'Blood in pee' campaign

A range of additional Be Clear on Cancer materials were developed for the 'blood in pee' campaign, including symptom cards, leaflets and briefing sheets:

‘Blood in pee’ campaign overview briefing sheet

An easy-read version of the campaign leaflet

Results from early ‘blood in pee’ campaigns showed that the campaign was successfully changing levels of public awareness. There were also early indications that clinical outcomes were improving too. Results following the second national ‘blood in pee’ campaign showed:

• Six in ten of those aware of the cancer advertising spontaneously mentioned ‘blood in pee’ as a cancer symptom (62% up from 31% pre campaign) [1].
• There was a 34% increase in the number of urgent GP referrals for suspected urological cancers* when comparing October – December 2014 with October – December 2012* [2].
• Preliminary results showed above-trend increases in the number of kidney cancers resulting from urgent GP referrals for suspected urological cancers for those aged 50 to 59 (39%)1 and 70 to 79 (72%)1 when comparing October – December 2014 and October – December 2012 [2].
• Preliminary results showed there was no significant change in the number of bladder cancers resulting from urgent GP referrals for urological cancers [2].

Results from the first national ‘blood in pee’ campaign showed:

• Confidence in knowledge of signs and symptoms of bladder and kidney cancer significantly increased from 28% pre-campaign to 41% post-campaign [3].
• After the campaign there was an increase in people saying they would see the GP if they noticed blood in their pee just once, up from 49% to 55% [3].
• A statistically significant increase of 26% in the number of urgent GP referrals (two-week wait) for suspected urological cancers*, during the campaign period [2].
• The number of bladder, kidney and urological cancer diagnoses resulting from an urgent GP referral for suspected urological cancers increased by 8.2%, 22% and 14%*, respectively, in October – December 2013 compared to October – December 2012 [2].

Early results looking at staging data for cancers diagnosed during the first national ‘blood in pee’ campaign showed:

• For bladder cancer [4] in early 2014 [5], there appeared to be higher than average stage I diagnoses and lower than average stage IV diagnoses. This corresponded to around 50 extra stage I cases. Please note, there was missing stage data which might affect this interpretation.
• For kidney cancer [6] in early 2014 [5] there appeared to be a higher proportion of stage I/II diagnoses but limited evidence of a reduction in stage IV diagnoses. This corresponds to around 30 extra stage I/II cases. Please note, there was missing stage data which might affect this interpretation.

Results from the regional pilot campaign that ran from January to March 2013, in the Tyne Tees and Borders TV regions also showed positive results:

• A statistically significant 48% increase in bladder cancer diagnoses in pilot areas following a 2WW referral, compared to a statistically significant decrease of 12.3% in control areas [2].
• A statistically significant increase of 47% in kidney cancer diagnoses in pilot areas following a 2WW referral, compared to an 8.5% increase in control areas [2].
• Cystoscopy activity significantly increased by 3% (after adjusting for working days) in pilot areas during the campaign period compared to the same period the year previous [7].

References

*Pathway covers several urological cancer types in addition to bladder and kidney cancers (including prostate and penile cancers)

1. TNS BMRB on behalf of Public Health England. Be Clear on Cancer Bladder and Kidney Cancer Blood in Pee Second National Campaign
2. Obtained through Public Health England, from the National Cancer Waiting Times Monitoring Dataset provided by NHS England
3. TNS BMRB on behalf of Public Health England. (February 2014). Be Clear on Cancer Bladder and Kidney Cancer Blood in Pee First National Campaign, Evaluation Phase 1
4. Bladder cancers – ICD10 code C67
5. The analysis uses a week-on-week approach as the number of weekends in a month affects the total diagnoses. It uses a 2013 median weekly diagnoses as a baseline
6. Kidney cancer – ICD10 code C64
7. Cystoscopy data sourced from Hospital Episodes Statistics and the Diagnostic Waiting Times and Activity Dataset

Men and women over the age of 50 from lower socio-economic groups, and the key people that influence them, such as their friends and family.

Advertising included TV, radio, social media (Facebook) and advertising in key locations e.g. washrooms.

Different adverts were used for men and women because research showed that men and women may respond differently to finding blood in their urine. Men might ignore the symptom, especially if it only happens once, and BCOC was keen to encourage women not to pass the symptom off as a urinary tract infection (UTI). It was estimated that half of all women in the UK will have a UTI at least once in their life, but if they had blood in their urine, they should see their GP.

In England around 17,450 people are diagnosed with bladder or kidney cancers each year [1], and approximately 8,000 die as a result. [2]

In 2013, 3,340 bladder and kidney cancers were diagnosed through an emergency presentation [3]. When people are diagnosed at this stage, the majority are likely to be in advanced disease, when treatment is less successful, and survival is much poorer.

References

1. Incidence and Mortality data supplied by Public Health England based on the NCRS dataset (2009-2013)
2. Deaths data supplied by Public Health England based on the ONS mortality data,2012-2016
3. Data supplied by Public Health England using Routes to Diagnosis 2006-2013
    

Visible haematuria is the most common symptom of bladder [1] and kidney [2] cancers. However, when asked to recall signs or symptoms of cancer via a Cancer Awareness Measure, only 16% of the public mentioned ‘blood in pee’ [3]. This indicates a need to raise public awareness of the significance of this symptom.

There are other symptoms of these diseases, yet the most recent evidence concludes that visible haematuria is the most common symptom and a powerful predictor of these cancers in primary care.

References

1. Clinical features of bladder cancer in primary care. Shephard EA, Stapley S, Neal RD, Rose P, Walter FM, Hamilton WT. Br J Gen  Pract. 2012 Sep; 62(602):e598-604
2. Clinical features of kidney cancer in primary care:  a case-control study using primary care records. Shephard E, Neal R, Rose P,  Walter F, Hamilton WT. Br J Gen Pract. 2013 Apr; 63(609):e250-5
3. Published Cancer Awareness Measure (2014)

After the 2016 national campaign, Luke Hounsome reported the  indicating that the campaign was a success in raising awareness of the key messages. Further data is currently being reviewed but this video summary is still relevant.