‘Blood in pee’ campaign: Information for community based partners

Be Clear on Cancer aims to achieve earlier diagnosis of cancer by raising awareness of the signs and symptoms. The campaigns encourage people with relevant symptoms to see their GP without delay.

All the Be Clear on Cancer campaigns aim to use everyday language to help people feel more comfortable when discussing symptoms with their GP, which is why the word ‘pee’ is used in this campaign, rather than ‘urine’. This was the universally accepted term when tested with the target audience.

Results from previous 'blood in pee' campaigns are promising, with notable changes in symptom awareness and referral activity. However, we want to keep the campaign message at the front of people’s minds since there is still a great deal of potential to improve bladder and kidney cancer survival in England. That’s why Public Health England is running a national reminder campaign in 2018. 

Download the campaign announcement

Find out more about the background to Be Clear on Cancer

The campaign is aimed at men and women over the age of 50 from lower socio-economic groups, and their key influencers, such as friends and family.

Advertising will run across England from 19 July to 23 September 2018 and will include TV, radio, social media (Facebook) and advertising in key locations e.g. washrooms.

The key message promoted is: ‘If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor.’

The aim is to encourage more people with the symptoms to go and see their GP early. 

Results from the ‘blood in pee’ campaigns that have run to date show that the campaign is successfully changing levels of public awareness. There are also early indications that clinical outcomes are improving too. Results following the second national ‘blood in pee’ campaign show:

• 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 show 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 show 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 show:

• 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].

We are now able to look at staging data for those cancers diagnosed during the first national ‘blood in pee’ campaign period. The analysis is still ongoing, but early results are promising:

• For bladder cancer [4] in early 2014 [5], there appear to be higher than average stage I diagnoses and lower than average stage IV diagnoses. This corresponds to around 50 extra stage I cases. Please note, there is missing stage data which might affect this interpretation.
• For kidney cancer [6] in early 2014 [5] there appear 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 is 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

Local authorities and their staff can help to raise awareness of the ‘blood in pee’ Be Clear on Cancer campaign, by encouraging employees and local community groups to actively talk about the campaign. This will help to reinforce key messages communicated via the advertising.

Those who are at greater risk of developing bladder or kidney disease include: over 50s, smokers, those who are overweight or obese, or suffering from other medical conditions such as kidney disease or diabetes. You could brief community-based organisations that cater to these groups and are already promoting healthy lifestyle behaviours. Briefing these groups would encourage them to reference the campaign in meetings and raise awareness of how stopping smoking for example, could reduce people’s risk of developing the diseases. You could promote the campaign on your website or intranet, or display campaign posters in communal areas.

Distribute campaign materials to local community groups or encourage them to order their own materials to be displayed in their communal areas.

You can order or download free copies of leaflets, posters and other collateral through the Campaign Resource Centre (CRC) or by calling Orderline on: 0300 123 1002.

Remind colleagues, they don’t need to be medically qualified to promote the campaign or to advise people to see their GP if they have symptoms. Simply advising people on what to look out for, and encouraging them to tell their doctor straight away if they do notice the sign or symptom can help save lives.

Follow the link below for more advice on how to open conversations about cancer and how you can source further training and support if needed.

Talk Cancer

View downloadable resources

You can help to raise awareness of the main signs and symptoms of bladder and kidney cancers and the risk factors associated with the diseases by familiarising yourself with the advertising, talking about the campaign, and reinforcing the importance of seeing a GP if blood is found in the pee, even  just the once.

Within the workplace, you can combine talking about the campaign and the symptom of blood in the pee, with healthy lifestyle messages. For example, you could encourage staff to take part in smoking cessation initiatives, since smoking is one of the main risk factors of bladder and kidney cancers. If smoking is stopped, people will reduce their risk of developing the diseases.

This campaign is particularly relevant to employers within some workplaces where employees are/were exposed to certain chemicals. It has been estimated that in the UK, around 7% of bladder cancer cases in men and 2% in women are linked to occupational exposures [1, 2].

Campaign materials including posters and leaflets are available to order.  Please display these and distribute leaflets to help disseminate essential information about the signs and symptoms of bladder and kidney cancers.

Order free campaign materials through the Campaign Resource Centre (link is external)

View downloadable resources

References

1. Parkin DM. Cancers attributable to occupational exposures in the UK in 2010. Br J Cancer 2011; 105(S2):S70-S72; doi: 10.1038/bjc.2011.487

2. Rushton L, Bagga S, Bevan R, et al. Occupation and cancer in Britain. Br J Cancer 2010; 102:1428-1437

Community champions, volunteers, and community and voluntary sector organisations are well-placed to proactively raise awareness about the campaign. As you may have experienced yourself, people often feel more comfortable opening up about a worrying sign or symptom of cancer with someone who is similar to them. For some, talking to a peer initially can be much less intimidating than the prospect of talking to a GP first.

You can help to disseminate the main campaign message of ‘If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor.’ by talking about the campaign with service users, colleagues, carers and friends and family. Ask people if they’ve seen the adverts and if they know the main symptom of bladder and kidney cancer is blood in pee. Aim to give people the confidence to get checked out if they have noticed blood in their pee by reassuring them that the chances are it’s nothing serious, but these cancers are more treatable if they are found early. Your encouragement could help save their life.

Campaign materials including posters and leaflets are available to order. Please display these and distribute leaflets to help disseminate information about the campaign. Familiarise yourself with the campaign adverts and understand which groups are at a high risk of developing bladder or kidney cancers. A summary briefing containing all the information you will need to support the campaign is available for you to print off and share with colleagues, or retain for your own reference.

Order free campaign materials through the Campaign Resource Centre (link is external)

View downloadable resources

Opening conversations about cancer can be difficult. Try asking people if they’ve seen the TV adverts or heard the radio adverts. Follow that up with asking if they can remember what the main symptom of bladder and kidney cancer is. These questions should help to start a conversation about the campaign.

People may offer information up voluntarily if they have previously, or recently, noticed blood in their pee. Others may not. It’s often best not to ask too many questions about signs or symptoms, or get involved in a discussion. Simply give the advice ‘If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor.’ Reassure people, the chances are it’s nothing serious, but these cancers are more treatable if they are found early.

If you or your employees are regularly having conversations about cancer, you may wish to learn more about cancer awareness training delivered by Cancer Research UK. Talk Cancer training workshops aim to equip community based staff and local volunteers with the information and confidence they need to talk about cancer, and to help address common barriers which people often report as reasons for not wanting to visit their GP.

Find out more about Talk Cancer awareness training

A number of campaign resources are available to support you in the run up to, and during the ‘blood in pee’ campaign. Download them for free from the Campaign Resource Centre.

There are a number of tools and available data detailing local cancer statistics:

• Public Health England (PHE) has a number of tools which allow you to source local cancer statistics including: National General Practice Profiles (link is external)
• The Urological Cancer Profile tool (link is external) allows you to compare incidence and mortality rates for major urological cancers, survival, and influencing factors, such as deprivation, with other areas in England.
• Cancer e-Atlas (link is external) allows you to view cancer incidence and mortality statistics for the UK.
• Cancer Research UK have a local cancer statistics tool which allows you to search by your healthcare area and compare statistical information and intelligence about cancer with other Clinical Commissioning Groups or former Primary Care Trust areas across the UK. This tool now includes CCG level data for cancer incidence and mortality. You will also find information on early diagnosis, screening and smoking.
• PHE has an Outcomes Data tool which allows you to compare and benchmark cancer indicators in your local authority area with others in England.

The campaign was initially set up as part of the Government’s strategy for improving cancer. This outlined the ambition to prevent 5,000 deaths per year, by 2014/2015, and aimed to bring survival in England up to the average for Europe. In line with the NHS Outcomes Framework, the CCG Outcomes Indicator Set 2015/16 (link is external), continues to highlight cancer survival as a key area for improvement under indicator one: preventing people from dying prematurely.

The Be Clear on Cancer campaigns also form part of the 2015 recommendations of the Independent Cancer Taskforce, Achieving World-Class Cancer Outcomes: A strategy for England 2015-2020. If the ambitions of the strategy are achieved, it is estimated that an additional 30,000 patients per year will be surviving cancer for 10 years or more by 2020. Of these, almost 11,000 will be through earlier diagnosis. This ambition is reflected in the mandate to NHS England for 2016-17.

Be Clear on Cancer is a vital part of the work to drive the earlier diagnosis of cancer.

See the background to the campaign including evaluation results from other campaigns.

For more information, or if you have any queries, please contact partnerships@phe.gov.uk.