Symptom Awareness Campaigns Research Articles

The presenting symptom signatures of incident cancer: evidence from the English 2018 National Cancer Diagnosis Audit

BackgroundUnderstanding relationships between presenting symptoms and subsequently diagnosed cancers can inform symptom awareness campaigns and investigation strategies.MethodsWe used English National Cancer Diagnosis Audit 2018 data for 55,122 newly diagnosed patients, and examined the relative frequency of presenting symptoms by cancer site, and of cancer sites by presenting symptom.ResultsAmong 38 cancer sites (16 cancer groups), three classes were apparent: cancers with a dominant single presenting symptom (e.g. melanoma); cancers with diverse presenting symptoms (e.g. pancreatic); and cancers that are often asymptomatically detected (e.g. chronic lymphocytic leukaemia). Among 83 symptoms (13 symptom groups), two classes were apparent: symptoms chiefly relating to cancers of the same body system (e.g. certain respiratory symptoms mostly relating to respiratory cancers); and symptoms with a diverse cancer site case-mix (e.g. fatigue). The cancer site case-mix of certain symptoms varied by sex.ConclusionWe detailed associations between presenting symptoms and cancer sites in a large, representative population-based sample of cancer patients. The findings can guide choice of symptoms for inclusion in awareness campaigns, and diagnostic investigation strategies post-presentation when cancer is suspected. They can inform the updating of clinical practice recommendations for specialist referral encompassing a broader range of cancer sites per symptom.

Protocol for a feasibility study of a cancer symptom awareness campaign to support the rapid diagnostic centre referral pathway in a socioeconomically deprived area: Targeted Intensive Community-based campaign To Optimise Cancer awareness (TIC-TOC)

IntroductionRapid diagnostic centres (RDCs) are being implemented across the UK to accelerate the assessment of vague suspected cancer symptoms. Targeted behavioural interventions are needed to augment RDCs that serve socioeconomically...

Early-stage lung cancer associated with higher frequency of chest x-ray up to three years prior to diagnosis.

Symptom awareness campaigns have contributed to improved early detection of lung cancer. Previous research suggests that this may have been achieved partly by diagnosing lung cancer in those who were not experiencing symptoms of their cancer. This study aimed to explore the relationship between frequency of chest x-ray in the three years prior to diagnosis and stage at diagnosis. Lung cancer service in a UK teaching hospital. Patients diagnosed with lung cancer between 2010 and 2013 were identified. The number of chest x-rays for each patient in the three years prior to diagnosis was recorded. Statistical analysis of chest x-ray frequency comparing patients with early- and late-stage disease was performed. One-thousand seven-hundred fifty patients were included - 589 (33.7%) with stage I/II and 1,161 (66.3%) with stage III/IV disease. All patients had at least one chest x-ray in the six months prior to diagnosis. Those with early-stage disease had more chest x-rays in this period (1.32 vs 1.15 radiographs per patient, P = 0.009). In the period 36 months to six months prior to lung cancer diagnosis, this disparity was even greater (1.70 vs 0.92, radiographs per patient, P < 0.001). Increased rates of chest x-ray are likely to contribute to earlier detection. Given the known symptom lead time many patients diagnosed through chest x-ray may not have been experiencing symptoms caused by their cancer. The number of chest x-rays performed could reflect patient and/or clinician behaviours in response to symptoms.

Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.

BackgroundLeprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis.Methodology/Principal findingsIn this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms.ConclusionsUnderstanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.

Approaches to diagnosing cancer earlier in general practice

In the UK there have been significant efforts over the last two decades to reduce delays in cancer diagnosis in response to the nation’s poorer survival outcomes compared to other high-income countries. Cancer screening programmes are one approach to improve survival through early detection, but the majority of cancers are detected following symptomatic presentation in primary care. Theoretical models of diagnostic delay emphasise the importance of considering patient, health system, and tumour factors along a pathway from symptom appraisal and help seeking to diagnostic assessment and treatment.1 Such models identify potential points of intervention to improve the timeliness of cancer diagnosis. Improving community symptom awareness and reducing barriers to early help seeking is one such approach. Several symptom awareness campaigns have occurred in the UK with some evidence, from before-and-after data, of positive effects on presentations to health care, cancer diagnoses, and earlier stage.2 In contrast, a controlled trial of a community symptom awareness intervention in rural Australia failed to demonstrate reduced time to presentation in people subsequently diagnosed with cancer.3 There remains some doubt about the effectiveness and cost-effectiveness of community awareness campaigns; they are …

Changes in the presenting symptoms of lung cancer from 2000-2017: a serial cross-sectional study of observational records in UK primary care.

BackgroundMost patients diagnosed with lung cancer present with symptoms. It is not known if the proportions of patients presenting with each symptom has changed over time. Identifying trends in lung cancer’s presenting symptoms is important for medical education and early-diagnosis initiatives.AimTo identify the first reported symptom of possible lung cancer (index symptom), and to test whether the percentages of patients with each index symptom changed during 2000–2017.Design and settingThis was a serial, cross-sectional, observational study using UK Clinical Practice Research Datalink (CPRD) data with cancer registry linkage.MethodThe index symptom was identified for patients with an incident diagnosis of lung cancer in annual cohorts between 1 January 2000 and 31 December 2017. Searches were constrained to symptoms in National Institute for Health and Care Excellence (NICE) suspected-cancer referral guidelines, and to the year before diagnosis. Generalised linear models (with a binomial function) were used to test if the percentages of patients with each index symptom varied during 2000–2017.ResultsThe percentage of patients with an index symptom of cough (odds ratio [OR] 1.01; 95% confidence interval [CI] = 1.00 to 1.02 per year; P<0.0001) or dyspnoea (OR 1.05; CI = 1.05 to 1.06 per year; P<0.0001) increased. The percentages of patients with other index symptoms decreased, notably haemoptysis (OR 0.93; CI = 0.92 to 0.95; P<0.0001) and appetite loss (OR 0.94; CI = 0.90 to 0.97; P<0.0001).ConclusionDuring 2000–2017, the proportions of lung cancer patients with an index symptom of cough or dyspnoea increased, while the proportion of those with the index symptom haemoptysis decreased. This trend has implications for medical education and symptom awareness campaigns.

20 - Sustained lung cancer mortality reduction following a symptom awareness campaign

20 - Sustained lung cancer mortality reduction following a symptom awareness campaign

Evaluation of a national lung cancer symptom awareness campaign in Wales

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.

Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study.

SummaryBackgroundEarly diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis.MethodsIn this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I–III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms.FindingsWe analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1–3; eight of 584 patients) for abnormal mole to 80% (71–87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the “any other symptom” category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV.InterpretationDespite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease.FundingUK Department of Health's Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis; and Cancer Research UK.

Timeliness of Presentation and Referral Among Cancer Patients Who Presented With Abdominal Symptoms: Evidence to Inform Symptom Awareness Campaigns

Background: Abdominal symptoms at presentation are common among patients subsequently diagnosed with cancer. While public health education campaigns in England and other countries have traditionally focused on 'red flag' symptoms associated with a single common cancer (e.g., 'blood in poo' and colorectal cancer), there is increasing interest in raising awareness of symptoms grouped by body area or system (eg 'abdominal symptoms'). Evidence regarding the frequency and nature of abdominal symptoms at presentation among a representative cancer patient cohort could inform the design and evaluation of community based cancer symptom awareness campaigns. Aim: To describe the frequency of abdominal symptoms at presentation among an incident cohort of cancer patients, examine variation in diagnostic timeliness and subsequently diagnosed cancer sites by abdominal symptom. Methods: The presenting symptom(s) of 15,956 cancer patients from a national audit of primary care records in England was coded into symptom categories. Eight abdominal symptoms with a range of predictive values and specificity for cancer were studied: abdominal pain, change in bowel habit, bloating/distension, dyspepsia, rectal bleeding, dysphagia, reflux, and nausea/vomiting. We investigated the prevalence of abdominal symptoms among the cancer patient population, examined variation in the length of the patient interval (time from symptom onset to presentation to primary care) and primary care interval (time from presentation to specialist referral) by symptom, and described the associated spectrum of diagnosed cancer sites for each individual symptom. Results: Almost a quarter (23%) of the incident cancer patient population had abdominal symptom(s) at presentation (n=3,661/15,956). The relative lengths of the patient and primary care intervals varied greatly by abdominal symptom. One in two cancer patients who had dysphagia before diagnosis presented 30 days after symptom onset (median (IQR) patient interval: 30 (10-61) days), but were referred immediately (median (IQR) primary care interval: 0 (0-14) days). In comparison, cancer patients who presented with abdominal pain had longer intervals postpresentation (median (IQR) patient interval: 7 (0-28) days, median (IQR) primary care interval: 16 (2-43) days). The majority (88.6%) of cancer patients who presented with an abdominal symptom were diagnosed with an abdominal or adjacent cancer, including colorectal, esophageal, ovarian, and pancreatic cancers. However, the remainder of patients were diagnosed with solid tumors of nonabdominal organ origin (7.6%) or a hematologic cancer (3.8%). Conclusion: Cancer symptom awareness campaigns focusing on abdominal symptoms could contribute to the earlier diagnosis of numerous common and rarer cancers. Evidence regarding the relative lengths of the patient and primary care intervals could be used as a measure of relative need for raising awareness.

Improving Cancer Outcomes for Vietnamese Speaking Migrants: A Mixed Methods Study

Background: Prompt diagnosis of symptomatic cancer has been shown to improve survival and quality of life. The time from noticing a bodily change and seeking medical help has been termed the 'symptom appraisal interval'. The processes people undertake during symptom appraisal are impacted by numerous factors, including culture. Aim: We aimed to explore culturally specific factors that impact symptom appraisal and help seeking for a cancer diagnosis in Vietnamese-speaking Australians and to develop a culturally relevant community-based symptom awareness campaign. Methods: We used a mixed methods approach to survey and interview people who had not experienced cancer and interviewed people with a recent diagnosis of cancer. We also tested campaign materials in focus groups and interviews with community members. Results: 28 people participated in the interview study and 65 completed surveys. We found poor symptom recognition and a prevailing Taoist or traditional Eastern model of health and illness. There was also a strong emphasis on being healthy for your family and fatalistic beliefs. Home remedies and Eastern medicine were commonly used for cancer symptom management and the people with cancer were shocked at their cancer diagnosis. Conclusion: The study findings were used to tailor a symptom awareness campaign for Vietnamese speaking communities to raise awareness of cancer symptoms and to prompt people to discuss symptoms with family and their general practitioner sooner to facilitate timely diagnosis and better outcomes.

Strengthening the Evidence Base of Cancer Symptom Awareness Campaigns: A Conceptual Framework

Background: Cancer control strategies in different countries increasingly encompass public health education campaigns that aim to promote earlier presentation and diagnosis of cancer by raising awareness of possible cancer symptoms. However, the theoretical understanding that underpins these complex early diagnosis interventions remains underdeveloped. Aim: To propose a theoretical framework to guide the design, implementation, and evaluation of cancer symptom awareness campaigns and motivate further relevant research. Methods: Informed by Wilson and Junger's principles of early disease detection for screening (1968) and existing conceptual frameworks for early diagnosis of cancer, we considered the logic model underlying cancer symptom awareness campaigns and relevant emerging evidence from disciplines including health psychology, cancer epidemiology, and health services research. Real-world examples across high-/low-income settings were used where possible to illustrate discussions of implications for practice. Results: We identified four major factors that contribute to the logic model of cancer symptom awareness campaigns beyond contextual and practical factors. Disease burden statistics (cancer site-specific incidence, survival, mortality) could be used to gauge relative need for raising awareness. This should be triangulated with symptom epidemiology (including existing levels of awareness, symptom prevalence, the associated predictive value for cancer, symptom-specific diagnostic timeliness, and whether the symptom is a sign of early stage disease) to motivate selection of individual symptoms in a campaign. Psychosocial factors (such as cancer fatalism or fear and health literacy) and their interaction with symptom awareness should also be considered as they affect symptom appraisal. Further, an understanding and awareness of system factors (availability and access to healthcare, investigation processes, and clinical capacity) will be important for assessing campaign feasibility and knock-on effects in the health system. Based on the above, campaigns should ideally target symptoms that are strongly predictive of early stage (treatable) cancer for which there is low awareness in the target population, and are associated with long intervals to help-seeking. Campaign impact should be amplified by targeting psychosocial barriers to prompt presentation. Additionally, campaigns should be accompanied by downstream capacity planning for potential cancer investigation and subsequent treatment. Conclusion: The proposed framework considers the logic model of cancer symptom awareness campaigns, acknowledging key factors that should be taken into account beyond contextual factors. This could help identify evidential gaps in early diagnosis research, and improve campaign design and evaluation.

Lung cancer stage-shift following a symptom awareness campaign

BackgroundLung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes.MethodsAn early...

The Improving Rural Cancer Outcomes Trial: a cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia

Background:Rural Australians have poorer survival for most common cancers, due partially to later diagnosis. Internationally, several initiatives to improve cancer outcomes have focused on earlier presentation to healthcare and timely diagnosis. We aimed to measure the effect of community-based symptom awareness and general practice-based educational interventions on the time to diagnosis in rural patients presenting with breast, prostate, colorectal or lung cancer in Western Australia.Methods:2 × 2 factorial cluster randomised controlled trial. Community Intervention: cancer symptom awareness campaign tailored for rural Australians. GP intervention: resource card with symptom risk assessment charts and local cancer referral pathways implemented through multiple academic detailing visits. Trial Area A received the community symptom awareness and Trial Area B acted as the community campaign control region. Within both Trial Areas general practices were randomised to the GP intervention or control. Primary outcome: total diagnostic interval (TDI).Results:1358 people with incident breast, prostate, colorectal or lung cancer were recruited. There were no significant differences in the median or ln mean TDI at either intervention level (community intervention vs control: median TDI 107.5 vs 92 days; ln mean difference 0.08 95% CI −0.06–0.23 P=0.27; GP intervention vs control: median TDI 97 vs 96.5 days; ln mean difference 0.004 95% CI −0.18–0.19 P=0.99). There were no significant differences in the TDI when analysed by factorial design, tumour group or sub-intervals of the TDI.Conclusions:This is the largest trial to test the effect of community campaign or GP interventions on timeliness of cancer diagnosis. We found no effect of either intervention. This may reflect limited dose of the interventions, or the limited duration of follow-up. Alternatively, these interventions do not have a measurable effect on time to cancer diagnosis.

Do comorbidities influence help-seeking for cancer alarm symptoms? A population-based survey in England.

BackgroundWe examined associations between different chronic morbidities and help-seeking for possible cancer symptoms.MethodsPostal survey of individuals aged >50 years in England. Participants could report prior morbidities in respect of 12 pre-defined conditions. Among patients experiencing possible cancer symptoms we examined associations between specific morbidities and self-reported help-seeking (i.e. contacted versus not contacted a GP) for each alarm symptom using regression analyses.ResultsAmong 2042 respondents (42% response rate), 936 (46%) recently experienced 1 of 14 possible cancer symptoms considered in our analysis. Of them, 80% reported one or more morbidities, most frequently hypertension/hypercholesterolemia (40%), osteomuscular (36%) and heart diseases (21%). After adjustment for socio-demographic characteristics, patients with hypertension/hypercholesterolemia were more likely to report help-seeking for possible cancer symptoms, such as unexplained cough (OR = 2.0; 95% confidence interval (CI) 1.1–3.5), pain (OR = 2.2; 95% CI 1.0–4.5) and abdominal bloating (OR = 2.3; 95% CI 1.1–4.8). Urinary morbidity was associated with increased help-seeking for abdominal bloating (OR = 5.4; 95% CI 1.2–23.7) or rectal bleeding (OR = 5.8; 95% CI 1.4–23.8). In contrast, heart problems reduced help-seeking for change in bowel habits (OR = 0.4; 95% CI 0.2–1.0).ConclusionsComorbidities are common and may facilitate help-seeking for possible cancer symptoms, but associations vary for specific symptom-comorbidity pairs. The findings can contribute to the design of future cancer symptom awareness campaigns.

Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis

IntroductionMost symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis. Atypical presentations (with symptoms other than breast lump) may be responsible. MethodsWe examined the presenting symptoms of breast cancer in women using data from a national audit initiative (n=2316). Symptoms were categorised topographically. We investigated variation in the length of the patient interval (time from symptom onset to presentation) and the primary care interval (time from presentation to specialist referral) across symptom groups using descriptive analyses and quantile regression. ResultsA total of 56 presenting symptoms were described: breast lump was the most frequent (83%) followed by non-lump breast symptoms, (e.g. nipple abnormalities (7%) and breast pain (6%)); and non-breast symptoms (e.g. back pain (1%) and weight loss (0.3%)).Greater proportions of women with ‘non-lump only’ and ‘both lump and non-lump’ symptoms waited 90days or longer before seeking help compared to those with ‘breast lump only’ (15% and 20% vs. 7% respectively). Quantile regression indicated that the differences in the patient interval persisted after adjusting for age and ethnicity, but there was little variation in primary care interval for the majority of women. ConclusionsAbout 1 in 6 women with breast cancer present with a large spectrum of symptoms other than breast lump. Women who present with non-lump breast symptoms tend to delay seeking help. Further emphasis of breast symptoms other than breast lump in symptom awareness campaigns is warranted.

Facilitating early diagnosis of lung cancer amongst primary care patients: The views of GPs.

Early diagnosis of lung cancer (LC) is a policy priority. However, symptoms are vague, associated with other morbidities, and frequently unrecognised by both patients and general practitioners (GPs). This qualitative study, part of a larger mixed methods study, explored GP views regarding the potential for early diagnosis of LC within primary care. Five focus group discussions (FGDs) were conducted with GPs (n = 16) at primary care practices (n = 5) across four counties in south England. FGDs were audio‐recorded, transcribed verbatim and analysed using a framework approach. Four broad themes emerged: patients’ reporting of symptoms; GP response to symptoms; investigating LC, and; potential initiatives for early diagnosis. GPs reported they often required high levels of suspicion to refer patients on to specialist respiratory consultations, and concerns of ‘system overload’ were prevalent. Greater access to more sensitive diagnostic investigations such as computed tomography, was argued for by some, particularly for symptomatic patients with negative chest X‐rays. GPs challenged current approaches to promoting earlier diagnosis through national symptom awareness campaigns, arguing instead that interventions targeted at high‐risk individuals might be more effective without burdening services already under pressure. Further work is needed to identify primary care patients who might most benefit from such targeted interventions.

The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: a study protocol.

IntroductionWhile overall survival for most common cancers in Australia is improving, the rural–urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA).Methods and analysisThe community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness.Ethics and disseminationEthics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA.ResultsResults of this trial will be reported in peer-reviewed publications and in conference presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12610000872033.

Impact of cancer symptom awareness campaigns on diagnostic testing and treatment

Impact of cancer symptom awareness campaigns on diagnostic testing and treatment

PTH-125 A New Lower Gastrointestinal 2-Week wait ‘Direct to Test’ Pathway Results in Earlier Diagnosis of Cancer

IntroductionAs part of the National Awareness and Early Diagnosis Initiative (NAEDI)1, a symptom awareness campaign for bowel cancer was piloted in the UK in 2010 and 2011. The results suggested...