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The Effect of the ‘Be Clear on Cancer’ Campaign on Stage at Presentation of Colorectal Cancer. Rachel Rowlands 17 th May 2013. What will be covered. 2012 Be Clear on Cancer campaign Aims of the study Methodology Results Conclusions Limitations Recommendations. - PowerPoint PPT Presentation
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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