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Exploring public attitudes towards the new Faster Diagnosis Standard for cancer

An exploration into public attitudes towards the new Faster Diagnosis Standard for cancer, due to be introduced in England in 2020, within the context of a patients’ recent referral experiences.

It found that waiting for test results and responsibility for meeting the standard were the main concerns and it was concluded that patients should be asked what they would like to know about their referral and that GPs should be more transparent about the referral process and the potential for a lack of clarity around next steps.

Piano M, Black G, Amelung D et al. Exploring public attitudes towards the new Faster Diagnosis Standard for cancer: a focus group study with the UK public. Br J Gen Pract 2019.

Cancer awareness training evaluation

CRUK’s training (“Talk Cancer”) aims to increase awareness of screening programmes and risk factors, promote more positive beliefs about cancer and increase confidence to discuss cancer with members of the public, among people working across the health service, local government, community and voluntary sectors who are appropriately placed to have these discussions with the public.

The evaluation found that the trainees’ more positive beliefs about cancer, their increased confidence in discussing cancer and their increased awareness of bowel cancer screening were all maintained at 2 months.

Roberts A, Crook L, George H etc al. Two-month follow-up evaluation of a cancer awareness training workshop (“Talk Cancer”) on cancer awareness, beliefs and confidence of front-line public health staff and volunteers. Prev Med Rep 2019.

Obesity – smoking crossover report

Overweight and obesity could overtake smoking as the single biggest cause of cancer in UK women in around a quarter of a century, if current trends continue as projected. For UK males this crossover is likely to occur later. It is CRUK’s aim to reverse the rise in overweight and obesity prevalence, as we did with smoking. These calculations demonstrate just how vital that aim is to reduce the number of people diagnosed with cancer in the UK in future.

Cancer Intelligence Team. 2018 When could overweight and obesity overtake smoking as the biggest cause of cancer in the UK?

Addressing unmet needs in women’s health

We contributed to the “Cancer in women – addressing unmet needs” paper in this series by the British Medical Association. This paper sets out the situation for women in terms of cancer incidence, preventable risk factors and inequalities. We highlight that more focus is required on prevention and diagnostic capacity. We must keep striving to give the best chance of securing a curative treatment, long term survival and improved quality of life.

Cancer Intelligence Team. 2018 Addressing unmet needs in women’s health or Read online

Cancer in the UK

This report summarises the current state of cancer in the UK. It shows where we are making progress and the challenges that we still face. Running throughout is the clear message that the NHS does not have enough staff with the right skills to deal with our growing and aging population and with the increasing number of cancer cases that are an inevitable result. Addressing this has been urgent for some time. Now it is critical.

Cancer Intelligence Team. 2018 Cancer in the UK

Preventable cancers

Nearly four in ten cancer cases in the UK are attributable to known risk factors. The proportion is higher in males than females, and highest in Scotland and lowest in England. Tobacco and overweight/obesity remain the top contributors. Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, to have the biggest impact on reducing cancer incidence.

Brown K, Rumgay H, Dunlop C et al. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Brit J Cancer 2018.

Infographics showing how 4 in 10 cancer cases can be prevented and the cancers caused by which risk factors are available, for free, from Cancer Stats cancer risk publications.

Want to generate bespoke preventable cancers stats statements? Download our interactive statement generator.

Overviews of cancer in Devolved Nations

Cancer Research UK is committed to accelerating progress so that 3 in 4 people survive cancer by 2034. To achieve this, we need to understand the state of cancer and the actions required at a country level.

These overview reports show stats on cancer, prevention and early diagnosis indicators for Scotland, Wales and Northern Ireland separately. They also state what CRUK is calling on the governments, decision making bodies and the country to take action on, to improve the state of cancer in each country.

Cancer Intelligence Team. 2018   Wales (English     Wales (Welsh)     Scotland     Northern Ireland

Sociodemographic variation in treatments

Sociodemographic inequalities in cancer treatment have been generally described, but there is little evidence regarding patients with advanced cancer. Understanding variation in the management of these patients may provide insights into likely mechanisms leading to inequalities in survival.

Henson KE, Fry A, Lyratzopoulos G, et al. Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013–2014. Brit J Cancer 2018.

Treatments received

This unprecedented set of statistics details patients recorded to have received chemotherapy, radiotherapy and surgical tumour resections for their tumour in England, by cancer site and stage at diagnosis, for most cancers.  It focuses on the time period following diagnosis within which most patients’ first course of treatment occurred, although adjuvant and neo-adjuvent treatments may be captured as well as the primary treatment.  This provides the foundation for future research to improve care and outcomes for patients.

National Cancer Registration & Analysis Service and Cancer Research UK. Chemotherapy, Radiotherapy and Tumour Resections in England. NCRAS 2017.

Cancer projections

It is projected that 513,951 cases of cancer will be diagnosed in the UK in 2035 and that 212,546 deaths will occur. Incidence rates are projected to decrease slightly in males and increase slightly more in females. Most cancers’ mortality rates are decreasing; except for liver, oral and anal cancers. Risk factors continue to need addressing, and healthcare planners need to consider the increased burden of cases and deaths because of the growing and ageing population.

Smittenaar C, Petersen K, Stewart K et al. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016.

Barriers to help-seeking

This study adds to the evidence on the barriers that may influence the public’s decisions around help-seeking in the event of a symptom and found different or broader barriers, to the ones previously considered. Exploration of these barriers and understanding which are associated with actual help-seeking behaviour would be helpful in the development of policy or interventions to mitigate their impact. Confirmation of the sociodemographic inequalities in the barriers helps us to specifically target future activity.

Moffat J, Hinchliffe R, Ironmonger L, et al. Identifying anticipated barriers to help-seeking to promote earlier diagnosis of cancer in Great Britain. Public Health 2016.

30-day mortality from SACT

30-day mortality might be a useful indicator of avoidable harm to patients from systemic anticancer treatments, but data for this are limited. The Systemic Anti-Cancer Therapy (SACT) dataset collated by Public Health England allows the assessment of factors affecting 30-day mortality in a national patient population. This study aimed to establish national benchmarks, and to start to identify where patient care could be improved.

Wallington M, Saxon E, Bomb M et al. 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study Lancet Oncol 2016.

Cancer symptom awareness campaigns

National campaigns focusing on key symptoms of bowel and lung cancer ran in England in 2012, targeting men and women over the age of 50 years, from lower socioeconomic groups. It was found that campaigns reached their target audience and have also influenced younger and more affluent groups. Differences in impact within the target audience were also seen. There would seem to be no unduly concerning widening in inequalities, but further analyses of the equality of impact across population subgroups is warranted.

Moffat J, Bentley A, Ironmonger L et al. The impact of national cancer awareness campaigns for bowel and lung cancer symptoms on sociodemographic inequalities in immediate key symptom awareness and GP attendances Brit J Cancer 2015.

Interventions for gFOBT uptake

Three interventions (CRUK endorsement flyer, kit enhancement pack, and advertising campaign) were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme and assist stool sampling, with the aim to increase uptake. The greatest increase in uptake was where all three interventions were combined. Future research should investigate the effectiveness of each intervention component and attempt to identify the mechanisms through which they have an effect.

White B, Power E, Ciurej M, et al. Piloting the impact of three interventions on guaiac faecal occult blood test uptake within the NHS Bowel Cancer Screening Programme. Biomed Res Int 2015.

Survival gains by eliminating inequalities

Although inequalities in cancer survival are thought to reflect inequalities in stage at diagnosis, little evidence exists about the size of potential survival gains from eliminating inequalities in stage at diagnosis. The number of deaths that could be postponed by eliminating socioeconomic and sex differences in stage at diagnosis was estimated and it was found that this would result in substantial reductions in deaths within 5 years of diagnosis.

Rutherford M, Ironmonger L, Ormiston-Smith N et al. Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma. Brit J Cancer 2015.

Awareness of lung cancer symptoms

Long-term lung cancer survival in England has improved little in recent years and is worse than many countries. A public awareness campaign found significant increases in public awareness of persistent cough as a lung cancer symptom; urgent GP referrals for suspected lung cancer; and lung cancers diagnosed. Most encouragingly, there was a significant increase in the proportion of non-small cell lung cancer diagnosed at stage I and in resections for patients seen during the national campaign.

Ironmonger L, Ohuma E, Ormiston-Smith N. An evaluation of the impact of large-scale interventions to raise public awareness of a lung cancer symptom Brit J Cancer 2015.

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