The “Be Clear on Cancer” brand is being extended to raise awareness of other diseases, as Chris Harrison and colleagues explain

Chris harrison

Chris Harrison

Chris Harrison

As national clinical directors, we are supporting a campaign to raise awareness of the importance of patients with persistent cough or inappropriate breathlessness seeking early medical advice.

Over 100,000 premature deaths each year in England could be avoided through public health interventions (to prevent illness), greater symptom awareness, earlier diagnosis and by more consistent access to the highest quality treatment and care.

More than 70 per cent of premature deaths are attributed to cardiovascular disease (CVD), respiratory disease and cancer. As the national clinical directors responsible for these areas, we recognise the importance of early diagnosis.

Collaboration across disciplines is likely to add significant value in improving outcomes

The Public Health Outcomes Framework and NHS Outcomes Framework contain shared indicators on premature mortality for CVD, respiratory disease and cancer.

Collaboration across disciplines, particularly to support earlier diagnosis, is likely to add significant value in improving outcomes.

Our focus is on reducing premature mortality and morbidity in our respective disease areas, and in reducing inequalities in outcomes experienced by groups such as older people, minority ethnic and socioeconomically deprived communities.

This campaign takes a unified approach to raising awareness around respiratory symptoms that may be the result of one or more conditions, leading to earlier diagnosis of several conditions.

Building on experience

Public Health England’s “Be Clear on Cancer” activity, delivered in partnership with the Department of Health and NHS England, aims to raise awareness of symptoms to achieve earlier diagnosis of cancer. Previous national campaigns have had an encouraging impact on early diagnosis and clinical outcomes.

Previous national campaigns have had an encouraging impact on early diagnosis and clinical outcomes for patients

In the period following the first national lung cancer campaign, around 700 more people were diagnosed with lung cancer, 400 more were diagnosed at an early stage compared to the same period in the previous year, and strikingly, around 300 more had surgery as a first treatment.

Similarly, in partnership with the Department of Health, PHE has run local and regional campaigns highlighting breathlessness as a potential indicator of lung or heart disease, with findings indicating that spontaneous knowledge of the symptom and its associated conditions increased significantly.

Building on this experience, the “Be Clear on Cancer” brand is being extended to raise awareness of other diseases. Running for 14 weeks between mid-July and mid-October, the campaign will focus on a persistent cough and inappropriate breathlessness to encourage people with these symptoms to consult their GP.

Is the ’Be Clear on Cancer’ approach effective?

Evaluation of previous national “Be Clear on Cancer” lung cancer symptom-focused campaigns demonstrated that the average number of extra presentations per GP practice per week (three additional visits) and two-week referrals per week (1.5 extra referrals per hospital) are within manageable limits.

Analysis of other national campaigns (covering lung and bladder and kidney cancers) demonstrated an increase in cancers diagnosed at an early stage concordant with a reduction in late stage diagnoses. These campaigns also achieved significant changes in awareness of symptoms.

A clear call for joint action

Breathlessness is a common presenting symptom for chronic obstructive pulmonary disease (COPD), heart disease and lung cancer.

Late diagnosis of COPD is very common – over a million people in England are living with undiagnosed and untreated COPD.

Most people with the disease report breathlessness as the significant disabling symptom that interferes with their everyday activities – but many who are undiagnosed accept it is normal to be short of breath and do not seek help.

Raising awareness of breathlessness will encourage people to report their symptoms and access appropriate treatment.

Over 70,000 people died from heart disease in England in 2014, and many people are undiagnosed. It is estimated that in addition to the 1.8 million people in England diagnosed with coronary heart disease, there are a further 600,000 people undiagnosed.

Over 1.4 million hospital admissions each year can be attributed to CVD, more than half of which are via A&E departments, further emphasising the potential for earlier diagnosis and treatment both to improve outcomes and reduce costs of care.

Finally, although around 36,500 people are diagnosed with lung cancer each year, with around 28,400 annual deaths, less than one-third of patients in England are diagnosed at an early stage when curative treatment is a realistic possibility. There is an urgent need to ensure that patients and their influencers are aware of possible cancer symptoms, as highlighted in previous “Be Clear on Cancer” campaigns.

Casting the net further

Underpinning this collaborative venture is the high level of comorbidity among the campaign’s target audience. Rates of obesity are rising and this can exacerbate breathlessness.

COPD is often associated with other conditions – for example 40 per cent of patients also have heart disease. Indeed, anecdotal evidence has indicated that other conditions, such as TB, asthma, COPD and pneumonia have also been picked up as a result of previous “Be Clear on Cancer” lung campaign activity.

Breathlessness can be a symptom of anxiety which is noteworthy in the context of a cross-disease campaign such as this where significant numbers of the target audience are also diagnosed with mental health issues and/or anxiety disorders.

People with depression have higher rates of respiratory disease and CVD, including coronary heart disease.

Raising awareness of respiratory symptoms in vulnerable groups such as these contribute to reducing health inequalities and specifically may prompt patients to discuss mental health issues with healthcare providers.

The success of previous “Be Clear on Cancer” campaigns is a powerful reminder of the potential impact of raising public awareness of key symptoms, and should act as a catalyst for further cooperation and collaboration across the NHS and between all healthcare practitioners.

Professor Chris Harrison, national clinical director for cancer; Professor Huon Gray, national clinical director for heart disease; Dr Matt Kearney, national clinical director for cardiovascular disease prevention; Professor Mike Morgan, national clinical director for respiratory services