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