Abdominal symptoms campaign

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Essential info

Want and overview of the campaign and help to prepare for the campaign?

Health Care Professionals briefing sheet

Public Health England (PHE) carried out a regional Be Clear on Cancer campaign across the Midlands to raise awareness of abdominal symptoms that could be caused by cancer. The campaign ran from 9 February to 31 March 2017 and aimed to encourage people with the relevant symptoms to present to their GP.

The key message for the campaign was ‘if you have had tummy troubles for 3 weeks or more, it could be a sign of cancer, tell your doctor’. The advertising highlighted that finding cancer early makes it more treatable.

This campaign followed several tumour-specific Be Clear on Cancer awareness campaigns which have run across England and successfully raised awareness of symptoms such as ‘blood in poo’ for bowel cancer and ‘cough’ for lung cancer. The abdominal symptoms campaign marked a different strategic approach for Be Clear on Cancer – a broadening of the message that will hopefully enable more cancers, including some less common cancers, to be covered by the awareness raising activity. 

This campaign focused on symptoms associated with a specific body ‘area’, highlighting a number of key abdominal symptoms that may be a sign of cancer if experienced for three weeks or more.

The approach was developed based on insight from previous Be Clear on Cancer campaigns, to deliver the campaign messages more efficiently to a wider audience. The approach was thoroughly tested (through qualitative research) with the audience, to fully understand the best route to potentially increase the knowledge of signs and symptoms amongst the target audience and prompt them to take appropriate action. 

On this page you will find essential information about the abdominal symptoms campaign.

Essential information about this campaign

Briefing sheets are designed to provide healthcare professionals, GP practices and local support groups with an overview of the activity and to help them prepare during the campaign period. The briefings are electronic with links to further information and are print friendly. Please share this briefing with NHS, PHE and Local Authority (Public Health) colleagues who will find it useful to hear about the campaign.

Health Care Professionals briefing sheet (January 2017)

Leaflets and posters

A range of Be Clear on Cancer materials were developed to support the abdominal symptoms campaign. These include leaflets and posters that will be available to order as required from PHE through their Campaign Resource Centre (CRC).

To request posters and leaflets visit the CRC or call Orderline on: 0300 123 1002

Be Clear on Cancer aims to help achieve earlier diagnosis of cancer by raising awareness of signs and symptoms of the disease. The campaigns encourage people with relevant symptoms to see their GP without delay. The campaigns are carried out by Public Health England (PHE) in partnership with the Department of Health and NHS England and supported by Cancer Research UK (CRUK). The Independent Cancer Taskforce strategy ‘Achieving World Class Outcomes: A Strategy for England 2015 to 2020’ specifically recommended that PHE should continue to invest in Be Clear on Cancer campaigns to raise awareness of possible symptoms of cancer and encourage earlier presentation to health services.

The majority of Be Clear on Cancer campaigns have featured individual symptoms linked to specific cancers. For example, the ‘blood in pee’ campaign raised awareness of the link between this symptom and bladder and kidney cancers.

Following evaluation and insight gained from the results of previous campaigns, the decision was made to pilot this broader symptom approach at the regional level. The abdominal symptoms campaign will focus on a number of symptoms that are associated with the ‘tummy’ area of the body. These symptoms can be indicators of a number of different types of cancer, including bowel and ovarian cancer.

A significant amount of qualitative research was undertaken with the target audience during the development of this campaign. From that, it is understood that if symptoms are articulated in the context of a body area this has a good chance of resonating with our audience. This approach will also enable us to cover symptoms that are associated with a number of different tumour types.

Abdominal symptoms were chosen to feature in the campaign as a result of analysis carried out by CRUK on behalf of Be Clear on Cancer. A number of different scenarios were developed using publicly available cancer data e.g. incidence, mortality, symptom prevalence. Taking into account variations in the quality of available data, the scenarios were assessed to identify symptoms and cancers that could potentially be ‘grouped’ and communicated to the public. Following significant input from clinical and marketing experts, abdominal symptoms were selected for campaign development. This was on the basis that advertising this group of symptoms would achieve both a high level of reach amongst the target audience, whilst broadening the potential number of cancers associated with the campaign.

The advertising approach and messaging was developed and tested with the target audience (men and women over 50 from lower socio-economic groups). Multiple rounds of testing was carried out in order to refine the approach and messaging, to ensure that campaign advertising was focused, and that the call to action was clearly communicated. The advertising and final advertising was reviewed by clinical experts for accuracy and appropriateness.

As a result of this development process it was decided to feature the affected area (the abdomen), as the main image in campaign advertising as this helped anchor the symptoms in the mind of the target audience. This differed from previous Be Clear on Cancer campaigns which prominently included GPs. The campaign also included a ‘warning sign’ similar to one you may see on a car dashboard, in order to flag that these symptoms need attention.  GPs continue to feature in other campaign materials to reinforce the importance of the symptoms and provide the ‘permission’ to go and see their GP if symptoms persist or change.

A number of local, regional and national Be Clear on Cancer campaigns have taken place across England since 2010. The East and West Midlands were selected as the regional pilot areas for the abdominal symptoms campaign for a number of reasons, including the fact it is populous enough to support accurate campaign evaluation and the campaign had the support of both Strategic Clinical Networks (SCNs).

In addition, the area had a mix of urban and rural areas and demographically, the region is reasonably representative of the national population. These features support decision making should the abdominal symptoms campaign be scaled up. Levels of demand on cancer-related services likely to be affected by the abdominal symptoms campaign were also considered in the campaign planning stages. This includes diagnostic and other services.

The key message for the campaign was ‘Don’t ignore the warning signs. If you’ve been suffering from tummy troubles such as diarrhoea, bloating, discomfort or anything else that just doesn’t feel right for three weeks or more, it could be a sign of cancer. Finding it early makes it more treatable. Tell your doctor.’

The aim was to raise awareness amongst the over 50s that ongoing abdominal symptoms could be a sign of cancer, and that going to the GP could help detect it early, when it is more treatable.

The main three symptoms the campaign promoted were diarrhoea, bloating and discomfort. The public facing leaflet for the campaign also highlighted; constipation, nausea/feeling sick and blood in poo for three weeks or more, and encouraged those with other unusual changes like a lump in the tummy area, postmenopausal bleeding or unexplained weight loss, to go and tell their doctor as well. 

The campaign ran from 9 February to 31 March 2017. It included advertising in local and regional newspaper, radio adverts and out of home advertising (bus shelters, washrooms and pharmacy bag). It also included face to face events in shopping centres. Television advertising was not used for this campaign.

The campaign was aimed at those aged 50 years and older from lower socioeconomic groups. They were targeted through media channels of most relevance to this group. 

This was the first time that a Be Clear on Cancer campaign led with a focus on a specific body area and localised symptoms that may be indicative of cancer. The main aim of the pilot campaign was to test and evaluate the impact of the messaging on the target audience.

Results from other Be Clear on Cancer activity have shown that GPs are more likely to see patients with the symptoms advertised in the campaign. Although we don’t have any data for the abdominal campaign specifically, data analysis from a sample of GP practices on previous Be Clear on Cancer campaigns has shown a range from 0.1 additional visits per practice per week (2014, national ‘Breast cancer in women over 70’ campaign) to a maximum of 3.1 additional visits per practice per week (2012, national lung cancer campaign). It should be noted that these campaigns were at the national level and featured a much higher weight of advertising, including TV. 

The Be Clear on Cancer working group had regular contact with key healthcare stakeholders in both the East and West Midlands throughout the development of the abdominal symptoms campaign. Key decisions were communicated to this group to support dissemination and preparation for campaign activities. CRUK developed briefing sheets for service providers likely to be impacted by the campaign, such as GP practices.

The National Cancer Registration and Analysis Service (NCRAS) is responsible for evaluation of the Be Clear on Cancer campaigns and contacted colleagues from the East Midlands Cancer Clinical Network. The six pilot areas in the East Midlands were:

  • Southern Derbyshire
  • Nottingham City
  • Lincolnshire West
  • Mid-Nottinghamshire
  • Burton
  • Kettering

The public-facing web pages for the Be Clear on Cancer campaigns can be found on NHS Choices.

Other resources that are not specific to the campaign, but which you may find useful:

Review guidance on safety netting

Review NICE guidance

Review British Medical Journal online education tool

 Review the National General Practice Profiles with cancer data for individual practices.

You can order or download a leaflet that explains Urgent Referrals from Cancer Research UK. These can be used to help patients who have been urgently referred with suspected cancer.

One source of support for pharmacists that can help you raise the subject of cancer with patients is the British Oncology Pharmacy Association’s E-learning Centre. The centre has training for pharmacists and pharmacy team members about raising awareness of cancer in a pharmacy setting, with modules on different cancer types. This is free to access once you have registered on the website.

If you have any queries about the abdominal symptoms campaign, email partnerships@phe.gov.uk with ‘abdominal symptoms’ in the subject line.

As with all Be Clear on Cancer campaigns, evaluation metrics for the campaign have been developed in consultation with a range of experts. These include:

  • the impact of the campaign on public awareness through pre- and post-campaign surveys
  • the number of cancer presentations to primary care
  • the number of urgent GP (two week wait (2WW)) referrals for suspected cancer across multiple pathways
  • the conversion rates following urgent GP referrals

The National Cancer Registration and Analysis Service (NCRAS) is responsible for evaluation of the Be Clear on Cancer campaigns and they have been in contact with colleagues from the Midlands area to help shape their plans for evaluation.

Be Clear on Cancer statement

Be Clear on Cancer  is a cancer awareness campaign led by Public Health England, working in partnership with the Department of Health and NHS England. This page contains links to documents that we hope you find useful. Please note however that the views or opinions expressed within those links are not necessarily those of Cancer Research UK.

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