DETECT CANCER EARLY

BRIEFING PACK

CONTENTS

PAGE 3 - PROGRAMME OVERVIEW PAGE 4 - SOCIAL MARKETING CAMPAIGN OVERVIEW PAGE 7 - MARKETING ACTIVITY PAGE 8 - FIELD MARKETING JOURNEY PLAN PROPOSALPAGE 10 - ANTICIPATED OUTCOMES PAGE 11 - HOW YOU CAN HELP WITH THE CAMPAIGN PAGE 12 - GET IN TOUCH

APPENDICESAPPENDIX 1 - LETTER FROM CMOAPPENDIX 2 - HEADLINE STATSAPPENDIX 3 - KEY FACTS ABOUT CANCERAPPENIX 4 - USEFUL LINKSAPPENDIX 5 - FAQSAPPENDIX 6 - EVIDENCEAPPENDIX 7 - MATERIAL FOR INTERNAL COMMUNICATION CHANNELSAPPENDIX 8 - TOOLKIT

DETECT CANCER EARLYPROGRAMME OVERVIEW

Cancer survival is a key measure of the effectiveness of health care systems and survival rates will remain a key indicator of progress. In an effort to improve Scotland’s five year survival rates relative to the best performing coun-tries in Europe and the world, the Scottish Government has embarked upon a ‘Detect Cancer Early’ Programme. This is because much of the survival deficit is due to differences in survival at year one, suggesting that late pres-entation and advanced disease at diagnosis are responsible.

The Cabinet Secretary launched a stakeholder engagement period following publication of the draft Implementation Plan on 01 August 2011 and in the five months since then much progress has been made to facilitate and prepare for the programme of high profile social marketing campaigns and the impact that these are anticipated to have on the NHS.

THE DETECT CANCER EARLY PROGRAMME HAS FOUR MAIN WORK STREAMS:

PUBLIC AWARENESS AND BEHAVIOUR INFLUENCINGConsiderable insight gathering and research has informed a programme of social marketing campaigns. The first phase of these will be an overarching empowerment campaign to raise awareness of the benefits of early detec-tion. This aims to tackle fear and apprehension about seeing a doctor and to reaffirm that treatment and survival has improved in the last 30 years. This activity will be followed by a series of tumour specific campaigns to raise awareness of the symptoms and signs that could indicate cancer and that should prompt help seeking behaviour.

PRIMARY CAREThere are several elements to this work. This will include urgent cancer suspected referral profiling, ‘Think cancer’ education and training, cancer risk assessment – guidance and tools for referral and investigation, refresh of the Scottish Referral Guidelines for Suspected Cancer, exploring open access to investigations and the development of practice profiles that will enable practices to compare data and performance with peers. SCREENING AND DIAGNOSTIC CAPACITYSignificant expansion of diagnostic capacity will be required and will be funded. This will allow current performance against the 62 and 31 day cancer waiting times standards to be maintained in anticipation of the increase in num-bers of those people requiring investigation. Work will be taken forward to improve uptake of the national cancer screening programmes using informed consent as the basis.

DATA COLLATION AND PUBLICATIONBetter and more timely recording of staging data by NHS Boards will be encouraged that will facilitate up-to-date monitoring of progress against the programme aims and objectives including NHS Board achievement of the HEAT target associated with the programme.

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SOCIAL MARKETING OVERVIEW BackgroundThe number of people diagnosed with cancer is projected to rise to around 35,000 per annum between 2016 - 2010 (compared to around 30,000 a year between 2006-2010). This reflects the impact of Scotland’s ageing population as well as improvements in diagnosis.1

Over recent years, positive progress has been made in reducing cancer waiting times. However, too often in Scot-land, cancers are not detected early enough and late detection means poorer survival rates.

Scotland lags behind the European average for five-year survival rates from all types of cancer.2

The SNP manifesto included a commitment to increasing the number of cancers detected at the first stage of the disease by 25 per cent - with an initial emphasis on lung cancer, breast cancer and colorectal cancer. If successful, this initiative could save an additional 300 lives a year by the end of 2016.

NHS Scotland has been tasked with improving survival outcomes for people with cancer to amongst the best in Europe, managing the expected increase in incidence with limited increase in resource and continuing to improve patient and carer experience.

One way of achieving this is through earlier diagnosis. Earlier diagnosis means simpler, less expensive and less toxic treatments given. There are also fewer recurrences and longer-term wider benefits for society. The key phrase is ‘the earlier the better’: cancers which present at an advanced stage and are less amenable to treatment, have poorer survival outcomes.

Breast, colorectal (bowel) and lung cancer accounts for about half of the avoidable deaths. This is because diag-nosis is being made when tumours are at a stage when life-saving (usually surgical) treatment can’t contain the cancer’s impact and spread.3

THE SOCIAL MARKETING ISSUE:

THERE ARE THREE MAIN BEHAVIOUR CHANGES REQUIRED AS PART OF THIS CAMPAIGN:

• Maximising informed consent to participate in the national bowel and breast screening programmes

• Enabling people to look out for and recognise potential early signs and symptoms of cancer

• Encouraging people to act on these signs and symptoms as early as possible by visiting their GP

1. Better Cancer Care, An Action Plan. http://www.scotland.gov.uk/Publications/2008/10/24140351/32. http://www.scotland.gov.uk/Resource/Doc/924/0119872.pdf3. Further information can be found: http://cancerhelp.cancerresearchuk.org/type/ http://www.kingsfund.org.uk/publications/cancer_survival.html

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LEARNINGS FROM RESEARCH:

Qualitative research was conducted in late 2011 with the main target audience, as well as with cancer patients, survivors and health professionals in Scotland. This suggested that the ‘early detection of cancer’ message makes sense to most people on a rational level, although it doesn’t always translate into reality.

The word ‘cancer’ can prompt a negative and irrational emotional response, which is referred to as an ‘affect heuristic’, where people have a strong emotional response to a word or concept, that alters a person’s judgment.

The reasons for this are often complex, involving factors such as people’s current health, lifestage, emotional out-look, experience of cancer within their friends and family and attitudes and experiences around the health service.

However, three over-arching barriers to action were identified which often overlap:

• Fear of facing up to cancer

• Lack of knowledge of relevant signs and symptoms

• Concern over wasting GPs’ time

In addition, specific barriers exist in relation to lung, breast and bowel cancer, which will require targeted messaging to overcome them.

This research suggested that symptoms-based messages might be more effective if the other barriers (fear of cancer and of wasting GP time) could be addressed first.

In addition, consultation was conducted with a range of health professionals, including cancer consultants, screen-ing nurses, and public health consultants. This suggested:

• Support for the initiative’s aims from health professionals

• A pragmatic view that while a campaign will potentially increase patient numbers and resource uptake, this has been dealt with in the past (eg. the Jade Goody effect) and so ought to be manageable

STRATEGIC MARKETING RECOMMENDATION

As a result of the qualitative research, a number of key decisions were made about the implementation of the social marketing campaign.

• The public campaign would launch in its first phase with communications designed to allay people’s generalised fears about cancer and encourage them to see their GP with possible early signs and symptoms

• This would be followed by the first of three cancer-specific and symptoms-based adverts (around breast cancer). Campaigns around bowel cancer and lung cancer would then follow later in 2012

4. Men and women 45-74, C2DE, with possible lifestyle risk factors for cancer. More details available from the Leith Agency.

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CREATIVE IDEA FOR LAUNCH

A number of creative ideas were developed to support the launch of the campaign. These were researched, independently, with the target audience and sense-checked with health professionals.

One creative route, known as “Doctor” showed signifi-cant and universal potential to fulfil the objectives of this campaign stage.

In the TV advert, a woman talks about why cancer can feel so frightening, before going on to explain how many more people survive cancer these days and the value of early detection. At the start of the ad, the woman ap-pears to be a mother dropping her children to school and we’re led to think she may have cancer, before it is re-vealed that she is actually a GP.

Research showed this idea:

• Clearly communicated the value of early cancer detection

• Communicated beneficial positive news about cancer treatment and survival

• Reassured people that GPs want to see people with possible signs and symptoms of cancer

• ‘Normalised’ the role of the GP

The research concluded:

“ITS STRONG UNIVERSAL APPEAL IS WELL SUPPORTED BY CLEAR AND DIRECT MESSAGING AND A POWERFUL CALL TO ACTION”.

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MARKETING ACTIVITYA six-week marketing campaign will commence from 20 February 2012 comprising television, radio, outdoor, digital and field marketing activity, running alongside a public relations programme.

All marketing executions will use the strapline: Cancer. Don’t get scared. Get checked.

The www.nhsinform.co.uk website will be visible alongside the NHS Scotland logo and Healthier Scotland logo.

MASS MARKET ACTIVITY

A 40-second television advert will be broadcast on Scottish Television, Channel 4 Scotland, Channel Five Scotland and also on ITV breakfast in Scotland only.

Our television activity will target people in Scotland who are 45 years plus, within a socio demographic of C1, C2, DE. We will also run ten second commercials where possible to reinforce the campaign call to action - Don’t get scared. Get checked.

30-second radio adverts featuring real doctors give the campaign extra depth and credibility. The adverts capture the empathy that doctors and GPs have with people’s fears around cancer and will encourage the public to make an appointment with them straight away, to get any signs and symptoms checked out, no matter how slight.

Commercial radio stations include: Central FM, Kingdom FM, Real Radio Scotland, Smooth Radio Glasgow, Radio Borders, West Sound, Moray Firth Radio, Radio Forth, Radio Tay, Northsound and Radio Clyde.

Community radio stations include: Argyll FM, Caithness FM, Cuillin FM, Heartland FM, Isles FM, Leith FM, Loch-broom, Nevis, Oban, SIBC, Sunny Govan Radio, Superstation Orkney, Two Lochs Radio, Waves Radio and Your Radio.

Vinyl panels and posters will also be on display in washrooms in community centres, libraries, pharmacies and GP and dental surgeries in both rural and deprived areas across Scotland. The posters will signpost people to the NHS Inform website.

There will also be pay per click adverts on digital online channels and a fully exploited social media campaign.

FIELD MARKETING

To support the advertising and PR activity, the message will be taken directly to audiences via a field marketing tour of shopping centres and supermarkets across Scotland. This will visit over 40 locations and take place from 29 February to 17 March across the majority of NHS board areas.

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WEST TEAM

Ayrshire And Arran Irvine 29-FebAyrshire And Arran Kilmarnock 01-MarAyrshire And Arran Ayr 02-MarDumfries And Galloway Dumfries 03-MarDumfries And Galloway Dumfries 04-MarDumfries And Galloway Stranraer 05-MarLanarkshire East Kilbride 08-MarLanarkshire East Kilbride 09-MarLanarkshire Hamilton 10-MarLanarkshire Cumbernauld 11-MarLanarkshire Coatbridge 14-MarGreater Glasgow And Clyde Anniesland 15-MarGreater Glasgow And Clyde Cathcart 16-MarGreater Glasgow And Clyde Govan 17-MarGreater Glasgow And Clyde City Centre / Kelvin 18-MarGreater Glasgow And Clyde City Centre / Kelvin 21-MarGreater Glasgow And Clyde City Centre / Kelvin 22-MarGreater Glasgow And Clyde Maryhill 23-MarGreater Glasgow And Clyde Pollock 24-MarGreater Glasgow And Clyde Rutherglen 25-MarGreater Glasgow And Clyde Shettleston 27-MarGreater Glasgow And Clyde Clydebank 28-MarGreater Glasgow And Clyde Dumbarton 29-MarGreater Glasgow And Clyde Greenock 30-MarHighland Helensburgh 31-Mar

EAST TEAM

Fife Dumfermline 29-FebFife Dunfermline 01-MarFife Glenrothes 02-MarFife Kirkcaldy 03-MarFife Kirkcaldy 04-MarForth Valley Falkirk 07-MarForth Valley Falkirk 08-MarForth Valley Stirling 09-MarForth Valley Stirling 10-MarForth Valley Alloa 11-MarLothian Livingston 13-MarLothian Livingston 14-MarLothian Edinburgh City Centre 15-MarLothian Edinburgh City Centre 16-MarLothian Edinburgh North (Leith) 17-MarLothian Edinburgh South (Cameron Toll) 20-MarLothian Edinburgh West (Gyle) 21-MarLothian Edinburgh East (Musselburgh) 22-MarLothian East Lothian (Haddington) 23-MarBorders Peebles 24-MarBorders Hawick 26-MarBorders Hawick 27-MarBorders Galasheils 28-MarBorders Galasheils 29-MarTayside Perth 30-MarTayside Perth 31-Mar

NORTH TEAM

Tayside Dundee 01-MarTayside Dundee 02-MarTayside Arbroath 03-MarGrampian Aberdeen 06-MarGrampian Aberdeen 07-MarGrampian Aberdeen 08-MarGrampian Aberdeen 09-MarGrampian Peterhead 10-MarGrampian Elgin 13-MarGrampian Elgin 14-MarHighland Inverness 15-MarHighland Inverness 16-MarHighland Inverness 17-Mar

The dates above are indicative at this stage. A finalised journey plan will be issued on the 15th February 8

FIELD MARKETING JOURNEY PLAN PROPOSAL

PR ACTIVITY

There will be an on-going rolling PR programme focusing around media relations, events, social media activity and creative pro-motions.

The PR and marketing programme will kick off with a national launch on Monday 20 February 2012 when the Scottish Cabinet Secretary, Nicola Sturgeon will formally launch the campaign to the media.

Press releases will be issued to NHS boards for press office teams to promote the campaign within their own internal com-munications channels or to tailor for local media.

A range of features will be seeded into national, regional and local media, using case studies, support from cancer charities and health experts.

Consolidated PR will be in contact with local NHS boards and charities for help to source local case studies, professional ex-perts and on the ground support for any local events.

In addition, there are a number of paid-for media platforms planned, including feature items on Real Radio and Bauer Ra-dio stations. Similarly, the PR agency may be in contact with stakeholders for support with these.

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DETECT CANCER EARLY PROGRAMME

ANTICIPATED OUTCOMES• Social marketing campaigns have been thoroughly researched and are designed to have an impact where

the need is greatest. Although field work will be less visible than TV adverts, this is an important element of the overall strategy. The social marketing campaign has in-built ongoing measures of effectiveness - proven methods of evaluation used for other health campaigns are being adapted for use with the Detect Cancer Early work.

• Funding is being made available from the programme to support academic research into the impact of various components of the programme.

• NHS Boards will be monitored on their performance against the HEAT target associated with the programme and this will be published on an annual basis. NHS Boards will be expected, by end December 2015, to achieve a 25% increase over the baseline proportion of those diagnosed and treated in the first stage of cancer (for the three types combined: breast, colorectal and lung).

• It is difficult to predict the impact the first phase of the programme will have on workloads. There is no targeting

of specific symptoms in phase one and therefore this social marketing is innovative. Consequently there are no UK pilots on which to base estimates of impact, nor have literature searches demonstrated that any workload implications have been studied.

• Results from regional pilots of the NAEDI colorectal specific social marketing campaigns indicate an additional one patient seen per average practice. The impact on workload on primary care will be monitored throughout the programme using the PTI practice system. A public awareness programme (targeting colorectal and oral cancers) was conducted in the West of Scotland in 2006 and used high profile media campaigns. The results from the evaluation indicated that the impact on primary care workload was negligible but that additional capac-ity was required in secondary care.

• The NAEDI work in England has resulted in an additional one or two colonoscopy lists per week being required, depending on Trust size. This data is not absolutely transferrable to the Scotland as colonoscopy rates per head of population in Scotland are already considerably higher than in England, however the round of visits to NHS Boards is being used to highlight the need for early capacity planning particularly for colonoscopy. Measures of workload impact will be explored to estimate the effect on diagnostic services in secondary care.

• It will be a number of years before an improvement in five year survival (which is influenced by factors ad-ditional to the Detect Cancer Early Programme) is evident but it will be possible to obtain a proxy estimate of impact by monitoring changes in one year survival rates.

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HOW YOU CAN HELP WITH THE CAMPAIGN

If you work in healthcare, or if you’re a clinician, or if you work in some form of support for cancer patients, you can help by:

• Talking to your patients about the campaign and communicating some of the key messages to help us to break the stigma associated with talking about cancer

• Display the posters and leaflets provided for GP surgeries

• Ensure that information on the benefits and risks is readily available to allow people to make informed choices about participating in the national cancer screening programmes

• Support the Detect Cancer Early field marketing tour when it comes to your local area. We’ll be supporting these tours with articles in regional media titles and we may need help from local health experts

• Provide our PR agency with case studies of cancer survivors or comment that can be used in local media titles to help us raise awareness of the topic

• Promote the Detect Cancer Early campaign within your organisation. We can provide logos and images for leaflets, publications and the web. We also have template material that can be used across intranets, internal newsletters and social media channels such as Facebook or Twitter

• Signpost people to NHS Inform on www.nhsinform.co.uk or 0800 22 44 88 for more information about cancer and the signs and symptoms

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GET IN TOUCH

If you want to find out more about the Detect Cancer Early campaign, get hold of campaign images or discuss PR or field marketing activity, get in touch with Consolidated PR.

They can provide fact sheets, photography, campaign images, advertising executions and information packs about the campaign.

CONTACT:

Carolynne Coole or Nicola ArmstrongConsolidated PRHobart House80 Hanover StreetEdinburghEH2 1EL0131 240 6420Email: Scotland@consolidatedpr.com

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APPENDICES

CMO LETTERChief Executives, NHS BoardsCHP ManagersMedical Directors, NHS BoardGeneral PractitionersConsultant PhysiciansNursing Directors, NHS Board and Special Health BoardsPractice NursesChief PharmacistsHealth ScotlandNHS 24Directors of Public HealthConsultants in Public Health Medicine

Your ref: 30 January 2012

Our ref:

Dear Colleague

I wanted to make you aware of an ambitious programme of work which is about to start to improve survival for peo-ple with cancer in Scotland. It aims to ensure that NHS Scotland cancer outcomes are amongst the best in Europe by diagnosing and treating the disease at an earlier stage – the Detect Cancer Early Programme.

The starting point for this is the very strong evidence, of which you are no doubt aware, of the effectiveness of ear-lier diagnosis and treatment. This evidence is captured in a full supplement of the British Journal of Cancer (http://www.nature.com/bjc/journal/v101/n2s/index.html).

The main components of the Programme are as follows:

• To increase the proportion of people with stage 1 disease at diagnosis (as a proxy indicator of survival out-come) and to use performance against a HEAT Target as a lever for whole systems approach to improvement

• To improve informed consent and participation in national cancer screening programmes and ensure sufficient screening capacity to meet the anticipated increase in those choosing to take part

• To raise the public’s awareness of the national cancer screening programmes and also the early signs and symptoms of cancer to encourage them to seek help earlier and facilitate evaluation of the campaigns and the programme as a whole

• To work with GPs to promote referral or investigation at the earliest reasonable opportunity for patients who may be showing a suspicion of cancer whilst making the most efficient use of NHS resources and avoiding adverse impact on access

• To ensure that imaging, diagnostic departments and treatment centres are prepared for an increase in the number of patients with early disease requiring treatment

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The draft plan launched in August 2011 for stakeholder engagement was well received, with very positive feedback from a wide spectrum of clinicians across the professions in public health, primary, secondary and tertiary care, as well as from members of the public and cancer charities. This feedback has informed a Final Implementation Plan which we plan to launch in mid February along with the first phase of the social marketing campaigning, a key component of the overall programme. A Programme Board is now established to oversee implementation and ensure progress. The programme takes a ‘whole systems’ approach which involves wide participation across health and the voluntary sector. I wanted to make you aware of the timing of the high profile public awareness campaigns in Scotland. The plan is to launch an overall ‘empowerment’ campaign for six weeks or so from 20th February 2012 (to address negative atti-tudes about cancer and its treatment amongst the general public and to tackle the fear about presenting with worrying symptoms so that they will seek advice at the earliest possible stage). We will then go on to promote awareness of screening programmes and the symptoms and signs of individual tumour types - breast, colorectal and lung later in the year, starting (with breast first) from April/May 2012. In addition to the visible media campaigns, there will be extensive field work in targeted communities.

Full information packs will be distributed electronically in advance of the media campaign launch but in the meantime you may wish to re-familiarise yourself with the Scottish Urgent Referral Guidelines for Suspected Cancer http://www.scotland.gov.uk/Publications/2009/03/23140734/0

Many NHS Boards have adapted the national guidelines for local use (for example ‘RefHelp’ – see you local intranet site for more information).

In anticipation of the potential queries that will result from the media campaigns, it may also be useful to look at the information available on NHSInform, a website to which the media campaigns will also point http://www.nhsinform.co.uk/health-library/articles/c/cancer/symptoms

The Scottish Cancer Taskforce has endorsed a programme of work to revisit the Scottish Referral Guidelines for Sus-pected Cancer. This was last undertaken in 2007 but there has been considerable published primary care research since the guidelines were first introduced nearly 10 years ago, and much recent work on positive predictive values and threshold for referring. This update will contribute to achieving the ambitions of the Quality Strategy and resonates with the recommendations identified in the National Patient Safety Agency/RCGP report of 2010 on missed cancer diagnoses. Access to diagnostic services will be an important element of the work involved in the programme.

We are very conscious of the need for effective implementation and good communication.A representative Programme Board has been established and Executive Leads are in place in each NHS Board. A round of NHS Board visits has commenced to introduce the programme and a comprehensive information pack has been produced for each NHS Board. We have also published a newsletter and distributed it to NHS Board Executive Leads/DCE local implementation teams, requesting that this is widely cascaded. In doing so we hope that primary care, along with screening and assessment/treatment departments of the NHS in Scotland will be made fully aware of the aims and objectives of the programme, along with the potential impact. We would welcome any suggestions on how to make this communication as effective as possible.

While it is difficult to predict accurately the impact on health workforce workload, the evidence emerging so far from the similar initiative south of the Border is reassuring. However we plan to closely monitor the impact of Scottish social marketing campaigns and to ensure that the overall programme is fully evaluated well in advance of official publication of survival outcomes.

The Detect Cancer Early Programme is only one of a number of strands of work being taken forward by the Scottish Cancer Taskforce – others include Acute Oncology, Surgical Oncology, Radiotherapy Planning, the Cancer Quality Programme and Transforming Care after Treatment. However I’m grateful for your support in taking forward this im-portant component of the overall work programme.

SIR HARRY BURNS

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HEADLINE STATISTICS • Cancer is more common that you might think - more than one in three people will develop some form of

cancer during their lifetime

• Cancer has been on the increase – the number of cases diagnosed has increased by more than a quarter since the late 1970s

• Cancer is the number one fear for the British public; feared ahead of debt, knife crime, Alzheimer’s disease and losing a job

• Half of all people diagnosed with cancer now survive the disease for at least five years

• The proportion of deaths in Scotland due to cancer has dropped by 15% in males and 7% in females in the last ten years

EIGHT SIGNS AND SYMPTOMS OF CANCER

There are eight danger signs which we should all be aware of, and which definitely warrant a visit to your local GP.

1. Lumps which appear or get bigger, in the breasts, testicles or anywhere else.

2. Sores that don’t heal up, in the mouth, throat or skin.

3. Moles that change shape, size or colour.

4. Any growth that appears on the skin and continues to grow.

5. Coughing up blood, or blood in the urine or mixed through the stools.

6. Persistent conditions that refuse to clear up, like a cough that never goes away or a pain somewhere that won’t settle.

7. Changes in the pattern of going the toilet.

8. Unexpected weight loss.

But remembering that just because there is a change in your body like a pain, a lump or bleeding from somewhere it doesn’t mean you definitely have cancer – but it can mean something is wrong and you should get advice from your doctor.

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KEY FACTS ABOUT CANCERGENERIC

• Cancer is more common that you might think - more than one in three people will develop some form of cancer during their lifetime

• Cancer has been on the increase – the number of cases diagnosed has increased by more than a quarter since the late 1970s

• Cancer is the number one fear for the British public; feared ahead of debt, knife crime, Alzheimer’s disease and losing a job

• Half of all people diagnosed with cancer now survive the disease for at least five years

• The proportion of deaths in Scotland due to cancer has dropped by 15% in males and 7% in females in the last ten years. (ISD)

BREAST CANCER

• Despite more being diagnosed with the disease, the proportion of women who die from breast cancer has dropped by 18% over the last ten years

• Most lumps (90%) are not cancerous, but it is always best to have them checked

• Breast cancer is common - 1 in 9 women in Scotland will be diagnosed with it during their lifetime

• In the UK in 2007/2008 the NHS breast screening programmes detected more than 16,000 cases of breast cancer

• Breast cancer survival rates have been improving for forty years. More women are surviving breast cancer than ever before

• Almost two out of three women with breast cancer now survive the disease beyond 20 years

• Breast cancer survival rates are better the earlier the cancer is diagnosed - around nine out of ten of women diagnosed with stage I breast cancer, survive the disease beyond five years. This drops to around one out of ten diagnosed with stage IV

COLORECTAL CANCER

• Bowel cancer is often painless in the early stages, but there can be other symptoms

• The percentage of people who live for more than five years following a diagnosis of bowel cancer has doubled in the last forty years

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• Half of patients diagnosed with bowel cancer will survive the disease for at least ten years

• People diagnosed with bowel cancer are now twice as likely to survive the disease for at least ten years than those diagnosed in the early 1970s

• Research suggests over 90% of bowel cancer patients will survive the disease for more than five years if diagnosed at the earliest stage.

• There could be up to 20,000 fewer deaths from bowel cancer over the next 20 years if just 60% of those eligi-ble took up the invitation for bowel screening

LUNG CANCER

• Some people have no symptoms of lung cancer and only discover it during a routine medical check-up, whilst others may have had signs and symptoms for months. People should be aware of their risk and know what to look out for

• The chances of surviving lung cancer survival rates are much higher the earlier it is diagnosed

• More than two-thirds of lung cancers are diagnosed at a late stage when the chances of survival are lower

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DETECT CANCER EARLYUSEFUL LINKS

Please visit www.nhsinform.co.uk to view the site that people are being directed to from the media campaign for further information on cancer.

Scottish Referral Guidelines for Suspected Cancer can be accessed at http://www.scotland.gov.uk/Publications/2009/03/23140734/0 although there are plans to refresh these as a part of the overall Detect Cancer Early Programme.

The Scottish Cancer Taskforce website has a section on the Detect Cancer Early Programme where examples of useful resources can be accessed http://www.scotland.gov.uk/Topics/Health/health/cancer/ScottishCancerTaskForce/DetectCancerEarly

Eight healthy advice tips on preventing cancer can be found at The Europe Against Cancer website http://www.cancercode.eu

Cancer Research UK produce useful resources on cancer prevention http://info.cancerresearchuk.org/utilities/atozindex/atoz-cancer-prevention

Screening programme uptake rates for Scotland can be found at http://www.isdscotland.org/Health-Topics/Cancer/Bowel-Screening/http://www.isdscotland.org/Health-Topics/Cancer/Breast-Screening/http://www.isdscotland.org/Health-Topics/Cancer/Cervical-Screening/

Macmillan Cancer Support produces information on topics such as ‘About Cancer’ - causes and risk factors; tests and screening; cancer types; cancer treatments; living with and after cancer; and ‘If someone else has cancer’) www.macmillan.org.uk/Cancerinformation/Cancerinformation.aspx

Royal College of General Practitioners and National Patient Safety Agency has published a report on Delayed Diagnosis of Cancer- Thematic Review Mar 2010 which can be accessed at www.npsa.nhs.uk/nrls

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FAQSWHY IS THIS PROGRAMME

NECESSARY? Cancer survival is a key measure of the effectiveness of health care systems. Until the causes of cancer are more fully understood and effective strategies for prevention are fully implemented, thousands of people will continue to be diagnosed with cancer every year. Survival rates will remain a key indicator of progress. Even small improve-ments in survival from common cancers can prevent large numbers of premature deaths.

Scotland performs poorly relative to other European countries (in particular the Nordic countries) in terms of survival from cancer. This is usually measured as 5-year survival rates and the percentage relative survival rates for cancer (all types together) are shown in the table below:

There is some evidence that Scotland’s position may be artificially low because of record linkage is more complete in Scotland and registration is organised differently in other countries. However, even taking this into account there is no doubt that there is still room for improvement in cancer survival rates in Scotland and the Detect Cancer Early Programme seeks to improve Scotland’s position relative to other European countries.

Co-morbidity is likely to have an influence on these survival rates but most of the excess risk of mortality compared with the Nordic countries occurs within a year of diagnosis and it has been concluded that delays in presentation and/or referral, resulting in more advanced disease stage at diagnosis, are responsible for much of this survival deficit. Indeed, if those patients who die within a year of diagnosis are excluded from the five year survival rates above, then Scotland’s performance would be similar to the other countries.

Sweden 58.9Finland 58.0Norway 55.0Germany 53.7Italy 52.7EUROPE AVERAGE 52.0Spain 51.1Wales 49.2England 47.2NI 46.3Scotland 44.1

Percentage 5-yr survival rates for people diagnosed with cancer (all types combined) between 1995-2002

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HOW WILL IT BE TAKEN FORWARD?

There are four main workstream components to the programme – (1) influencing public behaviour through social marketing, (2) primary care engagement, (3)screening, diagnostic and treatment capacity and (4) data provision, collation and reporting

A combination of the following will be required:-

• More people will need to participate in the national screening programmes. This means ensuring that the infor-mation on benefits and risks is readily available to allow people to make informed choices

• People will need to be have a more positive view of cancer prognosis and cancer treatment, be more aware of the symptoms and signs which could indicate cancer and be prepared to act upon them

• It is anticipated that education, training and support will be required for primary care practitioners including community pharmacists, health visitors and practice nurses. GPs are likely to see more people with early symptoms and work will be required to facilitate lower threshold for further investigation and/or referral and robust safety netting

• To avoid delays in having tests to confirm cancer, more diagnostic capacity will be required

• Treatment centres – surgery and oncology – will need to be prepared for an increase in the numbers of patients with early disease requiring treatment

• Systems will need to be in place to collect data and report on performance

WHAT IS THE ROLE OF SOCIAL MARKETING?

The ultimate objective for the Detect Cancer Early Programme is to encourage those with worries, particularly in the deprived areas of Scotland to seek advice early.At present there is no legislative guidance or service led initiative in place to encourage people to present early. From in-depth research it is already clear that the target audience view cancer as ‘the’ killer disease. The aware-ness, belief and appreciation of the benefits of presenting early are not known.

In order for any behaviour change to take place, there will be a need to instil a confidence in people and reassure that they have more to gain than fear from presenting early.

The role for social marketing will be:

- to increase understanding and belief that early detection of cancer can save lives

- to overcome emotional and psychological barriers to presenting early

- to increase awareness of the signs and symptoms of breast, lung and colorectal cancer

- to encourage those who are worried to seek help straight away

- to clearly signpost where they should go for advice/support/help.

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A marked shift in attitude and behaviour will not happen overnight as opinions and perceptions are so ingrained, but the planned integrated programme of activity, will create a ground swell of awareness and empowerment amongst those most at risk in deprived areas.

All social marketing activity will be evaluated on an ongoing basis, to assess attitudinal shift, message take out and overall effectiveness in encouraging the target audience to present early.

WHAT SOCIAL MARKETING METHODS WILL BE EMPLOYED?

Work will be undertaken with key stakeholders in delivering both mass market and local activities including TV, Radio, digital advertising, PR and extensive fieldwork events. Engagement with local media, local business and community is critical to the success of this campaign. Materials will be cascaded to the relevant parties through the DCE Communication Sub Group for comment and distribution – engagement with NHS Board communications and Health Improvement departments will be key to the success of the overall programme.

WHY IS AN OVERARCHING ‘EMPOWERMENT’ CAMPAIGN NEEDED?

The insight gathering and research undertaken so far suggests that there is a need to address current attitudes, fears and apprehension, myths and beliefs about cancer, its treatment and survivability amongst the general public in order to improve the chances of success of the tumour specific campaigns. These later campaigns will raise awareness of the type of changes that should prompt help-seeking behaviour, but unless the anxieties about what it means to have cancer are addressed, there is a risk that the anticipated impact on awareness raising will not be converted into action or result in a shift towards earlier presentation.

WHAT WILL BE EXPECTED OF PRIMARY CARE?

The Scottish Cancer Taskforce have already endorsed work to revise the Scottish referral Guidelines for Suspected Cancer. It is anticipated that this work will be led by Health Improvement Scotland as part of their 2012/13 pro-gramme. A parallel piece of work is about to be progressed by NICE, but it is anticipated that the work in Scotland will approach the guideline development based on symptoms and signs and not tumour specific end points. It is also expected that the work will include guidelines on referral for investigations (eg imaging, endoscopic) and will cover safety netting and management of patients with ‘negative’ tests. Dissemination and promotion of the guide-lines will then become part of an overall effort to raise the threshold for considering cancer as a possible diagnosis and to inform the current work on referrals covered by QPQoF.

IT solutions will be developed and disseminated that will facilitate provision of data to practices on referral profiling, screening uptake, proportions of those diagnosed with cancer by route (eg emergency admission v. urgent cancer suspected referral) – this is not anticipated to generate additional work for practices but providing commentary and helping interpretation of the data will allow clinicians to think about ways in which they can influence the aim of the programme of earlier stage diagnosis. Tools will be provided that will allow clinicians to include this type of work within their portfolio of evidence for appraisal and revalidation where they wish to do so.

It is anticipated that NHS Boards will find it helpful to have lead cancer GPs or an equivalent role in place to facilitate this work.

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HOW WILL THE POTENTIAL INCREASE IN DEMAND FOR DIAGNOSTIC TESTS BE MANAGED?

A significant proportion of the £30M funding set aside for this programme will be directed towards increasing diag-nostic and treatment capacity. This will be distributed to NHS Boards who are in the best position to determine the priorities for addressing pressure areas. Discussions with NHS Boards have indicated that initiatives to extend the working day/week or to widen open access to those investigations where it is more efficient and productive to do so will be used.

WHAT IS THE IMPACT ON WORKLOAD LIKELY TO BE?

It is difficult to predict the impact of the overarching empowerment campaign on workload. There are no specific symptoms or signs mentioned and this could be seen as a criticism of this component of the social marketing strategy. This social marketing is innovative – NAEDI has not used this approach but has focussed on tumour spe-cific campaigning. Consequently there are no UK pilots on which to base estimates of impact, nor have literature searches demonstrated that any workload implications have been studied. Results from regional pilots of the NAEDI colorectal specific social marketing campaigns indicate an additional one patient seen per average practice. This has resulted in an additional one or two colonoscopy lists per week being required, depending on Trust size. This data is not absolutely transferrable to the Scottish context given that colon-oscopy rates per head of population in Scotland are already considerably higher than in England. A similar initiative was conducted in the West of Scotland in 2006 – using high profile media campaigns to raise awareness of colorectal and oral. The results of the evaluation indicated that the impact on primary care workload was negligible but that additional capacity was required in secondary care.

WHY FOCUS ONLY ON LUNG, COLORECTAL AND BREAST CANCER?

Colorectal, lung and breast cancer represent 45% of all cancers diagnosed in Scotland per year. To allow the early stages of the programme to be appropriately managed and be the most effective, a decision has been taken to focus on these three cancers initially. This will enable the greatest impact both in terms of patient numbers and in tackling cancer in areas of deprivation where survival has historically been poorest. For example, it is known that uptake of the national cancer screening programmes poorer in deprived areas and targeted work for breast and colorectal will help to address this and therefore attempt to ensure that the equality gap in cancer survival does not widen. Once this initial phase is completed, consideration will be given to which other cancers need to be tackled in a similar way. This is in response to feedback received as part of the stakeholder engagement process.

HOW WILL THE POTENTIAL TO WIDEN EXISTING GAPS BETWEEN SOCIO-ECONOMIC GROUPS BE AVOIDED?

The Detect Cancer Early Programme is constructed in such a way that encourages targeted efforts to raise aware-ness of cancer and to promote help seeking behaviour amongst groups where there is already evidence of late presentation. The social marketing campaigns already under development have been informed by extensive insight gathering and research amongst the traditional ‘hard to reach’ and ethnic minority groups and socio-economically deprived communities. Considerable field work activity will accompany the more visible national media campaigns. The programme will work extensively with the cancer charities who already have invaluable expertise in encour-aging early detection, particularly in these groups. NHS Boards will be encouraged through Health Improvement departments to skew effort towards those groups where there is poor uptake of cancer screening programmes, little awareness of the symptoms and signs of cancer and reluctance to seek help. Ongoing evaluation of interventions will be taken forward and roll out of initiatives that have been proven to be successful in other areas of the UK will be facilitated.

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HOW WILL WE KNOW IF THE PROGRAMME HAS MADE A DIFFERENCE?

The social marketing campaigns have in-built ongoing measures of effectiveness and proven methods of evaluation used for other cam-paigns are being adapted for use with the Detect Cancer Early work.

Funding is being made available from the programme to support a research call which will facilitate academic research into the impact of various components of the programme.NHS Boards will be monitored on their performance against the HEAT target associated with the programme and this will be pub-lished on an annual basis.

The impact on workload will be monitored through the PTI practice system and measures of workload impact will be explored to esti-mate the effect on diagnostic services in secondary care.

It will be a number of years before the improvement in five year sur-vival (which is influenced by factors additional to the Detect Cancer Early Programme) is evident but it will be possible to obtain a proxy estimate of impact by monitoring changes in the on year survival rates.

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THE EVIDENCE British Journal of Cancer Supplement published in December 2009 contains the articles which have provided the evidence to support the Detect Cancer Early Programme: Diagnosing Cancer Early: Evidence for a national aware-ness and early diagnosis initiativehttp://www.nature.com/bjc/journal/v101/n2s/index.html

Although Scotland has not formally participated in the International Cancer Benchmarking Project, its findings are applicable to the Scottish context. The results for Module 1 can be accessed at www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62231-3/fulltext

Other useful articles include: • Hamilton, W., Five misconceptions in cancer diagnosis Br J Gen Prac Advance Online publication 24 April

2009; DOI 10.3399/bjgp09X420860

• Vedsted, P. et al, Are the serious problems in cancer survival partly rooted in gatekeeper principles? Br J Gen Pract, Aug 2011

• Richards, M. A., The size of the prize for earlier diagnosis of cancer in England; British Journal of Cancer (2009), S125 – S129

British Journal of General Practice November 2011 edition has a number of articles on cancer and primary care. DOI: 10.3399/bjgp11X601523

Here are some useful articles on national screening programme participation. A UK review of the evidence, benefits and risks for breast screening has been commissioned and will be published later in 2012

• Hewitson, P: Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial British Journal of Cancer (2011) 105, 475–480. doi:10.1038/bjc.2011.255

• Brawarsky P, Brooks DR, Mucci LA, Wood PA (2004) Effect of physician recommendation and patient adher-ence on rates of colorectal cancer testing. Cancer Detect Prevent 28: 260–268 | Article | PubMed |

• Cole SR, Smith A, Wilson C, Turnbull D, Esterman A, Young GP (2007) An advance notification letter increas-es participation in colorectal cancer screening. J Med Screen 14: 73–75 | Article | PubMed |

• Cole SR, Young GP, Byrne D, Guy JR, Morcom J (2002) Participation in screening for colorectal cancer based on a faecal occult blood test is improved by endorsement by the primary care practitioner. J Med Screen 9: 147–152 | Article | PubMed | ChemPort |

• Ling BS, Schoen RE, Trauth JM, Wahed AS, Eury T, Simak D, Solano FX, Weissfeld JL (2009) Physicians encouraging colorectal screening: a randomized controlled trial of enhanced office and patient management on compliance with colorectal cancer screening. Arch Intern Med 169: 47–55 | Article | PubMed |

• Rothman AJ, Kiviniemi MT (1999) Treating people with information: an analysis of review of approaches to communication of health risk information. J Natl Cancer Int Monogr 25: 44–51

• Steele RJC, Kostourou I, McClements P, Watling C, Libby G, Weller D, Brewster DH, Black R, Carey FA, Fraser C (2010) Effect of repeated invitations on uptake of colorectal cancer screening using faecal occult blood testing: analysis of prevalence and incidence screening. BMJ 341: c5531 | Article | PubMed |

The Scottish Cancer Taskforce website has links to other useful evidence articleshttp://www.scotland.gov.uk/Topics/Health/health/cancer/ScottishCancerTaskForce/DetectCancerEarly/DCEInformationPack

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MATERIAL FOR INTERNAL COMMUNICATION CHANNELS

You can help to promote the campaign by using your own internal communication channels to your own audiences.

Copy for internal magazine or website

The material below can be adapted for use across a variety of internal communication channels

Detect Cancer Early campaign launches in Scotland

A new Scottish Government public information campaign aims to improve cancer survival rates by increasing the number of Scots diagnosed in the earliest stages of the disease.

Although huge in-roads have been made to cut cancer waiting times, the new campaign aims to increase the num-ber of cancers detected at the first stage of the disease by 25 per cent over three years.

It’s estimated that the Early Cancer Detection campaign could save more than 300 lives per year by the end of 2016.

The new two-year campaign will commence in February 2012 to raise awareness of the benefits of detecting cancer early and to highlight symptoms and signs of different cancers. It will focus on the three most common cancers in Scotland - breast, lung and bowel cancer.

It will give people the confidence to talk about cancer by providing them with facts, figures and knowledge on how to spot signs and symptoms. Members of the public will be encouraged to act quickly if they notice any unusual or persistent changes to their body or health and make an appointment with their GP at the earliest opportunity.

Campaign adverts will appear across TV, radio, online and public washrooms from February to March 2012.

NHS Scotland, leading clinicians and Scottish charities are working together to throw their weight behind the cam-paign and healthcare professionals across Scotland are being urged to promote the importance of detecting cancer in its early stages to their patients.

Audrey Birt, Chair of the Scottish Cancer Coalition said: “The average survival rate for cancer sufferers has doubled over the past 30 years and thousands of people beat the disease every year. If detected at the early stages, the chances of survival are greater as there are more treatment options available. We need to communicate this to people and encourage them to visit their GP at the earliest opportunity.

“The campaign will encourage the public to approach their GP if they notice any changes to their body or health and educate them on the signs and symptoms of cancer. Healthcare professionals have their part to play by talking to patients about cancer and encouraging them to take part in screening programmes.”

To find out more about cancer and the signs and symptoms, contact NHS Inform by phoning 0800 22 44 88 or log on to www.nhsinform.co.uk

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An example of what a payslip insert could say

Talking about cancer

Acting quickly on signs and symptoms of cancer can in-crease the chances of survival. If you notice any unusual or persistent changes to your body or health, make an appointment with your GP at the earliest opportunity. To find out more about cancer and the signs and symptoms, contact NHS Inform by phoning 0800 22 44 88 or log on to www.nhsinform.co.uk

Post for social media (Facebook, Twitter, LinkedIn)

Don’t get scared – get checked

Talking about cancer shouldn’t be scary and it could save your life. The average survival rate for cancer has doubled over the past 30 years and you have a higher chance of surviving the disease if it’s detected in its early stages. So get to know your body and see your GP if you spot any unusual or persistent changes. To find out more about cancer and the signs and symptoms, contact NHS Inform by phoning 0800 22 44 88 or log on to www.nhsinform.co.uk

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TOOLKIT

EXAMPLE 6 pAGE LEAFLET

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A3 POSTERS

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TV COMMERCIALS – 40 SECOND AND 10 SECOND

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diGITAL ASSETS

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