Lung cancer campaign: Information for pharmacy teams

There are around 34,900 [1] new cases of lung cancer in England each year and more than 28,100 [1] people die from it. Although the survival rates are rising slowly, the improvement has been slower than for other common cancers.

Survival rates in Britain are worse than those in some comparative European countries and it was estimated that around *1,300 deaths  from lung cancer could be avoided in England each year if survival rates matched the best in Europe [2]. The poor survival seen with lung cancer in Britain compared with Europe is thought to be predominantly due to larger numbers of patients being diagnosed with late stage disease, when the cancer is already locally advanced or has spread, therefore  excluding them from potentially curative surgery. Early diagnosis is one of the key ways to improve survival rates, alongside improved access to diagnostics and optimal treatment.

When diagnosed at its earliest stage, around 73% of patients with non small cell lung cancer and around 56% of patients with small cell lung cancer will survive their disease for at least one year after diagnosis [3]. But around 70% of lung cancer patients in England are diagnosed at a late stage [4].

References

1. Office for National Statistics http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/no--42--2011/sty-lung-cancer.html

2. British Journal of Cancer (2009) 101, S115–S124.  doi:10.1038/sj.bjc.6605401 www.bjcancer.com. Published online 3 December 2009 http://www.nature.com/bjc/journal/v101/n2s/full/6605401a.html

3. Walters, S et al. Lung cancer survival and stage at diagnosis in  Australia, Canada, Denmark, Norway, Sweden and the United Kingdom: a  population-based study, 2004-2007. Thorax 2013.

4. National Lung Cancer Audit, Open data -  December. http://data.gov.uk/dataset/national-lung-cancer-audit-open-data-december-2012

Results from previous lung cancer activities indicate that Be Clear on Cancer is changing levels of public awareness and behaviour. There are also early indications that clinical outcomes are improving too. There are some statistically significant findings following the first national lung campaign in 2012:

• There was an increase in unprompted public awareness of a persistent/prolonged cough (from 12% pre-campaign to 15% post-campaign). When given a list of possible symptoms and asked how much of a warning sign of lung cancer each was, a cough for three weeks or more was the symptom that saw the largest increase – up 15 percentage points (18% - 33%) [1]
• There was an increase of 32% in two-week-wait referrals for suspected lung cancer in the campaign months compared with the previous year, with the majority of additional referrals in the over 50s [2]
• Around 700 more people were diagnosed with lung cancer when compared with the same period in the  previous year. Approximately 400 more people had their cancer diagnosed at an early stage and around 300 additional patients had surgery as a first treatment of diagnosed lung cancer [3].

However, despite these promising results, there is still a great deal of potential to improve lung cancer survival in England, and for this reason, Public Health England is running the lung cancer campaign again.

References

1. TNS-BMRB report for the national lung  cancer campaign 2012. Produced for Public Health England

2. National lung cancer awareness campaign: Analysis of urgent GP  referrals. An analysis looking at the impact of the national lung cancer  awareness campaign on the number of urgent GP referrals for suspected lung  cancer. Produced by Trent Cancer Registry, July 2012

3. National Lung Cancer Audit. Data provided by HSCIC

Adverts ran on TV, radio and in the press from 10 March until the end of April 2014 highlighting the symptom of a persistent three-week cough in line with NICE guidelines.  The campaign’s key message to the public is: ‘Been coughing for three weeks? Tell your doctor.’

As this was a ‘reminder’ campaign, the advertising was less intense than previous lung cancer campaigns. As an indication, the first national lung cancer campaign which ran from May to July in 2012, 92% of the target audience were likely to have seen the TV advert 12 times. This time, 90% are likely to have seen the advert 10.8 times.

The campaign focused on the symptom of a cough that has persisted for 3 or more weeks, because more than 90% of patients with lung cancer are symptomatic at diagnosis. Cough is the most common presenting symptom [1]. Weight loss is an indicator of systemic disease (widespread disease that affects a number of organs and tissues, or affects the body as a  whole) and is the second most prevalent symptom of lung cancer. Dyspnoea (shortness of breath) develops early in up to 60% of patients and is usually associated with increasing cough and sputum (mucus).

When developing the campaign for the general public, research showed it was important to lead with one clear symptom that they would be able to easily understand and identify. However, there are other symptoms to look out for including:

• A cough that gets worse or changes
• Coughing up blood
• Breathlessness
• Repeated chest infections
• Unexplained weight loss
• Feeling more tired than usual
• Chest/shoulder pain

The Be Clear on Caner leaflet highlights these other symptoms of lung cancer, as well as the risk factors associated with the disease. Case studies emphasise that smokers shouldn't put a persistent cough or change in cough down to 'just a smoker's cough'.

Take a look at the campaign leaflet 

References

1. Beckles M A et al; Initial Evaluation of  the Patient With Lung Cancer; Chest. 2003;123(1_suppl):97S-104S.  doi:10.1378/chest.123.1_suppl.97S

Lung cancer is more common in older age, with 97% of people diagnosed in England aged over 50 [1]. Tobacco is by far the biggest cause of lung cancer – smoking causes more than eight in ten lung cancers in the UK. People who smoke, used to smoke, or are exposed to second-hand smoke have an increased chance of developing the disease [2].

But it’s important to remember that an estimated 17% of lung cancers in the UK are caused by factors other than being a current or past smoker. Other risk factors include exposure to radon and chest problems such as COPD (chronic  obstructive pulmonary disease).

All pharmacies sell over-the-counter (OTC) nicotine replacement products.  Many pharmacies also provide stop smoking services and may have taken part in the NHS Quit Kit campaign. You will also be providing ‘medicine-use reviews’ and  may be aware of those who are self medicating. Therefore you are ideally positioned to help customers monitor any potential symptoms and encourage prompt  presentation to their GP if they persist.

References

1. Source: Office for National Statistics http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/no--42--2011/sty-lung-cancer.html

2. Parkin DM. Tobacco-attributable cancer burden in the UK in 2010. Br J Cancer  2011;105(S2):S6-S13.

When developing the Be Clear on Cancer message, it was important not to be seen as negative or nagging – we need to be supportive and encourage earlier presentation. We know from qualitative research and anecdotal information on existing lung cancer awareness projects that including a stop smoking message, or highlighting that this affects mainly those who smoke, can act as a barrier to early presentation. Smokers may feel they will be chastised and therefore delay going to see their GP, and non smokers don’t see it as relevant to them.

Be Clear on Cancer case studies are used to highlight that smokers shouldn’t put a persistent cough or change in cough down to ‘just a smoker’s cough’. Information leaflets highlight the risk factors, including a stop smoking message.

Remember, this campaign isn’t about lifestyle, such as smoking habits, but encouraging people to see their GP early if they have symptoms.

The Be Clear on Cancer materials promote the potential benefits of early presentation and reassure people that the symptom is unlikely to be cancer, but that it’s best to get it checked. The tone is balanced, practical and reassuring.

Research has shown that the campaigns are seen as targeted, sensible, easy to understand and action-orientated by the public. Overall, Be Clear on Cancer is viewed as a valuable campaign which ‘tells us what to do’ and normalises seeing a GP with worrying symptoms.

If you’re a pharmacist, talk to the customer about how long they’ve had symptoms or have been using the OTC medicine and whether  they have spoken to their GP. We know that people may delay going to see their GP for a variety of reasons. They may not realise their symptoms are serious; they may worry about wasting the GP's time; if they suspect cancer, they may fear the diagnosis and treatment; or they may be embarrassed. Where relevant, be confident and give them permission to visit their GP. If you feel comfortable, tell the customer to mention that their pharmacist sent them. It may be the push they need to get themselves checked out.

If you are a pharmacy counter assistant or member of the pharmacy team, be confident and follow your normal protocol. If you are concerned about a customer and feel uncomfortable talking about cancer, ask your pharmacist to speak to them or, if that isn’t possible, encourage the customer to go to see their GP  and get their symptoms checked out. Chances are it’s nothing to worry about, but if it is cancer, it’s better for it to be detected early.

One source of support in raising the subject of cancer with patients is the British Oncology Pharmacy Association’s e-Learning Centre. The centre has training for both pharmacists and for pharmacy team members about raising awareness of cancer in a pharmacy setting, with a whole module on lung cancer. This is free to access once you have registered on the website.

Make it part of your day: During your regular consultations, such as medicine-use reviews, when advising on OTC medicines or providing a repeat prescription, ask customers if they have seen the campaign.  They may have already seen the ads or information and have come to ask you about symptoms before seeing their GP.

Give permission: Our target audience can put off seeing their GP for a number of reasons, and are looking for an 'excuse' or  'permission' to make an appointment.  Where relevant, encourage customers to see their GP. If you feel comfortable, tell them they can mention that the pharmacist sent them. You could hand over a leaflet to take with them when they see the doctor. It may be the push they need to get checked out.

Promote the campaign: Put up posters in your pharmacy and have some lung cancer campaign leaflets readily available for customers. Chat to your friends, family, customers and colleagues about Be Clear on Cancer. We need to talk about cancer and make it a less taboo topic.

You can order hard copies of lung cancer leaflets  and posters free of charge via the Health and Social Care Publications Orderline or by ringing 0300 123 1002.

Visit our dedicated page for more information about the other materials that are available.

Yes. We know that there isn’t always much time in a busy day, so we developed a briefing sheet for pharmacists and pharmacy staff about the lung cancer campaign.

Download briefing sheet for pharmacists and pharmacy staff

Please do share the briefing sheet with your pharmacist and pharmacy teams.