Oesophago-gastric cancers campaign: Impact on services - preparing for the campaign

It is anticipated that local teams across England are likely to experience pressures on their services as a result of the upcoming national oesophago-gastric cancers campaign. Heartburn is a common symptom, and we know from the regional pilot that for many members of the public, heartburn as a symptom of cancer is new news.

However, measures are being taken to help limit the impact of the campaign. For example the advertising will run for four weeks, rather than six. By providing four month's advanced notice and sharing learning from the regional and local pilots, it is hoped local teams can begin conversations within their NHS trust and with CCGs early enough to accommodate an uplift in demand for services.

Download NHS campaign plans

And it is likely that pressure points will vary across the country. Learnings from local teams who participated in the regional pilot are provided in a ‘campaign overview’ briefing.

Download a ‘campaign overview’ briefing

View available results from oesophago-gastric pilot campaigns

We interviewed a number of colleagues in the North East and North Cumbria to ask them what they thought of the regional pilot. Watch the video below to hear from primary and secondary care colleagues, public health specialists and representative from the network as they talk about the challenges and results.

We are expecting to see an increase in demand for endoscopy services as a result of the campaign. On average across eight trusts in the pilot region, the increase per trust per week was an additional 16 gastroscopies. However, during the regional pilot campaign period and three months following, uplift in endoscopy services varied considerably across participating trusts, for example:

• A trust, which prior to the campaign, had an average 482 gastroscopies per month . They experienced an increase of 23 additional gastroscopies per week.

• At the other end of the range, another trust that prior to the campaign had an average of 606 gastroscopies per month. They experienced an increase of 1 additional gastroscopy per week.

All NHS trusts that participated in the regional pilot experienced the greatest impact on endoscopy services at around one month following the start of the campaign, in March 2014. Demand began to reduce at around 3 – 4 months post-campaign.

It is recommended that methods of accommodating an increase in demand for endoscopy services be considered prior to the campaign. For example, during the regional pilot, County Durham and Darlington NHS foundation Trust implemented an endoscopy triage pathway aimed at managing endoscopies as efficiently as possible during the campaign period. Further details on this triage can be found in the ‘overview briefing'.

Download a ‘campaign overview’ briefing

Download a local example of an endoscopy triage pathway

It is likely GP practices will also see an increase in the number of patients presenting with dyspepsia (heartburn) and dysphagia (difficulty swallowing food).

It is acknowledged that heartburn is a common symptom however the focus of the advertising will be very specific. Although the adverts don't talk about an at-risk age group, the advertising is carefully targeted at the over-50s from lower socioeconomic groups. There are signs the regional OG pilot campaign was successful in reaching this target group, since increases in 2WW referrals for upper GI cancers were largest for those in their 50s (85%) and 60s (69%) [1].

Preliminary analyses for the regional OG pilot campaign show that GP attendances for the symptoms promoted in the campaign increased by 46% during the campaign period, compared with the average attendance for the previous 3 years. This equates to an additional 0.6 attendances per practice, per week. As a further guide, when the Be Clear on Cancer lung cancer campaign (which raised awareness of a similarly common complaint of a persistent ‘cough’ as a symptom of cancer) rolled out across England (May - Jun 2012):

• Analysis from 486 GP practices showed a statistically significant 62% increase in attendances for a persistent cough in the over 50s during the campaign period when compared with the same period in the previous year, equating to an additional 2.99 visits per practice, per week (adjusted for bank holidays)
• This resulted in a statistically significant increase of 32% in urgent GP referrals for suspected lung cancer during the campaign period, compared to the previous year

View evaluation findings from the OG regional pilot

References

1. Data from the National Cancer Waiting Times (CWT) Monitoring Dataset provided by NHS England and accessed via Public Health England’s Knowledge & Intelligence Team (East Midlands)

2. Data from Mayden (IT healthcare specialist company)

Strive to plan for an increase in GP visits during the campaign period by managing resource where possible, during this time. Distribute the 'campaign overview' briefing to colleagues and encourage them to re-visit the NAEDI website regularly over the coming months for further briefings and information.

During the campaign, GPs are advised to follow their locally agreed referral pathways for suspected oesophago-gastric cancers, to review the learnings shared by teams who participated in the regional pilot (see 'overview briefing' and 'supplementary guidance' [1]) and to use their clinical judgement when making referral decisions for dyspepsia and dysphagia. NICE guidance (August 2014) for management of dyspepsia is also available.

Further advice and information will be provided in subsequent campaign briefings, which are due to be published in November 2014.

Download a ‘campaign overview’ briefing

Download supplementary guidance for the upper GI cancer pathway, developed by the Northern England SCN during the regional oesophago-gastric pilot

Review NICE guidance for management of dyspepsia

1.The supplementary guidance aims to assist GPs in their decision making process during the campaign period, and was developed by the North of England SCN during the local pilots. Current evidence and two different sets of NICE guidance (CG27: Referral for suspected cancer and CG17 Dyspepsia: Managing dyspepsia in adults in primary care) informed development of the guidance. 

Public Health England and its partners pay for all national advertising, and campaign materials are provided to local teams free of charge. In the early years of Be Clear on Cancer, some grants were available for networks to apply for, to help boost local activities. Such grants are no longer available.