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Rachel Rowlands 17 th May 2013
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2012 Be Clear on Cancer campaign Aims of the study Methodology Results Conclusions Limitations Recommendations
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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
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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
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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
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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
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Adjusted Dukes’ Stage
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Intent of First Treatment Intent of First Treatment 2011 Cohort2012 Cohort No. Patients% PatientsNo. Patients% Patients Definitive12587.110684.8 Palliative17111915.2 Unknown21.9300 Total155125
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Urgency of Formal Resection 10.7% 89.3% 87.2% 12.8% 2011 Cohort 2012 Cohort
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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
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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
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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
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Re-audit following the national 2013 campaign Encourage patients to seek advice on first notice of symptoms Raise awareness of survival rates
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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-cancershttp://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/. http://www.dh.gov.uk/health/2012/01/bowel-cancer-campaign/ Improving Outcomes: A Strategy for Cancer. s.l. : Department of Health, 2011. Miss Sarah Mills Mr Mike Bradburn Michele Waimsley-Tonks
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