Lung cancer awareness campaign: Wales

Coronavirus (COVID-19)

We have created a central resources hub for Health Professionals which hosts all of our CRUK resources and further materials to help with managing the pandemic. We are updating the information as guidance changes. There is also a page specifically for patients on our about cancer hub.

Health Professional COVID-19 and Cancer Hub

Essential information about this campaign

Campaign materials

These briefing sheets were produced by NHS Wales with support from Cancer Research UK. They are designed to help local teams prepare for the lung cancer campaign in Wales. The briefings are electronic with links to further information. All are print friendly and available in English and Welsh. Please pass these on to colleagues as appropriate, so they can get up to date on the campaign too.

Briefing sheets

GP briefing sheet

GP briefing sheet (Welsh)

Health Board briefing sheet

Health Board briefing sheet (Welsh)

Pharmacy briefing sheet

Pharmacy briefing sheet (Welsh)

Community briefing sheet

Community briefing sheet (Welsh)

Symptom cards, leaflets and posters

A range of additional Be Clear on Cancer materials have been developed for the lung cancer campaign in Wales, including symptom cards, leaflets and posters.

Community poster

Pharmacy poster

Symptom card

The public-facing leaflet for the campaign gives information on the symptoms of lung cancer, as well as how to reduce the risk of developing lung cancer.

Public-facing leaflet

Public-facing leaflet (Welsh)

What is Be Clear on Cancer?

Be Clear on Cancer aims to achieve earlier diagnosis of cancer by raising awareness of the signs and symptoms. The campaigns encourage people with relevant symptoms to see their GP without delay.

The activity in Wales was based on Public Health England’s first national lung cancer campaign which ran in 2012.

In Wales, a significant number of cancer deaths are due to lung cancer. One of the ways in which lung cancer survival could be improved, is by diagnosing more cases of the disease earlier. Earlier diagnosis and rapid access to potentially curative treatments such as surgery and radiotherapy, are crucial to improve survival – however, more people need to be aware of the significance of symptoms and going to their GP early.

Research has found that as in the rest of the UK, people in Wales have lower awareness of the risk of cancer related to older age and reported more barriers to presenting their symptoms than other countries.¹

The decision to run the campaign in Wales was based on the Lung Cancer Initiative (LCI), which is one of the Cancer Implementation Groups’ five priority areas for 2016/17. It includes objectives aimed to improve outcomes for people diagnosed with lung cancer. The lung cancer awareness campaign is a key part of this Initiative which spans the pathway from awareness to treatment.

References:

L.J.L. Forbes et al., Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden, and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival? B.J.C (2013), 108, 292-300

Why is Wales running a lung cancer awareness campaign?

Lung cancer in Wales is the third most common cancer in men and the second most common in women. Each year it is responsible for more deaths than bowel and prostate cancer combined.¹ Survival from lung cancer in Wales is one of the worst in Europe.² If lung cancer in Wales matched the best in Europe during 2012, an estimated 340 more people might have survived at least one year, and over 190 more people might have survived at least five years.³

Key lung cancer facts (Wales):¹

There are around 2,400 new cases of lung cancer in Wales every year
It is the third most common cancer in men and the second most common in women
Only 20% of people are diagnosed at an early stage, when patients could have potentially curative surgery
98% of lung cancer cases diagnosed in Wales are in people over the age of 50

In order to improve outcomes in Wales, more people need to be aware of the symptoms of lung cancer. One of the ways in which we aim to improve outcomes in Wales is by raising awareness of the signs and symptoms – we hope that this will contribute to an increase in early stage diagnosis and a reduction in late stage diagnosis (as seen in the first national lung cancer campaign in England). Diagnosis at an early stage (Stage I and II) in Wales remains low, in 2012 only 20% of people with lung cancer presented at these stages, when the disease is potentially curable.¹ 67% of people are diagnosed in the advanced stages of the disease (Stage III and IV), when treatment options are limited and chances of surviving for longer are significantly reduced.

Earlier diagnosis and rapid access to potentially curative treatments such as surgery and radiotherapy are crucial to improve survival – however, more people need to be aware of the significance of symptoms and going to their GP early.

References:

Lung Cancer in Wales. Wales Cancer Intelligence and Surveillance Unit. http://www.wcisu.wales.nhs.uk/lung-cancer-overview
De Angelis R et al. Lancet Oncol 2013;15:23-34.
L.J.L. Forbes et al., Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden, and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival? B.J.C (2013), 108, 292-300

What is the campaign's key message?

The key message for the public was ‘If you’ve had a cough for three weeks or more, tell your doctor.’

The aim was to encourage more people with the symptom to visit their GP earlier. The advertising highlighted that finding cancer early makes it more treatable.

What activities are taking place and when?

The campaign ran from 11 July to 11 August 2016, highlighting the symptom of a persistent three week cough.

Adverts will appear on ITV Wales and S4C, on Wales’ radio stations and in the press, as well as on buses across Wales. Additional activities were held across various communities, as well as media and public relation activities.

The campaign in Wales ran alongside England’s respiratory symptom campaign, which aims to raise awareness of cough as a symptom of lung diseases such as COPD and lung cancer, and breathlessness as a symptom of lung and heart disease.

The TV adverts for the England campaign appear on digital channels across Wales, for example, on channels such as Sky TV. England will also be using national press and social media to advertise the campaign, all of which appeared in Wales, and will continue until the England campaign finishes.

Who is the campaign aimed at?

The campaign is aimed at men and women who are over the age of 50, as 98% of people diagnosed with lung cancer in Wales are aged 50 and over.¹ The campaign also targets key influencers, such as friends and family – so they can pass on the message to anyone they feel may be experiencing these symptoms, but who may not have realised the significance or has delayed going to their GP.

References

Lung Cancer in Wales. Wales Cancer Intelligence and Surveillance Unit. http://www.wcisu.wales.nhs.uk/lung-cancer-overview

Will there be advertising in our communities?

In addition to the advertising on TV and radio, NHS Wales worked strategically to raise awareness across pharmacies in Wales.

Pharmacies play a crucial role in encouraging anyone with symptoms to tell their GP. People can delay for a variety of reasons. They may not realise their symptoms are serious; they may worry about wasting the GP’s time; or if they suspect cancer, they may fear the diagnosis and treatment. Most people have quick and easy access to pharmacies, and may be willing to discuss their symptoms or worries more easily in an informal setting. By talking to people face to face, you can help them understand the significance of getting symptoms checked early, and advise that if they have any other concerns, then should speak to their GP.

The activity that took place across pharmacies in Wales was organised by NHS Wales’ Lung Cancer Initiative (LCI) on behalf of the Health Boards, the Cancer Network, Community Pharmacy Wales and third sector organisations, including Tenovus Cancer Care. The Lung Cancer Initiative is one of the Cancer Implementation Groups’ priority areas for 2016/17, to improve outcomes for people diagnosed with lung cancer. The awareness campaign is a key part of the Lung Cancer Initiative, which spans the pathway from awareness to treatment.

Pharmacies will receive a campaign pack in advance of the start of the campaign, containing:

A pharmacy briefing
1 A4 bilingual poster
1 A3 bilingual poster
50 symptom cards
50 Leaflets
Evaluation sheet

Some pharmacies will also receive campaign branded dispensing bags.

Community Pharmacy Wales are supporting this campaign and the Wales Centre for Pharmacy Professional Education (WCPPE) has produced a training webinar that is available to anyone interested.

Things pharmacy colleagues can do to support the campaign in Wales:

Promote the campaign in your pharmacy. Put up posters in your pharmacy and hand out the lung cancer awareness symptom cards to people you feel would benefit from talking to their GP about their symptoms.
Make it part of your day. During your regular consultations, such as medicine use reviews or when advising on over-the-counter (OTC) medicines, be mindful that the people you are talking to may have seen the lung cancer campaign. It may prompt people who have previously ignored their symptoms to do something – they may come to your pharmacy to collect a prescription, to buy OTC medicines or to ask for advice.
Give permission. Our target audience can delay going to see their GP and often seek permission to make an appointment. Where relevant, encourage customers / patients to visit their doctor. If you feel comfortable, tell the customer to mention that their pharmacist sent them. It may be the push they need to get themselves checked out.

Finally, chat to your friends, family, customers and colleagues about Be Clear on Cancer. We need to talk about cancer and make it a less taboo topic.

For more information about what you can do to help support the campaign, please see the impact on health services page for the respiratory symptoms campaign.

Why does the advertising not lead on a smoking message?

Although smoking is a major risk factor for developing lung cancer, the campaign materials don’t lead on smoking. The campaign is all about encouraging those with a symptom to take prompt action and visit their GP. Previous lung cancer awareness projects have revealed that including a smoking message can make smokers disengage because they feel they are being nagged. It can also make non-smokers feel it is not relevant to them, when no matter if a person smokes or not, the message shouldn’t be ignored.

About lung cancer

What are the main symptoms of lung cancer?

More than 90% of patients with lung cancer are symptomatic at diagnosis, with cough being the most common presenting symptom. There are a number of other symptoms that could be indicative of the disease, these include:

Cough
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss

Other symptoms that are being advertised to the public in Wales via a leaflet include:

Repeated chest infections
Coughing up blood
An ache or pain in your chest or shoulder that has lasted some time

For more information about lung cancer symptoms, visit NHS Direct

Cancer Research UK’s lung cancer symptoms page also has additional information on lung cancer symptoms

NICE guidelines

The NICE referral guideline for suspected cancer was updated in 2015. Take the opportunity to review the updated recommendations for lung cancer.

Cancer Research UK has produced an interactive desk easel for GPs, which summarises the NG12 guidelines. GPs can access the summary from their computer and click through to the recommendations for each symptom group:

Download the interactive desk easel

Cancer Research UK also developed summaries of the referral guidelines in other various formats:

Infographic style: Symptoms are grouped according to organ system, with a key directing you to NICE’s recommendations.
Text style: Symptoms are displayed alphabetically, with a key directing you to NICE’s recommendations.
Table style: Information is displayed in a table format with recommended pathways displayed along the top of the table.

You can also order physical copies of these poster resources, for free, from the CRUK publications website. For more information please visit the page.

What are the risk factors for lung cancer?

Lung cancer is more common among the older population - 98% of all lung cancer cases diagnosed in Wales are in people over 50.¹

Other risk factors for lung cancer include: ²

Smoking is the main avoidable risk factor for lung cancer, accounting for nearly 9 out of 10 cases diagnosed in the UK
More than 1 in 10 cases are linked to occupational exposure (primarily in men) occurring decades ago before these carcinogens were banned (e.g. asbestos)
Around 1 in 20 cases can be linked to exposure to radiation for medical reasons e.g. radiotherapy. However, this risk should be taken in context of the obvious benefits of medical imaging and treatments which use radiation
Just under 1 in 10 cases are accounted for by deficiency of fruit and vegetables in one’s diet.

References

Lung Cancer in Wales. Wales Cancer Intelligence and Surveillance Unit. http://www.wcisu.wales.nhs.uk/lung-cancer-overview
Parkin, D.M., Boyd, L. and Walker, L.C. (2011) The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer. 105, S77-S81

Potential impact of the campaign

How are GPs and hospitals preparing for the lung cancer awareness campaign?

The Lung Cancer Initiative is working with all Health Boards in Wales to help ensure the NHS is prepared for the campaign. GPs and hospital providers are aware that they are likely to get extra referrals during the campaign.

What impact will the campaign have on primary care?

GP attendance data for England’s first national lung campaign (2012) showed that more people with a cough visited their GP. Impact on services will vary and be influenced by the size and age profile of your local population, however, the results below from previous English campaigns may help you to plan for activity during and after the campaign period:¹

When looking at the campaign period of May to June 2012, compared with May to June 2011, the number of patients aged 50+ presenting with a cough went up 63% – the equivalent of around 3 additional visits per practice, per week (based on practices in the sample that had an average list size of around 7,800 patients)
There was a 15.7% rise in GP-referred CT scans per working day between May – July 2012 compared with April 2012
The number of GP-referred chest X-rays increased by 18.6% in May – July 2012, compared with April 2012.

We are encouraging GPs to continue to use their clinical judgment and to refer for further tests as appropriate.

Things you can do to help support the campaign in Wales:

Talk about the campaign. People who have previously ignored their symptoms may be prompted to come along to your surgery but they may be afraid, not find it easy to communicate their symptoms, or worry they’re wasting your time. Even if the patient doesn’t have cancer, it’s a great opportunity to discuss prevention or lifestyle changes.
Encourage your colleagues to support the campaign. The whole practice team has an important role to play. Ensure everyone is aware of the campaign, so they can plan for any increases in service demand, such as key diagnostic tests (chest x-rays) and referrals – there are briefing sheets being developed for key groups. Prepare for more patients coming to your practice as a result of the campaign.

For more information about what you can do to help support the campaign as a GP, or as part of the practice team, please see the impact on health services page for the respiratory symptoms campaign.

References

L. Ironmonger et al., An evaluation of the impact of large-scale interventions to raise public awareness of a lung cancer symptom. B.J.C (2015) 112, 207-216

What impact will the campaign have on secondary care?

The first national lung cancer campaign which ran in England saw an increase of 32% in urgent GP referrals for suspected lung cancer during the campaign months, compared to the same period in the previous year. We expect there to be an increase in urgent referrals for suspected lung cancer as a result of this campaign too. We might expect to see an increase in diagnostic tests such as x-rays and CT scans, but the impact on services will vary by trust and be influenced by the size and age profile of your local population. Results from previous activity in England show:

In 2012, urgent GP referrals for suspected lung cancer peaked in July, approximately two months after campaign activity started – it equated to approximately 1.5 extra referrals per hospital, per week¹
In 2012, there was a significant increase in the proportion of patients receiving surgical resection as a first definitive treatment for lung cancer (from 13.7% to 16.0%, equating to around 300 more patients) during the campaign months when compared to the same period in 2011²
Between May – July 2012, when the first national lung cancer campaign took place, the number of GP-referred chest X-rays increased by 18.6%, compared with April 2012.³

Things you can do to help support the campaign:

Brief colleagues. Service managers, multi-disciplinary teams and clinicians all need to be aware that this campaign is running and that they are likely to see increases in demand for their services.
Capacity planning. Continue to plan for an increase in urgent GP referrals for chest X-rays, requests for CT scans, urgent suspected cancer referrals as this will depend on the level of implementation of NICE referral guidance issued last year. Surgical centres are planning for increased activity and Welsh Health Specialised Services Committee (WHSSC) are aware of this.

For more information about what you can do to help support the campaign, please see the impact on health services page for the respiratory symptoms campaign.

References

National lung cancer awareness campaign: Analysis of urgent GP referrals. An analysis looking at the impact of the national lung cancer awareness campaign on the number of urgent GP referrals for suspected lung cancer. Produced by Trent Cancer Registry, July 2012
National Lung Cancer Audit. Data provided by HSCIC
NHS England. Diagnostic Imaging Dataset. http://www.england.nhs.uk/statistics/statistical-work-areas/diagnostic-imaging-dataset

What can people in the community do to promote the campaign?

You have a vital role to play. People can put off getting symptoms checked out for lots of different reasons. They might worry about wasting the GP’s time. Or, if they think it could be cancer, may be frightened of finding out or scared of treatment.

We know that people often take advice from friends, family and people they trust when deciding if symptoms are serious enough to see their doctor. By talking to people in your community you can help them understand the main messages and overcome any concerns.

You don’t need a medical background to give campaign advice. You can:

Explain that it’s best to get symptoms checked out – the chances are it’s nothing serious, but it may still need treating. But if it is cancer, finding it sooner and getting treated can make a real difference.
Reassure them that the doctor or nurse wants to hear about their concerns. They’re not wasting anyone’s time.
Some people might need help to make an appointment or like someone to go with them if it’s appropriate.
Help people feel more confident about speaking to their doctor by offering to run through what they will say during the appointment. Suggest they underline their symptoms on the Be Clear on Cancer lung cancer leaflet and take it with them to see their doctor.
Reassure people that their doctor will want to know if their symptoms haven’t gone away, have changed, or got worse, even if they have seen the doctor already. Explain that it’s important they go back and see their doctor again.
Ask people to come back and tell you how they got on. This gives you the chance to give them a nudge if they haven’t done anything about their symptoms the next time you see them.

Remember, this campaign isn’t about changing lifestyle but to encourage people to see their GP if they have symptoms.

Talking about cancer can be difficult. Here are some tips:

A nurse, who specialises in talking about cancer, advises: ‘It is important to feel confident and to try to make cancer a normal part of conversation – you don’t need the answers, talking about it is the most important part. Find phrases that you are comfortable with and practise using them.

‘You could start by talking about the campaign and ask if they have seen the TV advert. Someone might have stopped noticing their cough, especially if they’ve had it for a few weeks, or think it’s not worth getting it checked out. If you are concerned about someone or they mention a symptom that they’re worried about, why not ask them: “Do you think it might be a good idea to tell your doctor?”

Things you can do:

Make it part of your day to day conversations. Talking about the campaign may prompt someone to make an appointment or open up about a symptom they’ve been hiding or didn’t think was serious. We need to encourage people to talk openly about cancer.
Encourage people to see their doctor. If people are worried about possible symptoms, we know they often just need a nudge from family, friends or those around them to persuade them to tell their doctor.

For more information about what you can do to help support the campaign, please see the impact on health services page for the respiratory symptoms campaign.

Evidence

Is there any evidence the campaigns work?

Be Clear on Cancer campaigns have run in England since 2010. Results from the first national campaign focusing on symptoms of lung cancer, which ran from May to June in 2012, indicate that the campaign changed levels of public awareness – including indications that clinical outcomes improved too following the campaigns.

Findings from the campaign that ran in England show:

Increases in unprompted awareness of cough as a symptom of lung cancer from 54% pre-campaign to 65% post campaign, with specific mention of persistent / prolonged cough increasing from 12% pre-campaign to 15% post-campaign¹
An increase of 9.1% in the number of lung cancer cases diagnosed during the months surrounding the campaign²
An increase of 3.1 percentage points for the proportion of non-small cell lung cancers diagnosed at Stage I (14.1% to 17.3%). There was also a corresponding 3.5 percentage point decrease in the proportion of people diagnosed at Stage IV (52.5% to 49.0%)²
An increase of 2.3 percentage points (13.7% to 16.0%) for the proportion of patients receiving surgical resections as a first definitive treatment.²

Below you will find results from a number of the lung cancer campaigns that have run in England. However, if you would like more information about these campaigns, please visit the lung cancer pages.

References

Be Clear on Cancer national lung cancer awareness campaign evaluation – impact on patients attending GP appointments. Produced by Mayden, February 2014 for NHS IQ
National Lung Cancer Audit. Data provided by HSCIC

Lung cancer: regional campaign (Oct – Nov 2011)

Results from the regional lung cancer campaign show:

There was a statistically significant (30%) increase in urgent GP referrals for suspected lung cancer in pilot areas during October – December 2011, compared to the same period in the previous year
There was a statistically significant increase in the percentage of small cell lung cancers diagnosed as “limited” in October – December 2011 in the pilot trusts (25.9%), compared to the same period in the previous year (36.6%)
The percentage of late stage non-small cell lung cancers decreased significantly in Oct–Dec 2011 from the same period in the previous year in the pilot trusts, whilst no significant change was seen in control areas
The percentage of carcinoid tumours detected increased significantly in the pilot trusts from 0.4% to 1.3% between October – December 2010 and October – December 2011.
Pilot trusts also saw a statistically significant increase in surgical resections which was not replicated in the non-pilot trusts.

Lung cancer: first national campaign (May – Jun 2012)

The results in the months surrounding the first national lung cancer campaign show:

Urgent GP referrals for suspected lung cancer saw a statistically significant increase of 32% in May – July 2012 when compared to the same period in the previous year
Analysis from 486 GP practices showed a statistically significant 63% increase in attendances for cough in the over 50s during the campaign period when compared with the same period in the previous year, equating to an additional 3 visits per practice, per week
Statistically significant increase (9%) in lung cancer cases diagnosed (equating to 700 additional cases) in patients first seen for lung cancer during the campaign months when compared to the same period in previous year. No significant increase was seen over the control months
Statistically significant increase, from 23.4% to 26.9%, in the proportion of non small cell lung cancers diagnosed at early stage (approximately 400 more cancers) across the campaign months when compared to the same months in the previous year. This is matched by a corresponding statistically significant decrease in the proportion diagnosed as late stage (Stage IV)
Statistically significant increase in the proportion of patients receiving surgical resection as a first definitive treatment (from 13.7% to 16.0%, equating to around 300 more patients) during the campaign months when compared to the same period in 2011. No significant change in surgical resections was seen across the control months.

For more information on the impact of this campaign on raising public awareness of lung cancer symptoms, please read the publication from the British Journal of Cancer.

Lung cancer: second national campaign (Jul – Aug 2013)

Findings from the second national lung cancer campaign show:

There were increases in the number of urgent GP referrals for suspected lung cancer, with a 30% increase in July-September 2013 compared to the same months in 2011, and compared to a 26% increase in urgent GP referrals for other suspected cancers
Tracking research following the second national lung cancer campaign shows that spontaneous knowledge of the key campaign awareness message of a persistent cough increased significantly, to a higher level than after the first national campaign (22% after the second national campaign, up from 15% after the first national campaign).

Lung cancer: third national campaign (Mar – Apr 2014)

Initial findings show that:

The monthly numbers of urgent GP referrals for suspected lung cancer were above the general trend for April and May 2014, particularly for April, following the third national lung cancer campaign.

Evaluation of the second and third national lung cancer campaigns is still ongoing. Information for these campaigns (including analysis of urgent wait referrals and related diagnoses) will be published in the coming months, so please keep checking back for more information.

Lung cancer awareness campaign: Wales

Coronavirus (COVID-19)

Contact Us

Essential information about this campaign

About lung cancer

Potential impact of the campaign

Evidence

Be Clear on Cancer statement