Transcript Bowel Cancer Symptoms - Cheshire & Merseyside Strategic Clinical

Maureen Sayer
Health Improvement Practitioner
Cheshire and Merseyside Bowel
Cancer Screening Programme
Bowel Cancer
Aims
• To Identify and discuss the early signs of
Bowel cancer
• To give an overview of the Bowel Cancer
Screening Programme
Bowel Cancer Symptoms
• Symptoms lasting 4-6 weeks need to be
investigated
• Any clients with symptoms should be
encouraged to see their GP
Bowel Cancer Symptoms
• Bleeding from the Rectum ( Back
passage)
Bright Red or Dark Black blood
Found in or on Bowel Motion ,toilet paper or toilet
bowel
• Tiredness
Caused by blood loss
Needs investigating
Bowel Cancer Symptoms
• Change of Bowel Habit
Change from your normal pattern
Constipation
Decreased Bowel Motions
Diarrhoea
More frequent Bowel Motions
May alternate
Bowel Cancer Symptoms
• Abdominal or Rectal Pain
• Abdominal Lump
Needs Investigating
Bowel Cancer Symptoms
• Nausea ( feeling Sick)
• Unexplained loss of appetite
• Unplanned Weight Loss
Bowel Cancer Screening Programme
Cheshire and Merseyside NHS North West
Bowel Cancer Screening Programme
• FOB testing will be offered to all men &
women aged 60-69 - 2 yearly.
• 70+ can request to join the BCSP but
have to contact Regional Hub at Rugby
on the
free phone 0800 707 60 60
• Age Extension up to 75 in 2010
Public Health Perspective
• Bowel Cancer is the third most
common cancer in the UK
• Approximately 34,900 new cases p.a
• It is is the second largest cause of
cancer deaths in the UK (Cancer Research UK,
2005. Cancerstats).
Public Health Perspective
• In 2004 approximately 16,100 people
died from bowel cancer in the UK, 737
deaths within Cheshire & Merseyside
• Life time risk of developing Bowel
Cancer in the UK is about 1:18 for men
and 1:20 for women
Who is at risk of developing bowel
cancer?
• Both men and women
• People who– Take little exercise
– Are overweight
– Have a diet high in red meat and
low in vegetables, fruits and fibre
Who is at risk of developing bowel
cancer? (continued)
• People with a family history (CRC
•
•
Relatives)
Inflammatory Bowel Disease
Genetics– Familial Adenomatous Polyposis
(FAP)about 1% of cases
– Hereditary Non-Polyposis Colorectal
Cancer (HNPCC) about 2-5% of cases
Mental Health and Learning
Disabilities
• Schizophrenia
Recent research shows that people with this
condition are at increased risk of developing
bowel cancer
• Learning Disabilities
Increased risk is linked to obesity, poor diet,
lack of physical activity ,exclusion from
screening programmes. Mortality is linked to
late presentation of symptoms.
Who is at risk of developing bowel
cancer? (continued)
• The risk of developing bowel cancer
increases with age.
• About 80% of people who get Bowel
cancer are aged 60 and over
Bowel Cancer Screening Pilot
• In 2000 the Bowel Cancer screening Pilot
began in Scotland (Dundee) and England
(Rugby)
• Evidence from pilot studies showed that
early detection through regular Bowel
Cancer Screening has a significant impact
upon overall survival rates
• BCSP can reduce mortality (deaths) by
16% in the population invited for
screening
Health Inequalities of the BCSP
Pilot
• Men were less likely to participate in FOBt
• Lower uptake in deprived areas.
• Poor uptake in Black and Ethnic Minority
groups particularly Muslims.
• Ethnic groups more likely to DNA before
colonoscopy.
Health Inequalities of the BCSP
• Other groups who may experience
inequalities
–
–
–
–
–
–
–
–
–
Learning disabilities/ difficulties
Blind and Visual impairment
Deaf
People with mobility problems
Illiterate
Mental illness
Travellers
Homeless
Prison population
Responsibility for the BCSP
• Cheshire & Merseyside NHS North
West have the lead responsibility for
BCSP initially. Thereafter PCT’s will
commission the programme.
Agreed Model
• Operationally driven and managed by 1
host Trust.( Aintree) This is the local
BCSP administration centre.
• Endoscopy nurse-led screening
assessment clinics (community)
SHA BCSP Statistics
• Screening population 327,683
• Assume 60% uptake based on pilot figures =
•
•
196,610 of which,
Approximate 2% will have a positive FOBt = 3,932
of which,
11% of FOBt positive patients will have cancer
=433.
• 35% will have polyps requiring surveillance =1376
Proposed organisation
Overarching Structure:
• 5 Programme Hubs across
England, based on IT Local
Service Providers (LSP)
undertaking call/recall and lab
functions
HUB
HUB
HUB
HUB
HUB
• 1 Programme Hub for approx 20
screening centres
Role of HUB
•
•
•
•
•
•
To Manage call and recall for the screening
programme
To provide a telephone help line for people
invited for screening
To dispatch and process test kits
Send results letters to participants and notify
GP
Book the first appointment at a nurse led clinic
for patients with an abnormal test result
Coordinate Quality assurance activities
Model in brief
• Invitation letter is sent to participant
from Rugby dispatch centre (HUB).
• Participants can opt out of the BCSP
by contacting Rugby on the free
phone 0800 707 60 60.
National Hub
• National hub send invitation to
screening letter
• One week later an FOB screening kit
which includes leaflets, sample sticks
and a foil lined envelope are dispatched
Faecal Occult Blood Testing Kit
• Participants smear the stool sample onto the
2 Squares in the 1st flap indicated on the kit.
This is repeated on 2 further days until all 6
Squares are completed
• Completed kit is returned by post to Rugby
within 2 weeks of the 1st sample being
smeared on the kit (foil-lined envelope
supplied)
Results
Negative result
Unclear Result (1-4 of the squares are
positive)
Spoilt Kit
Technical Failure
Positive ( abnormal) Result
Screening Centres
•They will provide nurse led clinics for patients with
an abnormal test result
•Arrange colonoscopy appointments for patients with
an abnormal test result
•Arrange alternative appointments for patients in
whom colonoscopy has failed
•Ensure appropriate follow-up or treatment for
patients after colonoscopy
Screening Centres
•Provide information about the screening
programme for the local health community
•Promote the screening programme to the
general public in their locality
•Provide information and support for local people
in completing the FOB test(on referral from the
programme hub
Screening Journey
• Appointment arranged at Endoscopy
Nurse screening assessment clinic if the
FOBt is positive. The participant will
receive:
• Counselling
• A health questionnaire
• Information
• Consent
• Preparation for the procedure
• Bowel Cancer Screening-The
colonoscopy Investigation (leaflet)
Screening journey (Continued)
• Referred to screening provider unit for
colonoscopy
• Follow-up dependant on procedure results
– Normal, sent a BCSP kit in 2 years
– Polyps, surveillance by BCSP
– Cancer detected cases referred to local
Multi Disciplinary Team (local Cancer
Team)
Sensory Impairment Research
• Cheshire & Merseyside commissioned by
•
•
•
•
National office
Aims to explore the sensory impaired
people’s understanding of the process
Identify actual or perceived difficulties
Identify coping strategies to help them
participate
Qualitative study; made use of focus
groups and interviews
Sensory Impairment Research
– Findings
• Engage support organisations to ensure
•
•
•
•
•
wider spread of information
Training ambassadors within deaf
community
Establish text phone and email helpline
Target isolated individuals
Easy to use language in leaflets
More pictures in leaflets
Sensory Impairment Research
– Findings
• Consider new design of FOBt kit
• Send sampling pots with FOBt kit
Sensory Impairment Research
– Next Steps
• Make public the research report
• National office to review findings
• New strategies to be tested out in a followon project
Contact Details
• Maureen Sayer
Health Improvement Practitioner
[email protected]
0151 529 3035