awareness campaigns for oesophageal & gastric cancer d. perren, j. shenfine, s. m. griffin...
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Awareness Campaigns for Oesophageal & Gastric Cancer
D. Perren, J. Shenfine, S. M. GriffinNorthern Oesophago-Gastric Cancer Unit
Newcastle upon Tyne
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UK 5th Most Common Cause Cancer Death in 2010
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UK Oesophagogastric Cancer Statistics
Oesophageal Cancer Incidence
Gastric Cancer Incidence
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Improving Outcomes
Patient selection/fitness
Critical care & enhanced recovery
Centralisation of services
Surgical technique
Oncology
Earlier diagnosis
Prevention
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Prevention Smoking
Alcohol
Diet
Obesity
Genetics
Screening Barrett’s Achalasia
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Early Diagnosis
Earlier diagnosis has the potential to
improve outcomes to a far greater extent
than any surgical or oncological measures
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Open Access Endoscopy OG cancer
n=123 patients
85% had alarm symptoms
15% would have been ‘missed’ by guidelines Earlier stage i.e. curable cases
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Why Have an Awareness Campaign?
Patients continue to present with advanced disease
80% of delay is in people presenting to their GP
Public education is therefore the next crucial step
Highlights oesophago-gastric cancer as an important health issue
To bring health professionals together as a team across regions
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Oesophagoose
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Public Awareness Campaigns:Oesophagoose
Face-to-face interactions
Advertising Public transport Hospitals Health clubs Pubs
Media Television Radio Newspapers
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Concerns about the Awareness Campaigns
Vague symptoms in early disease
Common symptoms
Who to target
Unnecessary worry
Increased workload for GPs
Increased referrals to endoscopy
Value for money?
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Conclusions: OesophagooseAwareness Campaign 2009
Baseline knowledge is poor Just over 50% knew what the oesophagus is Knowledge levels were highest amongst people
who had seen the campaign Metro posters were most recognised aspect of
campaign Modest but manageable increase in endoscopy
referrals Discernable impact on presentation to GPs
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OesophagooseAwareness Campaign 2009-2012
May / June 2012
Questionnaire
359 responses over two weeks
Repeat of previous audit; allowing comparison
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Oesophagoose 2012
<44 45-59 >600.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
23.7%20.9%
55.4%
Participant Demographics (Age)
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Oesophagoose 2012
Male Female0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
41.8%
58.2%
Participant Demographics (Sex)
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Oesophagoose 2012
TV/Radio Metro Newspaper Bus Hospital/GP Taxi Beermat0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
20.9%
12.0%
5.8%4.5%
1.7%0.3% 0.3%
Campaign Visibility
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Oesophagoose 2012
Locate Oe-sophagus (p=0.02)
Dysphagia (p=0.0919)
Weight Loss (p=0.7799)
Indigestion (p=0.0054)
Longstanding Cough (p=1)
Coughing Up Blood (p=0.616)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Increasing Awareness: Symptoms (Correct Answers)
Not Seen Campaign Seen Campaign
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Oesophagoose 2012
Smoking (p=0.6383)
Alcohol (p=0.0237) Being Overweight (p=0.0142)
Indigestion (p=0.0095)
Low Fibre Diet (p=0.4484)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Increasing Awareness: Risk Factors (Correct Answers)
Not Seen Campaign Seen Campaign
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Oesophagoose 2012
70 Year Old, Dysphagia (p=0.023)
55 Year Old, Heartburn (p=0.0746)
29 Year Old, Heartburn (p=0.0808)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Increasing Awareness: Cases (would refer)
Not Seen Campaign Seen Campaign
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Oesophagoose 2012
Dysphagia (p=<0.0001) Losing Weight / Appetite (p=0.0019)
Indigestion (p=<0.001) Longstanding Cough (p=0.5025)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
76.2%72.3%
51.3%
32.6%
88.3%
81.6%
67.4%
30.4%
4y Change: Symptom Recognition (Correct Answers)
Pre 2009 Campaign Post 2012 Campaign
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Oesophagoose 2012
Being Overweight (p=<0.001) Indigestion or Reflux (p=<0.001) Low Fibre Diet (p=<0.001)0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
56.2%58.5%
34.8%
68.5% 69.6%
46.5%
4y Change: Risk Factors (Correct Answers)
Pre 2009 Campaign Post 2012 Campaign
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Comments on Questionnaires
Terminology important Level of information on posters Answers to questions based on general health
knowledge Other health campaigns influence responses
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Conclusions Modest but manageable increase in endoscopy referrals (2009
data)
Discernible impact on presentation to GPs (2009 data)
Knowledge levels were highest amongst people who had seen the
campaign
Symptom and risk factor recognition has improved after 4 years of
campaigns
TV/radio and the Metro were most recognised aspect of campaign
in 2012