An evaluation of a national mass media campaign to raise public awareness of possible lung cancer symptoms in England in 2016 and 2017

Susan Ball,Lucy Elliss-Brookes,Carolynn Gildea,Helen L Hill,Chloe J Bright,Willie Hamilton,Vivian Mak,Jodie Moffat,Kwok F Wong,Lizz Paley,Chris Hyde

doi:10.1038/s41416-021-01573-w

Abstract

BackgroundA two-phase ‘respiratory symptoms’ mass media campaign was conducted in 2016 and 2017 in England raising awareness of cough and worsening shortness of breath as symptoms warranting a general practitioner (GP) visit.MethodA prospectively planned pre–post evaluation was done using routinely collected data on 15 metrics, including GP attendance, GP referral, emergency presentations, cancers diagnosed (five metrics), cancer stage, investigations (two metrics), outpatient attendances, inpatient admissions, major lung resections and 1-year survival. The primary analysis compared 2015 with 2017. Trends in metrics over the whole period were also considered. The effects of the campaign on awareness of lung cancer symptoms were evaluated using bespoke surveys.ResultsThere were small favourable statistically significant and clinically important changes over 2 years in 11 of the 15 metrics measured, including a 2.11% (95% confidence interval 1.02–3.20, p < 0.001) improvement in the percentage of lung cancers diagnosed at an early stage. However, these changes were not accompanied by increases in GP attendances. Furthermore, the time trends showed a gradual change in the metrics rather than steep changes occurring during or after the campaigns.ConclusionThere were small positive changes in most metrics relating to lung cancer diagnosis after this campaign. However, the pattern over time challenges whether the improvements are wholly attributable to the campaign. Given the importance of education on cancer in its own right, raising awareness of symptoms should remain important. However further research is needed to maximise the effect on health outcomes.

Highlights

A two-phase ‘respiratory symptoms’ mass media campaign was conducted in 2016 and 2017 in England raising awareness of cough and worsening shortness of breath as symptoms warranting a general practitioner (GP) visit
The national mass media campaign ran across England from 14 July 2016 to 16 October 2016 (Phase 1) [13 weeks] and from 18 May 2017 to 31 August 2017 (Phase 2) [16 weeks] using the ‘Be Clear on Cancer’ brand with the core messages: suspected lung cancer, new lung cancer cases that resulted from a TWW referral and the percentage of TWW referrals resulting in a diagnosis of lung cancer were sourced from the National Cancer Waiting Times Monitoring Dataset [15]
There was an increase in awareness of symptoms targeted by the campaign: getting out of breath (difference in the percentage of respondents answering ‘agree strongly’ or ‘agree’ 5.1%, 95% confidence interval (CI) 1.3–8.9); coughing regularly for 3 weeks (difference in percentage answering ‘agree strongly’ or ‘agree’ 6.5%, 95% CI 3.1–9.9)

Summary

Introduction

A two-phase ‘respiratory symptoms’ mass media campaign was conducted in 2016 and 2017 in England raising awareness of cough and worsening shortness of breath as symptoms warranting a general practitioner (GP) visit. RESULTS: There were small favourable statistically significant and clinically important changes over 2 years in 11 of the 15 metrics measured, including a 2.11% (95% confidence interval 1.02–3.20, p < 0.001) improvement in the percentage of lung cancers diagnosed at an early stage. These changes were not accompanied by increases in GP attendances. Lung cancer remains a very important health problem globally, including the United Kingdom, where it represented 13% of newly diagnosed cancers cases in 2016 [1]. The net effect is that UK lung cancer numbers are currently slowly increasing

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