Respiratory symptoms awareness campaign
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Be Clear on Cancer ran 2 respiratory symptoms campaigns, one nationally from 14 July - 16 October 2016 and a second in England from 18 May – 31 August 2017, to raise awareness of the respiratory symptoms of a persistent cough and inappropriate breathlessness. It encouraged those with relevant symptoms to present to their GP, with the aim of diagnosing more cases of cancer, lung disease and heart disease earlier.
The decision to run campaigns focussing on respiratory symptoms was based on evidence from the evaluation of the previous lung cancer campaign and the pilot for inappropriate breathlessness (as a symptom of chronic obstructive pulmonary disease, heart disease and a range of other conditions).
A number of briefing sheets and campaign resources were created for the Respiratory Symptoms Awareness campaigns, including accessible versions. Below are a few examples:
The campaign was aimed at men and women aged 50 and over, as well as their key influencers, such as friends and family. People over 50 are most at risk of having an undiagnosed respiratory disease and make up 97% of lung cancer diagnoses.
The key messages for the public were:
- If you’ve had a cough for three weeks or more, it could be a sign of lung disease, including cancer. Finding it early makes it more treatable. So don’t ignore it, tell your doctor.
- If you get out of breath doing things you used to be able to do, it could be a sign of lung or heart disease, or even cancer. Finding it early makes it more treatable. So don’t ignore it, tell your doctor.
- National Cancer Registration & Analysis Service (NCRAS) data based on 2010-2014 annual
More than 90% of patients with lung cancer are symptomatic at diagnosis, with cough being the most common presenting symptom . Breathlessness is a common symptom of COPD, heart disease and a range of other conditions . The campaign will combine lung cancer and breathlessness, with the aim of encouraging more people with these symptoms to visit their GP earlier. For all of these diseases, finding them sooner will make treating them successfully more likely, which helps to prolong survival.
- Source: Beckles M A et al; Initial Evaluation of the Patient with Lung Cancer; Chest. 2003; 123(1_suppl):97S-104S. doi:10.1378/chest.123.1_suppl.97S
Public Health England has run several Be Clear on Cancer campaigns since 2011. There have been a number of lung cancer campaigns, including local and regional pilots followed by three national campaigns. Results from these activities indicate that Be Clear on Cancer was changing levels of public awareness and behaviour. There are indications that clinical outcomes were improving too.
Findings from the campaign that ran in England showed:
- 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-campaign
- 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%)
- 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.
- 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
Results from the regional lung cancer campaign showed:
- Pilot areas saw a statistically significant (30%) increase in GP referrals for suspected lung cancer during October – December 2011 when 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 with 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.
The results in the months surrounding the first national lung cancer campaign showed:
- Urgent 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 time in the previous year. This is matched by a corresponding statistically significant decrease in the proportion diagnosed as late stage
- 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.
Findings from the second national lung cancer campaign showed:
- There were increases in the number of 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).
Initial findings showed 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.
The breathlessness campaign was piloted first at a local level and then at a regional level, with the aim of scoping whether it was possible to achieve earlier diagnosis of a range of conditions, particularly lung and heart disease but also other conditions such as anxiety.
Evaluation of the regional breathlessness campaign showed that:
- There were significant increases in spontaneous knowledge of what breathlessness could be a sign of:
- lung disease, up from 50% pre-campaign to 60% post campaign
- heart disease, up from 42% pre-campaign to 52% post campaign
- Of those people who recalled seeing advertising, when asked to describe the main message, 59% in the pilot region spontaneously mentioned “to encourage people to see their GP if they are getting out of breath” (up from 43% pre-campaign). Similarly, there was an increase in people mentioning that getting out of breath could be a sign of something more serious, up to 44% from 34%.
As the breathlessness campaign has only run at a regional level to date, we do not have national level data. However, qualitative research carried out with GPs in the regional pilot area following the campaign reported that while they while they were unsure if they had seen an increase in presentations for breathlessness, when retrospectively looking at the campaign materials they could recall patients using the same language.
For more information about the breathlessness campaign, please read the NHS evaluation.