Reviewing the impact of 11 national Be Clear on Cancer public awareness campaigns, England, 2012 to 2016: A synthesis of published evaluation results

Abstract

The Be Clear on Cancer (BCoC) campaigns have run in England since 2010. They aim to raise awareness of possible cancer symptoms, encouraging people to consult a general practice with these symptoms. Our study provides an overview of the impact of 11 national campaigns, for bowel, lung, bladder and kidney, breast and oesophago‐gastric cancers. We synthesised existing results for each campaign covering seven clinical metrics across the patient pathway from primary care attendances to one‐year net survival. For each metric, “before” and “after” periods were compared to assess change potentially related to the campaign. Results show that primary care attendances for campaign‐related symptoms increased for 9 of 10 campaigns and relevant urgent referrals for suspected cancer increased above general trends for 9 of 11 campaigns. Diagnostic tests increased for 6 of 11 campaigns. For 7 of 11 campaigns, there were increases in cancer diagnoses resulting from an urgent referral for suspected cancer. There were sustained periods where more cancers were diagnosed than expected for 8 of 10 campaigns, with higher than expected proportions diagnosed at an early stage for sustained periods for 4 of 10 campaigns. There was no impact on survival. In summary, there is evidence that the BCoC campaigns impact help‐seeking by patients and referral patterns by general practitioners, with some impact on diagnosis (incidence and stage). There was no clear evidence of impact on survival.

Awareness and help-seeking for early signs and symptoms of lung cancer: A qualitative study with high-risk individuals

“…This campaign was also associated with an increase in the number of patients diagnosed with early-stage LC, and a decrease in cases of advanced LC (Ironmonger et al, 2015). A recent overview of the impact of 11 national 'Be Clear on Cancer' campaigns for various cancers including LC found that these campaigns impacted positively on help seeking by patients and referral patterns by GPs (Lai et al, 2020). It was also found that some campaigns were associated with an increase in cancer diagnoses and higher proportions of cancers diagnosed at early stages (Lai et al, 2020).…”

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

“…Although some randomized control trials have been conducted, 120 , 142 the majority of early diagnosis programs are natural experiments and so evaluations more often take other forms such as before and after designs and interrupted time series analysis, commonly involving mixed-methods research. 22 , 25 , 27 , 40 , 135 , 143 - 145 …”

“…For example, a range of process and outcome measures have been examined for the evaluation of the Be Clear on Cancer campaigns in England. 25 These include the cancer referral rate (the number of urgent referrals for suspected cancer made by primary care practices divided by the registered practice population) and referral scheme sensitivity (the number of cancer diagnoses resulting from an urgent referral, rather than another route to diagnosis). The primary care interval (time from first presentation in primary care to referral to secondary care) has also been highlighted as a measure of diagnostic timeliness in England, Scandinavia, and other countries 50 , 147 but is of less relevance to jurisdictions where patients may access specialist care directly.…”

“…Nationwide campaigns designed to target individuals of age 50+ years have been conducted for colorectal, lung, breast, bladder, kidney, and esophagogastric cancers. 19 , 20 , 25 The visual and linguistic components of the campaign were designed to engage individuals from lower socioeconomic groups and alleviate possible concerns about bothering the doctor. 21 Campaign evaluations have found increasing levels of awareness and frequency of help-seeking for some symptoms and increased referrals and use of investigations for suspected cancer by primary care physicians although evidence of improvement in stage at diagnosis and survival is limited.…”

“… 21 Campaign evaluations have found increasing levels of awareness and frequency of help-seeking for some symptoms and increased referrals and use of investigations for suspected cancer by primary care physicians although evidence of improvement in stage at diagnosis and survival is limited. 22 - 25 …”