awareness campaigns for oesophageal & gastric cancer d. perren, j. shenfine, s. m. griffin...

Awareness Campaigns for Oesophageal & Gastric Cancer

D. Perren, J. Shenfine, S. M. GriffinNorthern Oesophago-Gastric Cancer Unit

Newcastle upon Tyne

UK 5th Most Common Cause Cancer Death in 2010

UK Oesophagogastric Cancer Statistics

Oesophageal Cancer Incidence

Gastric Cancer Incidence

Improving Outcomes

Patient selection/fitness

Critical care & enhanced recovery

Centralisation of services

Surgical technique

Oncology

Earlier diagnosis

Prevention

Prevention Smoking

Alcohol

Diet

Obesity

Genetics

Screening Barrett’s Achalasia

Early Diagnosis

Earlier diagnosis has the potential to

improve outcomes to a far greater extent

than any surgical or oncological measures

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

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

Oesophagoose

Public Awareness Campaigns:Oesophagoose

Face-to-face interactions

Advertising Public transport Hospitals Health clubs Pubs

Media Television Radio Newspapers

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?

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

OesophagooseAwareness Campaign 2009-2012

May / June 2012

Questionnaire

359 responses over two weeks

Repeat of previous audit; allowing comparison

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)

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)

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

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

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

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

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

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

Comments on Questionnaires

Terminology important Level of information on posters Answers to questions based on general health

knowledge Other health campaigns influence responses

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