Rachel Rowlands 17 th May 2013

 2012 Be Clear on Cancer campaign  Aims of the study  Methodology  Results  Conclusions  Limitations  Recommendations

 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

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

 Pre-campaign 2011 cohort: n=155  Post-campaign 2012 cohort: n=125  Case ascertainment; prospectively maintained database of known colorectal cancers within Northumbria Trust SJM  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

 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

 Adjusted Dukes’ Stage

 Intent of First Treatment Intent of First Treatment 2011 Cohort2012 Cohort No. Patients% PatientsNo. Patients% Patients Definitive Palliative Unknown Total155125

 Urgency of Formal Resection 10.7% 89.3% 87.2% 12.8% 2011 Cohort 2012 Cohort

Post Campaign cohort: 1. Greater proportion of patients presented as Dukes’ A (24.2%) and Dukes’ B (28.2%) 2. But..also an increase in Duke’s D (18.6%) 3. Fewer patients had definitive treatment 4. Fewer formal resections 5. Higher rate (2.1%) urgent surgery

 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

 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

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

 Cancer Research UK. Cancer mortality for common cancers. [Online] 03 November info/cancerstats/mortality/cancer/deaths/uk-cancer-mortality-statistics- for-common-cancershttp:// 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  Improving Outcomes: A Strategy for Cancer. s.l. : Department of Health,  Miss Sarah Mills  Mr Mike Bradburn  Michele Waimsley-Tonks