The Effect of the ‘Be Clear on Cancer’ Campaign on Stage at Presentation of Colorectal Cancer

1. The Effect of the ‘Be Clear on Cancer’ Campaign on Stage at Presentation of Colorectal Cancer Rachel Rowlands 17th May 2013

2. What will be covered • 2012 Be Clear on Cancer campaign • Aims of the study • Methodology • Results • Conclusions • Limitations • Recommendations

3. The ‘Be Clear on Cancer’ Campaign • 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

4. Aims of the Study 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

5. Methodology • 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

6. Results 1 • Adjusted Dukes’ Stage n=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

7. Results 1 • Adjusted Dukes’ Stage

8. Results 2 • Intent of First Treatment

9. Results 3 • Urgency of Formal Resection 2012 Cohort 2011 Cohort 12.8% 10.7% 89.3% 87.2%

10. Conclusions Post Campaign cohort: • Greater proportion of patients presented as Dukes’ A (24.2%) and Dukes’ B (28.2%) • But..also an increase in Duke’s D (18.6%) • Fewer patients had definitive treatment • Fewer formal resections • Higher rate (2.1%) urgent surgery

11. Discussion • 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

12. Limitations • 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

13. Recommendations • Re-audit following the national 2013 campaign • Encourage patients to seek advice on first notice of symptoms • Raise awareness of survival rates

14. References • 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. Acknowledgements • Miss Sarah Mills • Mr Mike Bradburn • Michele Waimsley-Tonks

15. Thank you