Oesophago-gastric cancers campaign
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Be Clear on Cancer ran a national campaign to raise awareness of Oesophago-Gastric cancers from 26 January - 22 February 2015.
Advertising ran across England from 26 January to 22 February 2015. The key messages promoted on TV were: ‘Having heartburn, most days, for 3 weeks or more could be a sign of cancer – tell your doctor.’
A number of resources were created for the campaign including briefing sheets for health professionals, and various campaign materials including accessible formats. You can view a few examples below:
View a pharmacy team briefing sheet
The term 'oesophago-gastric' (OG) refers to cancers of the oesophagus (ICD10 code C15) and stomach (ICD10 code C16).
Each year in England, nearly 6,900 people are diagnosed with oesophageal cancer and around 6,200 die from it; around 6,000 people are diagnosed with stomach cancer and over 4,000 die from the disease [1].
In the UK, survival outcomes for oesophageal cancer (adenocarcinoma) among men are the worst in the world.
Oesophago-gastric cancers are the 4th and 5th most common type of cancer death in males & females respectively [1].
Over the past 17 years, the numbers of adenocarcinoma oesophageal cancers diagnosed have increased by an average of 3.9% per year from 2,000 cases in 1995 to 3,800 cases in 2012 [1].
When diagnosed at the earliest stage, one-year survival for oesophago-gastric cancers is as high as 75 - 87%. At late stage, it is as low as 20-21% [2].
It is estimated that nearly 950 deaths from oesophago-gastric cancers could be avoided each year if five-year survival rates matched the best in Europe.
References
- Incidence data supplied by West Midlands KIT based on NCRS data
- Deaths data supplied by West Midlands KIT based on ONS data
The key message promoted on TV was: ‘Having heartburn, most days, for 3 weeks or more could be a sign of cancer – tell your doctor.’
A second message was promoted via other campaign materials: ‘Food sticking when you swallow could be a sign of cancer – tell your doctor.’
Results from a regional campaign (Feb - Mar 2014) and 7 local Oesophago-Gastric cancers pilot campaigns (Apr-Jul 2012) showed promising results. However, it is acknowledged that heartburn is a common complaint therefore measures were taken to help limit the impact of the campaign on local services. For example, advertising (including TV and radio) was only run for 4 weeks, rather than the usual 6 weeks.
Based on a review of current evidence at the time and the advice of a panel of experts, including clinicians and patient group representatives, these 2 symptoms were identified to hold a strong association with earlier stage ‘OG’ cancers. Examples of the supporting evidence for these key messages included:
- A strong association has long been identified between heartburn/regurgitation symptoms and oesophageal cancer.
- Data from the Northern Oesophago-gastric Unit indicates that 38% of patients with heartburn/indigestion (dyspepsia) but no dysphagia (food sticking upon swallowing) referred between January 2008 and January 2013 had early stage oesophageal cancer (stage 1-2) [1].
- An investigation into varying gastroscopy referral rates among GP practices supports the use of gastroscopy to investigate persistent heartburn (dyspepsia). The study found patients belonging to GP practices with the lowest gastroscopy rates were at greater risk of a poor outcome.
- The campaign also focuses on food sticking upon swallowing (dysphagia), which, along with the symptom of dyspepsia, features in NICE referral guidelines for suspected cancer. The guidelines recommend all patients presenting with dysphagia should be placed on an urgent referral.
References
- Northern Oesophago-gastric Unit (NOGU). The Oesophago-Gastric Cancer Awareness Campaign – The Importance of Heartburn in Improving Patient Outcomes. Newcastle upon Tyne: NOGU; 2013
Men and women over the age of 50 from lower socioeconomic groups, and their key influencers, such as friends and family.
One regional oesophago-gastric cancers pilot ran in the Northern England Strategic Clinical Network (SCN) area from February – March 2014. Research identified a significant uplift in spontaneous awareness of oesophago-gastric cancers symptoms post-campaign:
- 57% spontaneously mentioned they had seen publicity about cancer symptoms, and of those people [1];
– 31% in the pilot region spontaneously mentioned "heartburn"
– 24% mentioned "difficulty in swallowing food" - 63% agreed the advertising had told them something new [1]
When comparing the campaign period with the same time previous year, it showed;
- 52% increase in 2WW referrals for suspected upper GI cancers, compared with a 17% increase in the control areas (rest of England, excluding local and regional pilot areas) [2]
- Early indications of an increase in the number of Barrett’s oesophagus cases diagnosed (a condition known to increase a person's risk of oesophageal cancer) [3]
Currently there is no control group to compare these findings against, and not all trusts who participated in the regional pilot have been able to share their data yet, therefore the significance of this increase isn’t yet clear.
- The total number of upper GI cancers diagnosed did not increase following the campaign however there was a significant increase of 29 percentage points^ in the proportion of upper GI cancers diagnosed via a 2WW referral, among those aged 60–69 only [2]
This finding for people in their 60s is encouraging since we know that 12 month relative survival for those diagnosed by emergency presentation is lower than for those diagnosed via a 2WW referral. We also know that the association between age and the percentage of patients diagnosed by emergency presentation is highest in the elderly. However, further data over time will be required before we can fully understand the impact of this activity.
Note: ‘Upper GI’ refers to ICD10 C15-C16, C22-C25
^Based on a small number of cases and there was some variation in the data over time among the 60-69 age group, therefore the observed increase may not be wholly attributable to impact of the campaign.
References
- TNS BMRB on behalf of Public Health England, post-OG campaign survey of 300 adults aged over 50 interviewed face-to-face in the North East region, 12th – 25th March 2014
- Data from the National Cancer Waiting Times (CWT) Monitoring Dataset provided by NHS England and accessed via Public Health England’s Knowledge & Intelligence Team (East Midlands).
- Data supplied by individual NHS trusts who participated in the regional pilot which ran in the Northern England Strategic Clinical Network (SCN) area, (Feb-Mar 2014)
Seven local projects focussed on oesophago-gastric cancers. These projects covered the North of England; County Durham and Darlington; Dudley; Sandwell and Wolverhampton; Anglia; Hertfordshire, Luton and South Bedfordshire; and Wandsworth and ran between April and July 2012.
When comparing the campaign period with the same time the previous year, the results were as follows:
- 26% statistically significant increase in urgent GP referrals (two-week wait (2WW) for suspected upper gastrointestinal (GI) cancers in pilot areas, compared with a 16% increase in control areas [1]
- 20% increase (not significant) in oesophageal cancers diagnosed following a 2WW referral for suspected upper GI cancers in the pilot area, compared with 3% increase in the control area [1]
- No change to the oesophageal cancer conversion rate [1]
Download a Cancer Research UK evaluation poster
Download a Be Clear on Cancer Evaluation Summary 2014
References
- Cancer Research UK.Improving the early diagnosis of oesophago-gastric cancers; findings from seven local Be Clear on Cancer pilots.London: Cancer Research UK; 2012
Be Clear on Cancer statement
Be Clear on Cancer was 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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