Rachel Rowlands17th May 2013

2012 Be Clear on Cancer campaign

Aims of the study Methodology Results Conclusions Limitations Recommendations

The DoH aims that by 2014/15 an additional 5000 lives are saved/annum due to cancer care improvements

6/52 national Be Clear on Cancer campaign launched Jan 2012:◦ Raise public awareness of two red flag symptoms

Bloody stools And/or loose stools for three weeks

Earlier presentation and Dx at earlier pathological stage, ↑ 5-yr survival

Fewer complications due to ↓ emergency surgery

Compare ‘standard’ pre-campaign (2011)cohort with a post campaign cohort (2012) for:

Adjusted Dukes’ stage

Intent of first treatment

The proportion of urgent/emergent surgeries

Pre-campaign 2011 cohort: n=155 Post-campaign 2012 cohort: n=125

Case ascertainment; prospectively maintained database of known colorectal cancers within Northumbria TrustSJM

Data collected: Patient age; date of Dx; date and intent first definitive treatment; type and urgency of operation; CT, MRI and histology reports

Radiology and pathology reports interpreted and cross referenced with database information

Adjusted Dukes’ Stagen=279 (1 exclusion)◦ 4 patients R0 at polypectomy◦ Dukes NoS = no metastases, no resection

8/155 patients 2011 cohort 8/124 patients 2012 cohort

◦ Discussion over metastatic status 2011 cohort

16/155 no metastases 10/155 metastases

2012 cohort 10/124 no metastases 8/124 metastases

Adjusted Dukes’ Stage

Intent of First Treatment

Intent of First

Treatment2011 Cohort 2012 Cohort

No. Patients

% Patients No. Patients

% Patients

Definitive 125 87.1 106 84.8

Palliative 17 11 19 15.2

Unknown 2 1.93 0 0

Total 155 125

Urgency of Formal Resection

10.7%

89.3% 87.2%

12.8%

2011 Cohort 2012 Cohort

Post Campaign cohort:

1. Greater proportion of patients presented as Dukes’ A (24.2%) and Dukes’ B (28.2%)

2. But..also an increase in Duke’s D (18.6%)

3. Fewer patients had definitive treatment

4. Fewer formal resections

5. Higher rate (2.1%) urgent surgery

Dukes’ A and B◦ More vigilant patients?

Raising awareness too late?◦ Long term symptoms advice too late i.e. Dukes’

D

Dukes’ D is a late presentation◦ MORE palliative◦ MORE complications emergency surgery

Inter-observer variability on scan and histology reports

Equivocal language on scans when defining metastases vs. no metastases

Missing patient data: ◦ Tertiary referral◦ Poor scan quality◦ Incidental finding at colonoscopy so no pre-

imaging

Re-audit following the national 2013 campaign

Encourage patients to seek advice on first notice of symptoms

Raise awareness of survival rates

Cancer Research UK. Cancer mortality for common cancers. [Online] 03 November 2011. http://www.cancerresearchuk.org/cancer-info/cancerstats/mortality/cancer/deaths/uk-cancer-mortality-statistics-for-common-cancers

Department of Health. Government launches its first ever national bowel cancer campaign. [Online] 30 January 2012. http://www.dh.gov.uk/health/2012/01/bowel-cancer-campaign/.

Improving Outcomes: A Strategy for Cancer. s.l. : Department of Health, 2011.

Miss Sarah Mills Mr Mike Bradburn Michele Waimsley-Tonks