Our reports and publications
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Explore a selection of reports and publications from the Cancer Intelligence experts at Cancer Research UK, and through various collaborations.
The impact of COVID-19 on cancer patients’ experience
This report summarises the findings from the CRUK patient experience survey (PES), which collected data from 1st May to 28th May 2020. The findings indicate the impact of COVID-19 on cancer patients, and their testing, treatment and care. For many cancer patients the COVID-19 pandemic appears to have had a significant impact on their testing and treatment, and most notably their care. This has resulted in a negative impact on the emotional well-being of many cancer patients whether they were hoping to finish their treatment, find out the results of their test, have their regular screening, or continue with care that could support them, in some cases for the remainder of their life.
Cancer Research UK. Cancer Research UK Cancer Experience Survey 2020: The impact of COVID-19 on Cancer patients in the UK. July 2020.
Smoking prevalence projections
UK smoking prevalence has been declining overall for some decades, and ambitions to achieve 5% average adult smoking prevalence (‘smoke-free’) have been set by England for 2030, and Scotland for 2034. These projections, based on current trends in nationally-representative smoking surveys, suggest that 5% average adult smoking prevalence could be reached in 2037 for England and Wales, the late 2040s for Northern Ireland, and after 2050 for Scotland. There could be millions fewer UK smokers than projected in the 2030s, if smoke-free ambitions were achieved; however to do this the pace of change needs to increase markedly in all UK nations. Socioeconomic inequalities are a key concern: the projections indicate that in England, smoke-free could be achieved by the most deprived fifth of the population around 20 years later than in the least-deprived fifth; and in Scotland and Northern Ireland this deprivation gap may be markedly longer.
Cancer Intelligence Team, Cancer Research UK. Smoking prevalence projections for England, Scotland, Wales, and Northern Ireland based on data to 2018/19. February 2020.
Evaluation: e-cigarette relative harms pilot campaign 2018
An advertising campaign piloted by Cancer Research UK in 2018 aimed to promote quit attempts by increasing awareness of the relative harms of e-cigarettes compared with smoking. A cross-sectional survey evaluation was conducted surveying adults (≥16 years, n = 2217) living in the campaign region and the comparison/control regions. We tested interactions between time (pre, post) and region (campaign, control).
Compared with the control region, the campaign was associated with an increase in smokers’ motivation to quit but a smaller increase in adults’ perception of e-cigarettes as an effective cessation aid. It was identified that using mass media to communicate accurate information about the relative harms of e-cigarettes compared with smoking may be an effective strategy in increasing smokers’ motivation to quit. Further research is needed to evaluate effects on quit attempts and success.
Harry Tattan-Birch, Sarah E Jackson, Charlotte Ide, et al. Evaluation of the Impact of a Regional Educational Advertising Campaign on Harm Perceptions of E-Cigarettes, Prevalence of E-Cigarette Use, and Quit Attempts Among Smokers. Nicotine Tob Res 2019. doi: 10.1093/ntr/ntz236
Geographic variation in treatment of endometrial cancer
Our CRUK-PHE partnership team have investigated the geographic variation in the use of lymphonodectomy and external beam radiotherapy (EBRT) in the treatment of endometrial cancer. Significant variation was found between 19 Cancer Alliances using population level cancer registry data collected between 2013-2016, which is likely due to ambiguity in existing endometrial cancer management guidelines.
White B, Nordin A, Fry A et al. Geographic variation in the use of lymphadenectomy and external‐beam radiotherapy for endometrial cancer: a cross‐sectional analysis of population‐based data. BJOG 2019 doi: 10.1111/1471-0528.15914
Cancer Awareness Measure move to online
Cancer Awareness Measure move to online
The Cancer Awareness Measure (CAM) is a survey designed to assess public awareness of cancer warning signs/symptoms, cancer risk factors and barriers to help seeking. Data has been collected every two years from 2008 to 2014 from a representative face to face sample of Great Britain via the Office of National Statistics (ONS) Opinions and Lifestyle Survey.
In 2017, we analysed the extent to which public awareness of cancer and attitudes toward seeking help vary by online and face-to-face data collection methods. Results showed that online participants were more likely to recall cancer warning signs and risk factors and were also more likely to endorse barriers to help seeking than face to face responders. As a result of this analysis CRUK moved the CAM survey online and the first survey wave took place in 2019.
Cancer Intelligence. Cancer Awareness Measure (CAM) Key Findings Report: Comparing data collected online and face-to-face. October 2019.
Connor K, Hudson B, Power E. Awareness of the Signs, Symptoms, and Risk Factors of Cancer and the Barriers to Seeking Help in the UK: Comparison of Survey Data Collected Online and Face-to-Face. JMIR Cancer 2020;6(1):e14539.
Image of standard packaging on cigarette boxes
In the United Kingdom, standardised packaging for cigarettes was phased in between May 2016 and May 2017. A cross-sectional online survey was conducted with current smokers aged 16+ in two regions of England when both standardised and fully-branded packs were available. The study found that standardised packaging was associated with increased warning salience and thoughts about risks and quitting. Specifically, compared with never users, current users were more likely to have noticed the warnings on packs often/very often, read them closely often/very often, thought somewhat/a lot about the health risks of smoking and thought somewhat/a lot about quitting. These findings provided support for standardised packaging during the transition period.
Moodie C, Brose LS, Lee HS et al. How did smokers respond to standardised cigarette packaging with new, larger health warnings in the United Kingdom during the transition period? A cross-sectional online survey. Addiction Research & Theory 2019.
Smoking trends by occupation group
The proportion of current smokers in the population (smoking prevalence) has been falling for decades in the UK, However a clear deprivation gradient remains: smoking prevalence is around twice as high in routine and manual (R&M) workers compared with managerial and professional (M&P) workers. That gap has widened in recent decades, because smoking prevalence has fallen more slowly among R&M workers compared with M&P workers. This reflects both higher rates of uptake and lower rates of quitting in R&M workers compared with M&P workers. Occupation group is associated with smoking behaviour independent of other characteristics like age, sex, region, education, marital status, ethnicity, alcohol consumption and general perceived health. If the R&M worker population had experienced the same pace of decline in smoking prevalence as the M&P population, there would now be almost a million fewer R&M worker smokers.
Cancer Intelligence Team 2019 Smoking prevalence trends by occupation group in health survey for England
Diagnostic Intervals in England
Our CRUK-PHE partnership team have calculated diagnostic intervals for the first time for patients of 25 different cancer sites diagnosed in 2014 & 2015. Significant variation in these intervals were found by stage of disease, route to diagnosis and comorbidity score. An online tool demonstrates variation by these and other factors by cancer site and cancer alliance. A paper describing the methodology and results for colorectal and lung cancer was published in Cancer Epidemiology in June 2019. Two blogs detailed the project, one by CRUK and one at Public Health Matters.
Pearson C, Fraser J, Peake M. Establishing population-based surveillance of diagnostic timeliness using linked cancer registry and administrative data for patients with colorectal and lung cancer. Cancer Epidemiology 2019.
Handbook on Statistical Disclosure Control for Outputs
We contributed to this guide for those looking for an introduction about how to make statistical findings ‘safe’, those wanting practical step-by-step guidance for undertaking disclosure control assessments, and for staff setting up and managing a data ‘service’ where Statistical Disclosure Control is a significant contribution to staff roles.
Safe Data Access Professionals Working Group. Handbook on Statistical Disclosure Control for Outputs. The Health Foundation 2019.
Cancer in the UK
This report summarises the current state of cancer in the UK. It shows where we are making progress and the challenges that we still face. Running throughout is the clear message that the NHS does not have enough staff with the right skills to deal with our growing and aging population and with the increasing number of cancer cases that are an inevitable result. Addressing this has been urgent for some time. Now it is critical.
Cancer Intelligence Team. 2019 Cancer in the UK
Cancer Intelligence Team. 2019 Cancer in the UK - Early diagnosis (sub version of main report with focus on early diagnosis)
Exploring public attitudes towards the new Faster Diagnosis Standard for cancer
An exploration into public attitudes towards the new Faster Diagnosis Standard for cancer, due to be introduced in England in 2020, within the context of a patients’ recent referral experiences.
It found that waiting for test results and responsibility for meeting the standard were the main concerns and it was concluded that patients should be asked what they would like to know about their referral and that GPs should be more transparent about the referral process and the potential for a lack of clarity around next steps.
Piano M, Black G, Amelung D et al. Exploring public attitudes towards the new Faster Diagnosis Standard for cancer: a focus group study with the UK public. Br J Gen Pract 2019.
Want to generate bespoke preventable cancers stats statements? Download our interactive statement generator.
Cancer awareness training evaluation
CRUK's training (“Talk Cancer”) aims to increase awareness of screening programmes and risk factors, promote more positive beliefs about cancer and increase confidence to discuss cancer with members of the public, among people working across the health service, local government, community and voluntary sectors who are appropriately placed to have these discussions with the public.
The evaluation found that the trainees' more positive beliefs about cancer, their increased confidence in discussing cancer and their increased awareness of bowel cancer screening were all maintained at 2 months.
Roberts A, Crook L, George H etc al. Two-month follow-up evaluation of a cancer awareness training workshop (“Talk Cancer”) on cancer awareness, beliefs and confidence of front-line public health staff and volunteers. Prev Med Rep 2019.
Obesity - smoking crossover report
Overweight and obesity could overtake smoking as the single biggest cause of cancer in UK women in around a quarter of a century, if current trends continue as projected. For UK males this crossover is likely to occur later. It is CRUK’s aim to reverse the rise in overweight and obesity prevalence, as we did with smoking. These calculations demonstrate just how vital that aim is to reduce the number of people diagnosed with cancer in the UK in future.
Cancer Intelligence Team. 2018 When could overweight and obesity overtake smoking as the biggest cause of cancer in the UK?
Addressing unmet needs in women’s health
We contributed to the “Cancer in women – addressing unmet needs” paper in this series by the British Medical Association. This paper sets out the situation for women in terms of cancer incidence, preventable risk factors and inequalities. We highlight that more focus is required on prevention and diagnostic capacity. We must keep striving to give the best chance of securing a curative treatment, long term survival and improved quality of life.
Nearly four in ten cancer cases in the UK are attributable to known risk factors. The proportion is higher in males than females, and highest in Scotland and lowest in England. Tobacco and overweight/obesity remain the top contributors. Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, to have the biggest impact on reducing cancer incidence.
Brown K, Rumgay H, Dunlop C et al. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Brit J Cancer 2018.
Infographics showing how 4 in 10 cancer cases can be prevented and the cancers caused by which risk factors are available, for free, from Cancer Stats cancer risk publications.
Want to generate bespoke preventable cancers stats statements? Download our interactive statement generator.
Overviews of cancer in Devolved Nations
Cancer Research UK is committed to accelerating progress so that 3 in 4 people survive cancer by 2034. To achieve this, we need to understand the state of cancer and the actions required at a country level.
These overview reports show stats on cancer, prevention and early diagnosis indicators for Scotland, Wales and Northern Ireland separately. They also state what CRUK is calling on the governments, decision making bodies and the country to take action on, to improve the state of cancer in each country.
Sociodemographic variation in treatments
Sociodemographic inequalities in cancer treatment have been generally described, but there is little evidence regarding patients with advanced cancer. Understanding variation in the management of these patients may provide insights into likely mechanisms leading to inequalities in survival.
Henson KE, Fry A, Lyratzopoulos G, et al. Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013–2014. Brit J Cancer 2018.
This unprecedented set of statistics details patients recorded to have received chemotherapy, radiotherapy and surgical tumour resections for their tumour in England, by cancer site and stage at diagnosis, for most cancers. It focuses on the time period following diagnosis within which most patients' first course of treatment occurred, although adjuvant and neo-adjuvent treatments may be captured as well as the primary treatment. This provides the foundation for future research to improve care and outcomes for patients.
National Cancer Registration & Analysis Service and Cancer Research UK. Chemotherapy, Radiotherapy and Tumour Resections in England. NCRAS 2017.
It is projected that 513,951 cases of cancer will be diagnosed in the UK in 2035 and that 212,546 deaths will occur. Incidence rates are projected to decrease slightly in males and increase slightly more in females. Most cancers' mortality rates are decreasing; except for liver, oral and anal cancers. Risk factors continue to need addressing, and healthcare planners need to consider the increased burden of cases and deaths because of the growing and ageing population.
Smittenaar C, Petersen K, Stewart K et al. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016.
Barriers to help-seeking
This study adds to the evidence on the barriers that may influence the public's decisions around help-seeking in the event of a symptom and found different or broader barriers, to the ones previously considered. Exploration of these barriers and understanding which are associated with actual help-seeking behaviour would be helpful in the development of policy or interventions to mitigate their impact. Confirmation of the sociodemographic inequalities in the barriers helps us to specifically target future activity.
Moffat J, Hinchliffe R, Ironmonger L, et al. Identifying anticipated barriers to help-seeking to promote earlier diagnosis of cancer in Great Britain. Public Health 2016.
30-day mortality from SACT
30-day mortality might be a useful indicator of avoidable harm to patients from systemic anticancer treatments, but data for this are limited. The Systemic Anti-Cancer Therapy (SACT) dataset collated by Public Health England allows the assessment of factors affecting 30-day mortality in a national patient population. This study aimed to establish national benchmarks, and to start to identify where patient care could be improved.
Wallington M, Saxon E, Bomb M et al. 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study Lancet Oncol 2016.
Cancer symptom awareness campaigns
National campaigns focusing on key symptoms of bowel and lung cancer ran in England in 2012, targeting men and women over the age of 50 years, from lower socioeconomic groups. It was found that campaigns reached their target audience and have also influenced younger and more affluent groups. Differences in impact within the target audience were also seen. There would seem to be no unduly concerning widening in inequalities, but further analyses of the equality of impact across population subgroups is warranted.
Moffat J, Bentley A, Ironmonger L et al. The impact of national cancer awareness campaigns for bowel and lung cancer symptoms on sociodemographic inequalities in immediate key symptom awareness and GP attendances Brit J Cancer 2015.
Interventions for gFOBT uptake
Three interventions (CRUK endorsement flyer, kit enhancement pack, and advertising campaign) were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme and assist stool sampling, with the aim to increase uptake. The greatest increase in uptake was where all three interventions were combined. Future research should investigate the effectiveness of each intervention component and attempt to identify the mechanisms through which they have an effect.
White B, Power E, Ciurej M, et al. Piloting the impact of three interventions on guaiac faecal occult blood test uptake within the NHS Bowel Cancer Screening Programme. Biomed Res Int 2015.
Survival gains by eliminating inequalities
Although inequalities in cancer survival are thought to reflect inequalities in stage at diagnosis, little evidence exists about the size of potential survival gains from eliminating inequalities in stage at diagnosis. The number of deaths that could be postponed by eliminating socioeconomic and sex differences in stage at diagnosis was estimated and it was found that this would result in substantial reductions in deaths within 5 years of diagnosis.
Rutherford M, Ironmonger L, Ormiston-Smith N et al. Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma. Brit J Cancer 2015.
Awareness of lung cancer symptoms
Long-term lung cancer survival in England has improved little in recent years and is worse than many countries. A public awareness campaign found significant increases in public awareness of persistent cough as a lung cancer symptom; urgent GP referrals for suspected lung cancer; and lung cancers diagnosed. Most encouragingly, there was a significant increase in the proportion of non-small cell lung cancer diagnosed at stage I and in resections for patients seen during the national campaign.
Ironmonger L, Ohuma E, Ormiston-Smith N. An evaluation of the impact of large-scale interventions to raise public awareness of a lung cancer symptom Brit J Cancer 2015.
Patients with non-specific symptoms
The CRUK-PHE partnership have published a paper comparing patients presenting with non-specific but concerning symptoms with patients presenting with more obvious symptoms. Cancer registration data was linked to the National Cancer and Diagnosis Audit (NCDA) data, which has information about primary care for over 17,000 cancers. The work found that patients with non-specific symptoms had longer primary care intervals, more complex diagnostic pathways and were more likely to be diagnosed at stage 4 and after an emergency presentation. This work supports the evaluation of Multi-Disciplinary Centres (MDCs) by the ACE Programme, an early diagnosis imitative supported by CRUK, MacMillan Cancer Support and NHS England.
Pearson C, Poirier V, Fitzgerald K, et al. Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms. BMJ Open 2020;10:e033008. doi: 10.1136/bmjopen-2019-033008