Lung Cancer Campaign Was a Success, So Where Is It Now?

Liam Davenport

July 23, 2015

A 3-year campaign to raise awareness about the symptoms of lung cancer and that encouraged people to visit their doctor appears to have been shelved by the UK government, say lung cancer experts in an open letter that calls for its reinstatement to help save lives.

The open letter comes from the UK Lung Cancer Coalition (UKLCC), a group of leading experts, senior healthcare professionals, charities, and healthcare companies. Addressed to the secretary of State for Health, it asks for clarification on the future of the Be Clear on Cancer lung cancer awareness campaign.

This campaign encouraged people older than 50 years with persistent cough to visit their doctor. Despite concerns it would put a strain on the National Health Service, it has been considered a success, with increases in the number of patients presenting with cough, the number of urgent referrals for lung cancer, and the proportion of tumors diagnosed at an early stage.

However, the campaign, which was launched in 2012 and was renewed in 2013 and 2014, appears to have been quietly dropped by the government, with no announcements of any further initiatives for 2015. The open letter calls for the reinstatement of the lung cancer campaign, a stance that has been backed by a number of leading UK charities.

The letter stresses the importance of the campaign by underlining the toll that lung cancer takes ― it is responsible for more than 35,000 deaths every year in the United Kingdom, more than deaths from breast, prostate, bladder, and stomach cancer and leukemia combined.

Moreover, data from the Health and Social Care Information Centre suggest there are persistent, wide variations in lung cancer treatment and care across the country, and treatment and survival rates are lower than those in other European countries.

Many UK patients with lung cancer are diagnosed with advanced disease, with approximately 40% accessing specialist care via an emergency admission. Moreover, recent research indicates that advanced lung cancer is being missed in primary care, as reported by Medscape Medical News.

Noting that the Be Clear on Cancer lung cancer campaign had achieved a series of "positive outcomes," the signatories say: "As clinicians working in the frontline of lung cancer services, we fail to understand why the Department of Health has chosen to ignore the encouraging results of its own nationwide lung cancer awareness campaign by neglecting to announce a follow-up."

Details of the Campaign

The Be Clear on Cancer campaigns, part of the National Awareness and Early Diagnosis Initiative, are by led by Public Health England in partnership with the Department of Health and National Health Service England and are supported by the charity Cancer Research UK.

The lung cancer awareness campaign was initially launched in 2012 to raise awareness, particularly among people aged 50 years or older, of persistent cough as a lung cancer symptom. It was renewed in 2013 and again in 2014 and was supported by advertisements on television and radio and in the press, as well as by a series of leaflets.

Individuals were urged to see a doctor right away if they had been coughing for the past 3 weeks or longer. Other symptoms of lung cancer were also outlined in the campaign materials, alongside the typical questions that a doctor may ask. The questions included the following:

  • How long have you had your cough?

  • Has your cough changed over time?

  • Have you coughed up any blood?

  • Have you had any chest infections recently?

  • Have you been short of breath? For how long?

The open letter reproduces data from a recent article indicating that in its first year, the campaign increased public awareness of persistent cough as a lung cancer symptom from 54% in 2011 to 65% in 2012.

Furthermore, the letter states that the number of people aged at least 50 years presenting to general practice with a cough increased by 63% during the 8 weeks of the 2012 campaign compared with the same period in 2011. This represents three additional visits per practice per week.

This raised concerns at the time, with Pulse magazine reporting that, because the campaign did not stress risk factors such as age or smoking history, it would lead to an influx of "worried well" individuals and so put increased strain on the "already saturated" general practice.

Nevertheless, the campaign was considered to be a success. In the first year of the campaign, these extra visits resulted in a 32% increase in the number of urgent referrals for lung cancer in 2012 compared with 2011, a 19% increase in general practice–referred chest x-rays, and a 16% increase in the number of CT referrals.

There was consequently a 9% increase in lung cancer diagnoses during the campaign period, including a 3% increase in the proportion of non–small cell lung cancers diagnosed at stage I and a 2% increase in surgical resections.

Why Not Build on This Success?

Noting the high death toll from lung cancer in the United Kingdom, the high rate of late diagnoses, and the wide variations in lung cancer treatment and care, the signatories write: "We are therefore disappointed that the Department of Health does not appear to be intending to build on the success of its own nationwide lung cancer awareness initiative and we call on the new Government to reinstigate the campaign immediately ― in order to encourage early diagnosis and save British lives."

Approached by Medscape Medical News for comment, Penny Woods, MD, chief executive of the British Lung Foundation charity, said: "Every death from lung cancer is a tragedy, but getting an early diagnosis can give people a better chance of survival. The decision to shelve the Be Clear on Cancer lung cancer awareness campaign is therefore a huge step backwards."

 
The decision to shelve the Be Clear on Cancer lung cancer awareness campaign is therefore a huge step backwards. Dr Penny Woods
 

"In a country where lung cancer is the biggest cancer killer, this campaign has helped increase the number of people visiting their GP about a cough, increase the number of people receiving the diagnosis they need, and increase the number of people receiving potentially life-saving operations," she said.

"We therefore fully support the calls for the campaign to be reinstated. Doing so could literally be the difference between life and death," she added

Sara Hiom, Cancer Research UK's director of early diagnosis, agreed, saying: "Cancer Research UK is committed to supporting the Be Clear on Cancer campaigns, which aim to raise awareness of possible symptoms of cancer and encourage people to go to their GP if they have a persistent or unusual symptom. The Independent Cancer Taskforce has also recently highlighted the importance of these campaigns."

She told Medscape Medical News: "In December 2014, we were delighted to report the promising results of the first national Be Clear on Cancer campaign for lung cancer. More recent lung cancer campaigns are still being reviewed, and we look forward to working with Public Health England on this."

UKLCC. Open letter to the Secretary of State for Health, July 21, 2015. Full text

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