Transcript Raising awareness of oesophageal cancer

Raising awareness of
oesophageal cancer:
The regional pilot
Professor S. Michael Griffin
Northern Oesophago-Gastric Cancer Unit
Newcastle upon Tyne
Colorectal adenocarcinoma
Stage 1
Stage 3
Oesophageal adenocarcinoma
Stage 1
Small cell lung cancer
Stage 3
Stage 1
Stage 3
Cancer (2010). Cancer of the esophagus and esophagogastric junction. Rice et al
How to improve outcomes?

Prevention

Earlier diagnosis

Centralisation of services

Patient selection/fitness

Surgical technique

Oncology

Critical care

Enhanced recovery
OESOPHAGO-GASTRIC (O-G)
CANCERS
 Around 12,900 people in England are diagnosed with
O-G cancers each year. This equates to 35 people per
day being diagnosed with these types of cancer
 People over 50 make up 95% of all diagnoses
 Over ¼ of all O-G cases present as an emergency
 In England, approximately 10,200 people die from O-G
cancers each year
 If these cancers are diagnosed at the earliest stage,
one-year relative survival is as high as 75-87%. At a late
stage, it drops to just 20-21%.
 More men than women are diagnosed with these
cancers, and die from the disease
Incidence data supplied by West Midlands KIT based on NCRS data.
Deaths data supplied by West Midlands KIT based on ONS data
OESOPHAGEAL
ADENOCARCINOMA
 Fastest increasing solid cancer in Western World1
 UK has highest incidence rate in Men in the World2
 NorthEast England and West Scotland highest
incidence in the UK
 Directly related to Obesity and Reflux
 Proven evidence that earlier diagnosis dramatically
improves cure rates to above 90%
 Early diagnosis of precancerous changes (Barretts
Oesophagus) can prevent disease
1 Dan Med J (2012). Barrett’s esophagus. Diagnosis, follow-up and treatment. Bremholm L et. al
2 Oesophagus (2014). Global incidence of oesophageal cancer by histological subtype in 2012. Arnold M et. al
“OESOPHAGOOSE”– born 2008
Oesophagoose - evaluation
•
•
1850 people questioned in street intercept surveys
39% had seen campaign material
Local Be Clear on Cancer
pilots - 2012
 Seven local pilots across England1
Pilot scheme areas
Control areas
Upper GI 2 week wait referrals
↑ 26%
↑ 16%
2 week wait oesophageal
cancer diagnosis
↑ 20%
↑ 3%
 Data from one pilot shows that during the
campaign there was a 17% statistically
significant increase in GP visits in the over 55s
compared with the same period in 20112
1 Be Clear on Cancer (2014). Evaluation summary. Available from http://www.cancerresearchuk.org/evaluation_results_2014.
2 Source: Mayden (IT healthcare specialist company)
Preparation for the regional Be Clear
on Cancer Pilot, Feb10-March 9 2014
• A national panel of experts, including clinicians and
patient group representatives, reviewed the data and
evidence to decide which symptoms to lead with.
 Which symptoms to target?
n=788
Heartburn/Indigestion
(No dysphagia)
Dysphagia
p (Chi2)
N0
21 (28.4%)
39 (7.7%)
< 0.0001
Stage 1-2
28 (37.8%)
54 (10.7%)
< 0.0001
M+
10 (13.6%)
120 (23.8%)
0.0476
Curative Intent
53 (71.6%)
248 (49%)
0.0003
Data provided by NOGU with a diagnosis of oesophageal cancer since January 2008
Regional pilot February 10-March 9 2014
- Northeast and Cumbria
Bus stop billboards
 Newspaper coverage
 Postal mailshot
 TV advert

Data source: TNS-BMRB
Regional Be Clear on Cancer pilot –
evaluation 2014
 87% exposure within the target audience
 13% awareness of advertising about
heartburn
 31% recall of heartburn in the pilot region
when asked about advertising on certain
symptoms
 Increase in prompted knowledge of
heartburn as a definite warning sign of OG
cancer
 11% pre-campaign vs 31% post-campaign
Data source: TNS-BMRB (a market research agency)
Impact on services follow the
regional Be Clear on Cancer pilot
2WW:
• Eight trusts in the regional pilot saw an increase in 2WW referrals over
the campaign period, particularly in March 2014
• Max average 15 extra 2WW referrals per week per trust. This reduced
in April 2014 to on average 7 extra 2WW per week per trust
•
A reduction in the percentage of people seen within the 14 day
window also decreased over this time, from 94% in Feb 2014, to 90% in
May 2014, with some recovery seen by July 2014 (92%)
•
No additional increase in 2WW referrals was observed in the trusts not
covered by the pilot, although a slight decrease in the percentage of
people seen within the 14 day window was observed (from a peak of
95% in Feb 2014, to a low of 92% in Jun 2014)
Data provided by Department of Health
Impact on services following the
regional Be Clear on Cancer pilot
Endoscopy:
• The average increase per week was 16 additional gastroscopies over
the course of the pilot (data used from Mar 2014 to Jul 2014)
• However the range across eight NHS trusts in the pilot areas went from
1 additional gastroscopy per week up to 23 additional gastroscopies
• Caveat… The region for the pilot has abnormally high activity at
baseline levels compared to the rest of the country, even outside the
campaign period
• Average waiting times in the pilot sites showed an increase from Feb
2014 to May 2014, with a slight decrease between Jun 2014 - Aug
2014
• Neither of these trends were observed in the trusts outside of the pilot.
Data provided by Department of Health
Things to consider…
 High risk patients:
• Deprivation: Incidence is higher in more socioeconomically
deprived areas for both oesophageal and stomach
cancers
• Smoking is the biggest lifestyle risk for oesophageal cancer,
accounting for nearly 7 out of 10 cases. It accounts for
nearly 1 out of 5 cases of stomach cancer
• Diet: Approximately 1 in 2 cases of oesophageal and 1 in 3
cases of stomach cancer are linked with consuming too
little fruit and vegetables over a long time
 The number of prescriptions for PPIs was around 50m in England
for the financial year 2013/14
 Women are 50% more likely than men to have seen their GP at
least 3 times before a referral is made for a suspected
oesophageal cancer
Data provided by NCIN from a range of sources, details can be provided
Epidemiological study showing increased
2ww referral patterns on resectability rates
 Appropriate, informed increase in 2ww referrals would be
expected to improve the rate of resectability
Gut (2014). Variation in gastroscopy rate in English general practice and outcome for oesophagogastric cancer: Retrospective analysis of
Hospital Episode Statistics. Shawihdi et al
Towards improved
awareness and
early treatment
Summary
 Upper GI cancer awareness campaigns can lead to

Improved disease awareness and understanding

Manageable increase in referrals

Increased rates of cancer diagnosis
 Longer term evaluation awaited