was no overall national or Strategic Health Authority-level effect on long waits for symptomatic patients.[1]

The document does not specify a wider cancer-control framework beyond the early-diagnosis and awareness objectives, nor does it set out quantified targets for individual cancer types, screening uptake, diagnostic timeliness or survival outcomes other than the overall survival-gap ambition.[1][2]

Implementation

Implementation combines national advertising, regional pilots, community engagement, service preparation and evaluation.[2]Cancer Networks are expected to work with commissioners and providers so that primary and secondary care can manage increased demand arising from campaigns.[2]Advance notice, demand projections and practical preparation support are intended to help services, particularly general practice and endoscopy, respond safely and promptly.[1]

• Repeat the national bowel cancer campaign from 28 August 2012 for four weeks at lower intensity, then use further advertising in selected areas to test the effects of sustained campaigning.[2]
• Run regional pilots from January to mid-March 2013 on blood in urine and breast cancer symptoms among women over 70.[2]
• Test local activity on ovarian cancer and wider constellations of symptoms to establish whether broader symptom-based communication can help reduce late diagnosis.[2]
• Fund community engagement in selected regions and compare local non-advertising approaches with paid advertising.[2]
• Coordinate delivery through a national partnership programme involving primary-care support, improved diagnostic access, national charities and professional organisations.[2]
• Prepare for additional referrals and endoscopy activity in secondary care, while continuing to review the cancer pathway during the repeat bowel campaign.[2]
• Evaluate all campaign activity and publish findings in the public domain as soon as possible.[1]

Evaluation of the 2012 bowel campaign uses urgent two-week-wait referrals for suspected colorectal cancer and endoscopy activity, drawing data from the Department of Market Intelligence.[1]Analysis is intended to consider regional and age-group patterns, referral volumes, colonoscopy and flexible-sigmoidoscopy activity, and waiting times.[1]The programme also deliberately compares sustained advertising, community engagement and broader symptom campaigns to identify their respective effects and potential contribution to reducing late diagnosis.[2]

Financing for additional tests and treatments needed to support earlier diagnosis of symptomatic cancer is provided through Primary Care Trust baselines for the Spending Review.[1]Separate funding supports community-engagement work in selected regions as part of the campaign-testing programme.[2]The document does not specify total campaign budgets, allocations by intervention or region, named accountable organisations beyond the delivery partners, formal governance arrangements, cost-effectiveness findings, or wider economic assumptions.[1][2]

Monitoring & Evaluation

Campaign evaluation combines published assessments of activity and service impact with tests of alternative approaches intended to reduce late cancer diagnosis.[1][2]

• Evaluate all campaign activity and publish findings in the public domain as soon as possible.[1]
• Monitor urgent two-week-wait referrals for suspected colorectal cancer and endoscopy activity using Department of Market Intelligence data to assess the 2012 bowel cancer campaign.[1]
• Assess effects by region, age group, referral volumes, colonoscopy and flexible-sigmoidoscopy activity, and waiting times.[1]
• Record that the February and March 2012 campaign period was associated with increased two-week-wait referrals, including an increase of around 50% in regions not previously involved in pilot campaigns; the East of England recorded a 48% increase and the South West 5.5%.[1]
• Identify that 80% of additional referrals were among people aged 50 and over.[1]
• Note a statistically significant increase in colonoscopy and flexible-sigmoidoscopy activity, but no overall national or Strategic Health Authority-level effect on long waits for symptomatic patients.[1]
• Test sustained advertising, community engagement and broader symptom-based activity to establish their effects and potential to reduce late diagnosis.[2]

Costing & Financing

Additional diagnostic-test and treatment costs associated with earlier diagnosis of symptomatic cancer were financed through Primary Care Trust baselines for the Spending Review.[1]Funding also supported community engagement work in selected regions within the campaign testing programme.[2]

• Use Primary Care Trust baseline funding to meet additional costs of tests and treatments required for earlier diagnosis of symptomatic cancer.[1]
• Fund community engagement activity to compare local non-advertising interventions with paid advertising in selected regions.[2]
• Note that total campaign budgets, individual allocations, funding gaps, cost-effectiveness findings and wider economic assumptions are not specified.[1][2]