Presentation on theme: "Bowel Cancer & Bowel Cancer Screening Education and Awareness Sessions"— Presentation transcript:
1Bowel Cancer & Bowel Cancer Screening Education and Awareness Sessions Men and women have a similar risk of developing Bowel cancer up to the age of 40 but after this rates are higher for men.
2Bowel Cancer Screening Programme Maureen SayerHealth Improvement PractitionerCheshire and Merseyside Bowel CancerScreening Programme
3AIMS and Outcomes: Increased awareness of the signs and symptoms of bowel cancer Increased understanding of the Bowel Cancer Screening Programme (BCSP) Increased knowledge on how to support your client group in relation to the BCSP Increased ability of staff to act as health advocates to their client groupMen and women have a similar risk of developing Bowel cancer up to the age of 40 but after this rates are higher for men.
4Public Health Perspective Bowel Cancer is the third most common cancer in the UKApproximately 34,900 new cases p.aIt is is the second largest cause of cancer deaths in the UK (Cancer Research UK, Cancerstats).Men and women have a similar risk of developing Bowel cancer up to the age of 40 but after this rates are higher for men.
5Public Health Perspective In 2004 approximately 16,100 people died from bowel cancer in the UK, 737 deaths within Cheshire & MerseysideLife time risk of developing Bowel Cancer in the UK is about 1:18 for men and 1:20 for women
6Who is at risk of developing bowel cancer? Both men and womenPeople who-Take little exerciseAre overweightHave a diet high in red meat and low in vegetables, fruits and fibre
7Who is at risk of developing bowel cancer? (continued) People with a family history (CRC Relatives)Inflammatory Bowel DiseaseGenetics-Familial Adenomatous Polyposis (FAP)about 1% of casesHereditary Non-Polyposis Colorectal Cancer (HNPCC) about 2-5% of casesFamily History Individuals with either one first degree relative diagnosed with Bowel cancer before the age of 45 or two first degree relatives diagnosed at any age. The life time risk increases to 16-25% for men and between 10-15% in womenDiagnoses over 65 can lead to a slightly increased riskFAP develop 100s or 1000s of polyps in their 20s or 30s and have a 100% chance of developing bowel cancer by their 40s. Prophylactic Colectomy is usually given in their teens or 20s
8Who is at risk of developing bowel cancer? (continued) The risk of developing bowel cancer increases with age.About 80% of people who get Bowel cancer are aged 60 and over
9Mental Health and Learning Disabilities SchizophreniaRecent research shows that people with this condition are at increased risk of developing bowel cancerLearning DisabilitiesIncreased risk is linked to obesity, poor diet, lack of physical activity ,exclusion from screening programmes. Mortality is linked to late presentation of symptoms.
10What are the signs and symptoms of bowel cancer? Practical Exercise!Then feedback from groups
11Bowel Cancer SymptomsSymptoms lasting 4-6 weeks need to be investigatedAny clients with symptoms should be encouraged to see their GP
12Bowel Cancer Symptoms Tiredness Bleeding from the Rectum ( Back passage)Bright Red or Dark Black bloodFound in or on Bowel Motion ,toilet paper or toilet bowelTirednessCaused by blood lossNeeds investigating
13Bowel Cancer Symptoms Change of Bowel Habit Change from your normal patternConstipationDecreased Bowel MotionsDiarrhoeaMore frequent Bowel MotionsMay alternate
14Bowel Cancer Symptoms Abdominal or Rectal Pain Abdominal Lump Needs Investigating
15Bowel Cancer Symptoms Nausea ( feeling Sick) Unexplained loss of appetiteUnplanned Weight Loss
16Bowel Cancer Screening Programme Cheshire and Merseyside NHS North West Cheshire and Merseyside Consortium are composed of 8 Primary Care Trusts.Liverpool PCTSefton and Southport PCTWirral PCTKnowsley PCTHalton and St Helens PCTWarrington PCTEastern and Central Cheshire PCTWestern Cheshire PCTA consortium bid was submitted to the Department of Health in October The Bowel Cancer Screening Local Implementation Group was informed that their bid was successful in April 2006
18Cancer Reform Strategy Changes Extending screening from 2010 to year olds62 day waits to apply – end 2008Consideration of people in their 50s is next stepFlexi-sig trial results will be available in 2/3 yearsImmunological testing and CT colography to be considered in due course
19Responsibility for the BCSP Cheshire & Merseyside NHS North West have the lead responsibility for BCSP initially. Thereafter PCT’s will commission the programme.
20Responsibility of the PCT Representative identified to attend Primary Care and Health Inequalities GroupIdentify suitable venues for the Nurse Led ClinicsDevelop a Service Level Agreement with the Bowel Cancer Screening programme at AintreeDevelop Patient Information leaflets
21Responsibility of the PCT Publicise Bowel Cancer Screening programmeIdentify Groups who may experience Health InequalitiesHold education sessions for PHCTsInformation provided on PALs telephone service
22Cheshire & Merseyside BCSP Statistics Screening population 327,683Assume 60% uptake based on pilot figures = 196,610 of which,Approximate 2% will have a positive FOBt = 3,932 of which,11% of FOBt positive patients will have cancer =433.35% will have polyps requiring surveillance =1376
23Duke Staging of CRC on BCSP Duke A 53% (including malignant polyps)Duke B %Duke C 21.4%Duke D 4.2%These figures are based upon 115 patients who had undergone surgery at time of audit and had definitive post-operative staging.
24Bowel Cancer Screening Programme FOB testing will be offered to all men & women aged yearly.70+ can request to join the BCSP but have to contact Regional Hub at Rugby on theFREEPHONE:Age Extension up to 75 in 2010
25Organisation in England by March 2007 5 Programme Hubs across England, based on IT Local Service Providers (LSP) undertaking call/recall and lab functions1 Programme Hub for approx 20 screening centresGatesheadNottinghamRugbyLondonGuildford
26Role of Midlands and North West Programme Hub To Manage call and recall for the screening programmeTo provide a telephone help line for people invited for screeningTo dispatch and process test kitsSend results letters to participants and notify GPBook the first appointment at a nurse led clinic for patients with an abnormal test resultCoordinate Quality assurance activities
27Midlands and North West Programme Hub Invitation letter is sent to participant from Hub.Participants can opt out of the BCSP by contacting Hub on the free phone –One week later an FOB screening kit which includes leaflets, sample sticks and a foil lined envelope are dispatched
28Screening Centres (University Hospital Aintree) Provide information about the screening programme for the local health communityPromote the screening programme to thegeneral public in their localityProvide information and support for local people in completing the FOB test(on referral from the programme hub
29Screening Centres (University Hospital Aintree) They will provide nurse led clinics for patients with an abnormal test result.Arrange colonoscopy appointments for patients with an abnormal test result at either the Royal Liverpool University Hospital ,University Hospital Aintree or Leighton Hospital.Arrange alternative appointments for patients in whom colonoscopy has failedEnsure appropriate follow-up or treatment for patients after colonoscopy
30Faecal Occult Blood Testing Kit Participants smear the stool sample onto the 2 Squares in the 1st flap indicated on the kit. This is repeated on 2 further days until all 6 Squares are completedCompleted kit is returned by post to Hub within 2 weeks of the 1st sample being smeared on the kit (foil-lined envelope supplied)
31Results Negative result Unclear Result (1-4 of the squares are positive)Spoilt KitTechnical FailurePositive ( abnormal) Result
32Results Patient informed of Faecal Occult Blood Test results by post Colonoscopy: patient informed of results onthe dayInformation about polyps relayed to patient bytelephone clinic or clinic appointmentGP informed of all results, non-respondersand DNAs
33Screening journey Appointment arranged at Nurse Led Clinic ( Healthy Living Centre Ellesmere Port and St Martins Clinic Chester)Ellesmere Port) for FOBt positive patients. The patient will receive:CounsellingA health questionnaireInformationConsentPreparation for procedureBCSP – The Colonoscopy Investigation Leaflet
34Screening journey (Continued) Referred to screening provider unit for colonoscopyFollow-up dependant on procedure resultsNormal, sent a BCSP kit in 2 yearsPolyps, surveillance by BCSPCancer detected cases referred to local Multi Disciplinary Team (local Cancer Team)
35BCSP Clinical Statistics from September 2006- March 2008 Overall Uptake rate 55%1268 patients seen in nurse led clinics following FOB positive result1215 colonoscopies performed38 patients refused to have colonoscopy (2.6%)31 patients deemed clinically inappropriate (2.1%)15 patients had completion barium enema (1%)
36NEOPLASIATotal number of adenomatous polyps removed = 1330 (498 patients )Total number of malignant polyps removed= 21 patients
37Patient Outcomes10% patients to have 1 year surveillance (High risk polyps)18% patients to have 3 year surveillance (Intermediate risk polyps)60% to return to screening programme with 2 yearly invitation to repeat participation in screening ( Low risk polyps)12% referred to local MDT for cancer treatment ( 141 patients )
38Health Inequalities of the BCSP Pilot Men were less likely to participate in FOBtLower uptake in deprived areas.Black and Racial Minority Communities less likely to participate
39Potential barriers within BCSP? Mental Health?Learning disability?
40Barriers for patients with Mental Health problems Lack of awareness about the benefits of screeningPoorer knowledge of health topicsLow self esteemLack of motivationDifficulty in accessing servicesPractical issues for completion of the Faecal Occult Blood Test
41Support individuals with a Mental Health problem to: How can you help people with Mental Health problem overcome these barriers?Support individuals with a Mental Health problem to:Make an appointment with the GP or Practice Nurse at the earliest sign of ill health or disease.Inform and discuss with the GP or Nurse any signs or symptoms of ill health.Attend their annual health check at their GP surgery.Understand what the screening process entails: using easy read format.
42Barriers for patients with Learning Disabilities/Difficulties CommunicationRecognition of ill health is often difficult .Signs and symptoms for bowel cancer not always recognisedLiteracy levelResources / lack of pictorial easy read informationPractical issues for completion of the Faecal Occult Blood Test
43Barriers for patients with Learning Disabilities/Difficulties Lifestyle, behaviours and disengagementAttitudes of health professionals & NHS administrative procedures . Client group often excluded from screening by Primary Health Care TeamsPerceived difficulty obtaining consentFamily members/carers may not have the skills & knowledge needed about disease
44How can you help people with LD’s overcome these barriers? Support individuals with a LD to:Make an appointment with the GP or Practice Nurse at the earliest sign of ill health or disease.Inform and discuss with the GP or Nurse any signs or symptoms of ill health.Attend their annual health check at their GP surgery.Understand what the screening process entails: using easy read format.Access support from a LD nurse if required.
45New DevelopmentsMerseyside and Cheshire Early Detection & Prevention StrategyHealthy Communities Cancer Collaborative
46New Developments DVD Developed to meet the needs of Black and Racial MinoritiesDeaf and Hard of Hearing PeopleLow LiteracyLearning Disabilities
48Purpose of the Anticipatory Care Calendar Reduce health inequalities.Provide a sound clinical governance and critical care review mechanism.Provide care pathways that lead to action.Improve communication with the multidisciplinary team.Standardise information/documentation.
49Purpose of the Anticipatory Care Calendar Ensure that the legal requirements for documentation are met.Record patterns in behaviour and symptoms which can be visualised more easily using the monthly chart so that alterations in the client conditions can be viewed on more than one health variable.Reduce diagnostic overshadowingRecord accurate screeningProvide learning opportunities between teams caring for clients.