Evaluation of a national lung cancer symptom awareness campaign in Wales

Grace Mccutchan,Lucy Ironmonger,Kate Brain,Jodie Moffat,Rebecca Thomas,Amanda Boughey,Stephanie Smits,Ciarán Slyne,Dyfed Wyn Huws

doi:10.1038/s41416-019-0676-2

Abstract

BackgroundLung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes.MethodsPopulation-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors’ time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013). GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods.ResultsIncreased cough symptom recall (p < 0.001), recognition (p < 0.001) and decreased worry (p < 0.001) were observed. GP visits for cough increased by 29% in the target 50+ age-group during the campaign (p < 0.001) and GP-ordered chest X-rays increased by 23% (p < 0.001). There was no statistically significant change in USC referrals (p = 0.82), new (p = 0.70) or early stage (p = 0.27) diagnoses, or in routes to diagnosis.ConclusionsSymptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Short campaign duration and follow-up, and the small number of new lung cancer cases observed may have hampered detection effects.

Highlights

Lung cancer is the leading cause of cancer mortality in Wales
We evaluated the impact of the first nationwide mass-media lung cancer symptom awareness campaign to be conducted in Wales
We found no impact of the Welsh Be Clear on Cancer (BCOC) campaign on urgent suspected cancer (USC) referrals or other clinical outcomes

Summary

Introduction

Lung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes. GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods. CONCLUSIONS: Symptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Lung cancer incidence rises steeply with increasing deprivation and the survival inequality gap is widening.[4] Delayed symptomatic presentation to a primary care physician and delays within and across primary and secondary care contribute to diagnosis of lung cancer in the later stages of disease.[5,6,7] The possibility of curative treatment decreases with later-stage disease diagnosis; in the UK, less than a fifth of patients are eligible for surgical resection, in turn influencing outcomes.[6,8]

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Conclusion