An Initial Evaluation of the NAEDI Regional Awareness Pilots NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Introduction Background (1): Late diagnosis is a major problem 10,000 deaths could be avoided each year in England if our cancer survival rates matched those in the best countries (e.g. Australia, Canada and Sweden) Bowel cancer accounts for 1700 of these avoidable deaths Late diagnosis is thought to be the single most important factor underlying poor survival The Government has set a goal that an additional 5000 lives p.a. should be saved by 2014/15. This would bring survival in England up to the average for Europe NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Be Clear on Cancer Evaluation Background (2): Bowel cancer 5 year survival in England around 50%, compared with over 60% elsewhere Major opportunities for improving outcomes – prevention, screening, earlier diagnosis of symptomatic cases, better treatment But.... low public awareness and late diagnosis (25% present as emergencies) Hence... Regional awareness pilots run in 2 Regions (EoE and SW) over 7 weeks in late January – March 2011 Emphasis on 2 key symptoms: loose poo and blood in poo continuing for 3 weeks or more NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Defining an Area for Analysis Assumption: TV advertising had the most impact of all the media forms used in the campaign over the widest area. Analysis of broadcast areas and PCT/CT boundaries using GIS allowed classification of organisations. Please note there is a slight error in the map covering Milton Keynes, this has been allowed for in all analysis Contains Ordnance Survey data © Crown copyright and database rights 2008 NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Evaluation: Awareness and Acceptability Three phases of quantitative research: Pre/post tracking surveys with over 55s (face-to-face) –East of England and South West –c. 470 people per region per wave –Control: rest of England, c.490 per wave GP Survey –c. 100 telephone interviews per region (including control, rest of England) –Post campaign fieldwork Face to face events –Exit interviews at events –126 South West and 206 East of England All conducted by TNS BMRB NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Base: All who had seen bowel cancer advertising - Regional Pilot (Control Pre/Post: 66/74) (SW Pre/Post: 85/188) (EE Pre/Post: 66/153) All who had seen bowel cancer advertising – GPs (Control: 55) (Test: 175) To raise awareness of the link between lifestyle and bowel cancer To raise awareness of the signs and symptoms of bowel cancer To encourage people to take up the offer of a bowel cancer screening programme To encourage people to go and see their GP CM3. (Regional Pilot) Which of the following were the main messages of what you recently saw, heard or read about bowel cancer? Please select up to three.; Q3. (GPs) What was the main message of what you have recently seen or heard about bowel cancer? (Unprompted) Note: small base sizes for Control and pre stage CONTROL SOUTH WESTEAST OF ENGLAND % Pre Post Main message of bowel cancer advertising (prompted) Significantly different (95% level) to the: ∞ Control group † pre-stage in the same area ∞ ∞ ∞ ∞ † † NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Base: All respondents – GP (Control: 116) (SW: 125) (EE: 103) All who had seen bowel cancer advertising – GPs (Control: 55) (SW: 101) (EE: 74) …to raise awareness of the link between lifestyle and bowel cancer …to raise awareness of the signs and symptoms of bowel cancer …to encourage people to take up the offer of a bowel cancer screening programme …to encourage people to go and see their GP Q1. (GP) Have you seen, heard or read any adverts, publicity or other types of information since the beginning of February about bowel cancer?; Q3. (GPs) What was the main message of what you have recently seen or heard about bowel cancer? (Unprompted) Note: small base sizes for control Main message of bowel cancer advertising (unprompted) – GP survey % of GPs aware of bowel cancer advertising and publicity: Control: 46% South West: 79% East England: 74% Of those GPs aware, they perceived the main message to be... ∆ ∆ ∆ ∆ ∆ ∆ Control South West East of England % Significantly different at 95% to the: ∆ Control group (GP) NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

% TVRadioLeafletPrintAny ad Q24b-e. (Regional Pilot) Have you [seen this ad on TV/ heard this ad on the radio or anything similar/ seen any of these ads/ seen this leaflet] in the past couple of months? Base: All respondents – Regional Pilot (Control Post: 428) (SW Post: 510) (EE Post: 475) ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ The sample was split and each respondent was played 1 of 3 ads Control SW EE Prompted recognition of ads Significantly different (95% level) to the: ∞ Control group † pre-stage in the same area NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

% Control South West East of England Communication of ads It is important that adverts like this are shown This advertising is clear and easy to understand The advertising is relevant to you This advertising stands out from other advertising The advertising told you something new 89% of GPs who had heard of the campaign agreed with this (Please note: base sizes too small to report on control) Q.24h (Regional Pilot) Thinking about all of this advertising, please tell me to what extent you agree or disagree with each statement. Q9 (GP). Thinking back to this advertising, please tell me to what extent you agree or disagree with each statement – It is important that adverts like this are shown. Base: All respondents - Regional Pilot (Control Post: 428) (SW Post: 510) (EE Post: 475) All who had heard of campaign – GP (Control: 18) (Test: 85) ∞ ∞ ∞ ∞ ∞ ∞ ∞ 9 Significantly different (95% level) to the: ∞ Control group † pre-stage in the same area NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

% Pre Post Base: All respondents– Regional pilot : (SW Pre/Post: 475/510) † † † Q. 15 (Regional pilot): There are many signs and symptoms of bowel cancer. Please write in as many as you are aware of Focus of publicity 10 Significantly different (95% level) to the: ∞ Control group † pre-stage in the same area Top-of-mind knowledge of signs and symptoms: South West NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Focus of publicity % Pre Post Base: All respondents – Regional pilot: (EE Pre/Post: 490/475) † † † † Q. 15 (Regional pilot): There are many signs and symptoms of bowel cancer. Please write in as many as you are aware of 11 Significantly different (95% level) to the: ∞ Control group † pre-stage in the same area Top-of-mind knowledge of signs and symptoms: East of England NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Defining an Area for Analysis Assumption: TV advertising had the most impact of all the media forms used in the campaign over the widest area. Analysis of broadcast areas and PCT/CT boundaries using GIS allowed classification of organisations. Please note there is a slight error in the map covering Milton Keynes, this has been allowed for in all analysis Contains Ordnance Survey data © Crown copyright and database rights 2008 NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Categories Used in These Slides This approach produced the following number of PCT/CTs in each category (as at April 2011): CategoryNumber of Organisations Category One5 Category Two23 Category Three4 Category Four108 Category Five12 PCT level data is still unvalidated and in the process of being analysed. As part of this process, categories One and Two are being aggregated as they were “probably impacted” by the campaign, and likewise Categories Three and Four are being aggregated as “probably not impacted” NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Impact on 2ww lower GI referrals –Comparing urgent GP referrals for suspected lower GI cancers in Q4 2009/10 and Q4 2010/11 there was a 34.4% increase in the number of patients seen. Although some trusts saw at least a doubling of referrals during the campaign period. –The data we have so far does not show a change in number of cancers diagnosed or change in stage of diagnosis. We expect to have more complete staging data at the end of September, by which time we would expect that the majority of new patients diagnosed to be reported to the cancer registries. PLEASE NOTE: No attempt has been made to adjust for any impact from local awareness campaigns within these data, so any changes in activity levels may be due to local pressures rather than the regional pilot campaigns NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Summary 1.The regional campaigns raised awareness of the signs and symptoms of bowel cancer 2.TV advertising (as expected) had the greatest impact 3.Attendances in primary care with relevant symptoms increased, but numbers were manageable 4.2ww colorectal referrals appear to have increased markedly during the campaign NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Summary (2) 5. Colonoscopy rates increased markedly, but these are still being quantified 6. Impact on bowel screening uptake is still being evaluated 7. We do not yet have reliable data on numbers of patients diagnosed or stage at diagnosis 8. The increase in endoscopy will almost certainly have led to polyp detection and hence to cancers being prevented NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE