Introduction The UK national ‘Be clear on cancer (BCOC)’ campaigns led by Public Health England aim to improve public awareness of symptoms of cancer with a view to make an early diagnosis and reduce deaths arising from advanced disease. The 2015 national campaign for oesophago-gastric (OG) cancer ran from 26 January to 22 February with a key message of ‘ Having heartburn, most days, for 3 weeks or more could be a sign of cancer – tell your doctor ’ and a secondary message of ‘ Food sticking when you swallow could be a sign of cancer – tell your doctor .’ The initial analysis of endoscopic outcomes of the national campaign suggested no significant increase in diagnosis of OG cancers. A locality impact analysis has not been reported so far.
Methods Aims: This study is aimed as an impact analysis of the BCOC Oesophago-gastric cancer campaign in a specific locality of South Durham Hospitals (Darlington Memorial and Bishop Auckland[DA(CG1]). It aims to assess two aspects of the campaign: (1) clinical gain of a diagnosis of OG cancer and (2) the service impact of the increase in endoscopy demand as 2 WW and routine referrals.
Upper GI endoscopic data was captured from an electronic Endoscopy Scheduling software, as additions to gastroscopy waiting lists at two periods of time: 4 weeks after the OG campaign, in March 2015 and 4 months after the campaign, in July 2015. These included referrals from general practitioners for upper gastrointestinal symptoms in February/March 2015 (to coincide with the campaign period) and June/July 2015 (to coincide with a non-campaign period). Referrals for variceal screening, Barrett’s surveillance, inpatient referrals or patients already known to secondary care were excluded. Of 760 referrals during the two periods, 353 were excluded, leaving 407 true referrals from primary care.
Results There were a total of 283 referrals (2 WW-149, urgent-66, routine-69) during the campaign period, which was 2.2 times greater than non-campaign period of 123 referrals (2 ww-79, urgent-9, routine-35). The age distribution of cases was similar during both periods, with patients aged 61–80 having highest referral rates. The median age group of patients referred as 2 ww during the campaign period was 61–70 yrs compared to 71–80 yrs in the non-campaign period (one decade lower). Gender distribution was similar across both periods for 2 ww and routine referrals. However, there were 2.4 times more females referred urgently during the campaign period compared to male patients.
During the campaign, despite an increase in referrals, there was no significant increase in OG cancer diagnosis. Only 2 OG cancers (1 oesophageal squamous cell carcinoma, 1 gastric adenocarcinoma) were diagnosed from 2 ww referrals, while none was diagnosed from urgent or routine referrals. These 2 patients presented with dysphagia and weight loss. During the non-campaign period however, 3 malignancies were detected from 2 ww referrals. Only one was an OG cancer (gastric adenocarcinoma), the other two had normal gastroscopies with malignancy detected on imaging (lymphoma, metastatic adenocarcinoma of unknown origin).
A total of 10 Barrett’s oesophagus were diagnosed (2.4%), 8 during the campaign period and 2 in the non campaign period. There was no impact on average waiting time from referral to endoscopy for urgent referrals during both periods (29–42 days). The main impact on waiting times was seen for routine referrals: an increase from 29–42 days during non-campaign period to 43–56 days during the campaign period.
Conclusion A national Oesophago-gastric cancer awareness campaign produces a significant increase in the number of referrals for gastroscopy, which has an impact on routine waiting times. The campaign has not shown any increase in diagnosis of OG cancers, thereby indicating that other strategies need to be considered for reducing deaths due to these cancers.
Disclosure of Interest S. Koo: None Declared, B. Awadelkarim: None Declared, S. Choudhary: None Declared, Y. Viswanath: None Declared, A. Dhar Grant/research support from: Abbvie, Takeda, Shire, Consultant for: Takeda, Abbvie