'Know 4 sure' campaign: Information for GPs
'Know 4 sure' briefing sheets and marketing materials (e.g. leaflets and posters) are available on the resources and tools page.
The ‘Know 4 sure’ cancer symptoms campaign pilots took place in five areas in England from 14 January to mid-March 2013.
If your practice is within one of these areas, you may have seen more patients coming to see you with one of the four key cancer symptoms highlighted in the campaign. Over the last two years we have been working with local NHS teams and Cancer Networks around the country on early diagnosis of cancer pilots. There are a range of questions that we have heard GPs ask in relation to running activities to promote awareness of the signs and symptoms of cancer.
If you have a question about Be Clear on Cancer that isn’t answered here, please contact email@example.com.
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Following several tumour-specific cancer awareness campaigns, Be Clear on Cancer has become a well-recognised brand. Therefore, it is timely to pilot a more general cancer symptoms approach that will work with them. ‘Know 4 sure’ is the headline for this new Be Clear on Cancer campaign – it will be used in all the adverts and materials.
Around 268,000 people are diagnosed with cancer in England each year - more than 236,000 are aged 50 and over . Outcomes in Britain are worse than those in some European countries and it is estimated that 10,000 deaths could be avoided each year if cancer survival matched the best in Europe .
But, awareness of signs and symptoms of cancer is low and we know that people can delay going to see their GP for a number of reasons.
With more than 200 types of cancer, the Department of Health can’t continue to produce individual campaigns. So, for the first time, this campaign will focus on four key symptoms that are indicators for a number of cancers, including less common ones.
1. Source: All cancers excluding non-melanoma skin cancer (C00-C97 excl. C44). Data were provided by the Office for National Statistics on request, June 2012. Similar data can be found here: http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations
2. Note: Estimates based on figures provided in Abdel-Rahman et al (2009)
Approximately 10,000 deaths from cancer in England could be avoided every year if our cancer survival rates matched the European best. The Department of Health’s Improving Outcomes – A Strategy for Cancer sets out how it will seek to achieve the ambition to prevent 5,000 deaths from cancer per year by 2014/2015, bringing survival rates in England up to the average for Europe. The Government’s strategy for cancer includes a range of actions to improve cancer outcomes, including:
- reducing the incidence of cancers which are preventable by lifestyle changes;
- improving access to screening for all groups and introduce new screening programmes where there is evidence they will save lives and are recommended by the UK National Screening Committee;
- achieving earlier diagnosis of cancer, to increase the scope for successful treatment – diagnosis of cancer at a later stage is generally agreed to be the single most important reason for the lower survival rates in England;
- achieving earlier diagnosis of cancer, to increase the scope for successful treatment and making sure that all patients have access to the best possible care and support.
The Be Clear on Cancer campaign is one of a number of actions to achieve earlier diagnosis by specifically seeking to improve public awareness of cancer symptoms and encouraging earlier presentation.
Find out more about the background to the campaign.
Be Clear on Cancer is the overarching brand for a programme of work, which aims to improve early diagnosis of cancer by raising awareness of symptoms and making it easier for people to discuss them with their GP. Each campaign is tested locally to see how people respond and what impact it has on their behaviour. The results inform whether the campaign is taken forward more widely.
In early 2011, the Department of Health ran the successful regional Be Clear on Cancer bowel cancer pilot – the first test of the Be Clear on Cancer campaign. Lung cancer then became the focus of a regional pilot in the Midlands, running from 10 October to 13 November 2011. In addition, a number of local teams ran Be Clear on Cancer activities for breast, bowel and lung cancer in 2010/11.
From January to March 2012, the Department of Health ran the first national Be Clear on Cancer campaign to raise awareness of bowel cancer signs and symptoms. Eighteen local projects also ran activities to raise awareness of the symptom of blood in urine (for bladder and kidney cancers), breast cancer in women over 70, and oesophago-gastric cancer; and in May 2012 the lung cancer campaign rolled out nationally.
Over the next year, the programme of work will continue to develop. The national bowel campaign has been repeated and local pilots in three areas of England are piloting the impact of using different approaches to sustain the national bowel activity until March 2013. These three pilots cover North London and North East London; North West England; and Yorkshire TV region.
Regional pilot campaigns will run for ‘blood in pee’ in the North of England and for breast cancer in women over 70 in the Central TV area from 14 January to mid-March 2013. Smaller scale pilots to test the new campaigns focusing on ovarian cancer and ‘Know 4 sure’ cancer symptoms will be taking place too.
The message for the public is:
'Know 4 sure'
When it comes to cancer, there are 4 key signs to look out for:
1. Unexplained blood that doesn’t come from an obvious injury.
2. An unexplained lump.
3. Unexplained weight loss, which feels significant to you.
4. Any type of unexplained pain that doesn’t go away.
Chances are it’s nothing serious, but finding it early makes it more treatable. So if you notice any of these signs, tell your doctor.
The agency M&C Saatchi presented a range of possible campaign approaches to an expert panel, which included GPs and secondary care clinicians, who were asked by the Department of Health to assist in advising on the basic design of the campaign and the key public messages to be used.
A campaign that highlighted a limited number of possible cancer symptoms was agreed to be the optimal approach for a non-tumour specific campaign. Four main symptoms of cancer were identified based on clinical predictors of cancer and research into the most commonly reported symptoms by cancer patients .
This approach was tested alongside other potential alternatives with a sample of GPs and the target audience in two phases of qualitative research. The outcome of this qualitative research confirmed that the cancer symptoms approach would be the most effective choice to take to pilot.
1. Hippisley-Cox J, Coupland C. Symptoms and risk factors to identify women with suspected cancer in primay care: derivation and validation of an algorithm. British Journal of General Practice 2013;(in press)
Almost 9 in 10 cancers in England are diagnosed in people aged 50 and over. So, the campaign is targeting this age group, as well as their key influencers, such as friends and family.
No. The campaign was tested with the target audience during the two phases of qualitative research - people understood that they don’t need to experience all of the symptoms featured in the campaign. They also understood that the numbering does not rank the symptoms in order of seriousness or importance.
Overall, the target audience felt the campaign message was clear and found ‘Know 4 sure’ an engaging way to introduce the subject of cancer.
The campaign is aimed at covering a number of cancers, including less common ones, which can’t be achieved through the tumour-specific campaigns that have run so far. Work has been done to look at the most likely cancers that may present with the four key symptoms highlighted in the campaign message.
Although the messages in this campaign focus on persistent, new or unexplained symptoms, some patients that come and see you may prove not to have cancer. But they may still need treatment for something else. For example, during a previous lung cancer campaign in Leeds, some patients presenting with relevant symptoms were diagnosed with other respiratory conditions.
The Be Clear on Cancer campaign targets patients with symptoms, so screening is not mentioned in the posters and adverts – the Department of Health wants to keep the message simple and direct. The campaign leaflet was tested with GPs and the target audience, and both felt information on healthy lifestyles was more relevant than screening information.
But the campaign is an ideal opportunity to encourage people to take part in screening programmes as appropriate.
Local Cancer Networks are working with the Department of Health to develop activities aimed at reaching people in your community. Activities have varied across the pilots - all included advertising, for example in local press and radio, and some included community-based work, such as local events. These ran from 14 January to mid-March 2013.
The pilot campaigns ran in the following Cancer Network areas: North East London and North Central London; Lancashire and South Cumbria, and Greater Manchester and Cheshire; and Central South Coast.
Activities and adverts highlight the main message for the public featuring the four key symptoms of cancer. But the campaign leaflet also includes other possible symptoms of cancer. The aim is to encourage more people with these symptoms to go and see their GP earlier.
The honest answer is that we don’t know exactly how many people will respond to the advertising and promotion – this campaign approach is different to the previous campaigns, which have focused on specific tumour types. This is why the Department of Health is initially piloting the 'Know 4 sure' cancer symptoms campaign on a relatively small scale: to assess the impact on primary and secondary care, and test the feasibility of this approach.
We expect that you will see more people coming to your practice with symptoms as a result of ‘Know 4 sure’ campaign activities, but experience of previous Be Clear on Cancer campaigns suggest that you’re unlikely to be overwhelmed.
The national Be Clear on Cancer bowel campaign, which ran from January to March 2012, included TV advertising and the increase in people presenting to their GP equated to an increase of one patient with relevant symptoms per practice every two weeks.
It may take a few weeks for you to notice the impact of the campaign and any additional patients requesting appointments though. The 2011 regional bowel cancer pilot showed a peak four weeks into the campaign.
Early diagnosis of cancer is a very high priority for the Government. That is why Improving Outcomes: A Strategy for Cancer, published in January 2011, put an emphasis on improved GP access to key diagnostic tests to support the diagnosis of a number of cancers. The strategy is backed by over £750 million, including more than £450 million to support early diagnosis of cancer.
The NHS Constitution includes the right to see a specialist within two weeks or urgent referral, where cancer is suspected, or for the NHS to take all reasonable steps to offer a range of alternative providers where this is not possible. Recent statistics show that 95.4% of patients were seen by a specialist within two weeks.
The Department of Health put additional funding into Primary Care Trust baselines to meet the cost of any additional treatment resulting from work to improve earlier diagnosis. Alongside National Cancer Action Teams and Cancer Networks, they have been working with local NHS teams to estimate any potential impact.
The Department of Health has recently published ‘Direct access to diagnostic tests for cancer: best practice referral pathways for general practitioners’. It provides information on direct referral by GPs to specific diagnostic tests for the assessment of particular symptoms where cancer may be suspected but the urgent GP referral (two-week wait) process is not applicable .
The Department of Health initially piloted the ‘Know 4 sure’ cancer symptoms campaign on a small scale so that it could assess the extent of its impact on local services.
Cancer Networks in the pilot areas worked closely with NHS Trusts across their regions to prepare for the campaign. They have learned from the experiences of the previous Be Clear on Cancer campaigns and liaising with the Department of Health. They continued to work with their local clinical leads to monitor the capacity needs of their regions throughout the nine-week campaign.
We have learned from the other Be Clear on Cancer campaigns that the impact on diagnostic testing is very dependent on the existing capacity within the NHS for specific diagnostic tests.
The £450 million allocated to support early diagnosis over this spending review period also includes additional funding in NHS baselines, including enabling better GP access to key diagnostic tests and more testing in secondary care.
Be Clear on Cancer materials promote the potential benefits of early presentation and reassure people that the symptom is unlikely to be cancer, but that it’s best to get it checked. The tone is balanced, practical and reassuring.
There was overwhelming support from the public following the first national bowel cancer campaign in January 2012. More than 9 out of 10 people (92%) and 89% of GPs said it is important for the Government to be communicating these kinds of messages.
You can find out more about the cancer statistics in your area using Public Health England's National General Practice Profiles.
GPs have a pivotal role as the gatekeepers to investigation and referral, but the task is a difficult one as the number of new diagnoses encountered each year is typically very small.
We know from routes to diagnosis work conducted by Public Health England that 24% of all cancer patients present as emergencies. So there is a clear role for GPs in the early diagnosis of cancer.
We hope you will see an increase in the number of people presenting with symptoms and continue to use your clinical judgement and refer for investigation as appropriate.
So as a GP in the pilot region:
Be mindful. This campaign may prompt people who’ve previously ignored symptoms to come and see you. They may worry they’re wasting your time, not think their symptoms are serious, or not find it easy to communicate their symptoms. Be prepared for more patients wanting to see you about possible symptoms and keep a look out for those most at risk – they may be coming to see you about other things or it might be an opportunity for further assessment.
Encourage your colleagues to prepare for and support the campaign. Practice nurses, receptionists and practice managers all have an important role to play in this campaign.
There’s a separate briefing sheet for practice teams. Ensure everyone is aware of the campaign, so they can support it.
We have provided some questions and answers specifically for practice teams on this site and are making additional materials available to your practice teams to support them in preparing for the campaign, including planning for increases in the number of people visiting their GP or ringing for test results. Your local Cancer Network can also provide you with additional support.
Make the most of available support. There is lots of information to support you with the diagnosis of cancer, including the NICE referral guidelines for suspected cancer. Continue to use your clinical judgement - not every patient who presents to their GP with these symptoms will need to be referred using an urgent two-week referral. Standard outpatient referral and/or straight-to-test referrals may also be appropriate for some patients. Or it may be appropriate to initially carry out tests or monitor patients in primary care.
Other useful resources include:
- Cancer Decision Support Tools;
- Several NICE online educational tools focused on cancer;
- ‘Improving Diagnosis of Cancer’ GP toolkit;
- 'Direct access to diagnostic tests for cancer: best practice referral pathways for general practitioners' GP toolkit.
For more information about Be Clear on Cancer, or if you have any queries, please contact firstname.lastname@example.org.
All cancers excluding non-melanoma skin cancer (C00-C97 excl. C44). Data were provided by the Office for National Statistics on request, September 2012. Similar data can be found here: http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations
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.