Detect Cancer Early Health Inequalities and Lung Cancer Engaging with at Risk communities

The HEAT Target: Increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25% by 2014/15

5 Year Relative Survival 20 CAN

18

AUS

16 SWE 14

NOR

12 DEN

10

UK 8 6 1995-99

2000-02

2005-07

Lung Cancer 5yr RS 1 year relative survival. Coleman et al, Lancet 2011

Diagnostic Stage & Survival Two main types of primary lung cancer: Small Cell Non-Small Cell

accounts for around 20% of lung cancers is the most common type of lung cancer, accounting for around 80% of lung cancers

5 year survival at stage of diagnosis:

Stage at Diagnosis Stage 1 Stage 2 Stage 3 Stage 4

Small Small Cell Cell 21-38% 18-38% 9-13% 1%

Non-Small Cell 13-73% 25-46% 7-24% 2-13%

Diagnostic Stage: Scotland Baseline Staging for DCE HEAT Target Area

Stage 1

Stage 2

Stage 3

Stage 4

Unknown

7.3%

23.1%

7.0%

23.3%

49.5% 49.5% 52.8%

6.9%

North of Scotland

13.1% 10.8%

South East Scotland

13.9%

8.3%

24.0%

49.3%

4.5%

West of Scotland

13.8%

6.9%

22.6%

48.2%

8.6%

NHS Scotland

6.0%

Source: Prospective Cancer Audit. Data for patients diagnosed from 01 January 2010-31 December 2011 as at 09 April 2013

Lung Cancer “Lung cancer is absolutely the hardest tumour type to tackle. Not only from a clinical point of view in terms of the difficulties around early detection, diagnosis and treatment, but also from social marketing perspective (to change attitudes and behaviours around the disease)”. Scottish Government Detect Cancer Early Campaign

Resistance to Seeing the Doctor…  This continues to be an entrenched barrier – more so for men  People feel they need a strong justification…  Deprivation impacts materially on the ability of patients to access healthcare services

 …which poses a particular issue for the early detection of lung cancer

The common associated symptoms tend to be perceived as minor complaints

Cancer of the Trachea, Bronchus & Lung: Scotland Incidence & Mortality Rates by SIMD 5=Least Deprived 4 Mortality

3

Incidence

2 1=Most Deprived 0

2000

4000

6000

8000

Source: Scottish Cancer registry, ISD (incidence): National Records of Scotland (NRS) (mortality & populations) September 2014

Deprivation & Smoking Current Cigarette Smokers in Fife as at 2011

SIMD Quintiles: Q1 [MDQ] - Q5 [LDQ]

Current Smokers Q5

14.8

Q4

17.8

Q3

26.6

Q2

30.2

Q1

40.8 0

10

20

30

Percentage

40

50

People with lung cancer caused by smoking People with lung cancer caused by something other than smoking

Lung Cancer & Deprivation

The Campaign

Rates of postneonatal infant death from sudden infant death syndrome in relation to year of birth, for all deprivation categories and most deprived (category 6 and 7) and least deprived (category 1 and 2) areas.

Wood A M et al. BMJ 2012;344:bmj.e1552

Inverse Care Law Dr Julian Tudor Hart “The availability of good medical care tends to vary inversely with the need for the population Served” The Lancet February 1971

“Deprivation affects the incidence of and mortality associated with cancers. It also impacts materially on the ability of patients to access healthcare services. It is essential that any consultation or other opportunity where a patient from a deprived area presents with symptoms suggestive of possible cancer is used to full advantage.” Scottish referral guidelines for suspected cancer 2014

The Fife Project Focus on SIMD areas 1 & 2 Target Smokers

& Ex-Smokers Screen for symptoms

0800 025 3000

DCE-Lung Cancer Screening Tool & Pathway 2013 Incorporating The Scottish Referral Guidelines for Suspected Cancer 2013

NO

Complete parts A&B of XP form Provide x-ray card & Pt Info Send XP form to Project Manager

Suspicion

Practitioner Non-Medical Referrer?

Refer to GP requesting appointment for 5 working days following x-ray

Suspicion Remains

YES

Any Signs & Symptoms? A Haemoptysis (Any) Unexplained or persistent (i.e. >3 weeks): B Cough (persistent/changed) C Chest**/shoulder pain D Hoarseness E Dyspnoea YES F Finger Clubbing (new) G Weight loss H Fatigue in smoker >50 yrs

Refer

YES

NO

Not Currently Diagnosed with Lung Cancer

Refer for chest x-ray to open access clinic

Current or Ex-Smoker

NO Complete part A of XP form & send to Project Manager

Further Investigation

Aged 35 years or above YES

Community Based Keep Well/Stop Smoking Clinic

Patient

Project manager will generate referral to radiology & GP

Complete parts A,B &C of XP form: email to Project Manager Provide patient with information leaflet

Refer to GP requesting appointment within 7 working days

Any urgent symptoms including: Haemoptysis; Chest pain; Acute Shortness of Breath should be investigated immediately, speak to Duty GP or for out of hours contact NHS 24 for advice: 08454 242424 **Sudden onset of chest pain – call 999 Fiona Duff DCE Lung Cancer Strand Project Manager. Tel: 01383-565162 Email: [email protected]

Research “Exploring attitudes to reducing smoking amongst lung cancer patients and health care professionals” • To explore attitudes to reducing smoking amongst lung cancer patients who continue to smoke post diagnosis • To explore barriers/facilitators to reducing smoking amongst lung cancer patients who continue to smoke post diagnosis • To ascertain whether patients with lung cancer who smoke would like support to change their smoking behaviour, and if so, the type of intervention they would prefer • To explore health professionals’ views about raising the issue of reducing/stopping smoking with lung cancer patients who continue to smoke post diagnosis

“They maybe should stress a bit more that you should try and stop...but then again you see they can go overboard can’t they and do it too much”

“I were trying to stop....one day I said to the nurse ‘ooh I could murder a cigarette’ she said I shouldn’t be telling you this but if its really, really that bad, go downstairs and have one”

“I know myself it might not enhance my chances. It might only give me a couple of extra months, but at least I’ve tried”

Health promotion in acute care settings offers a significant opportunity to improve health and reduce inequalities, complementing action in other settings. Dr Kevin Woods Director General for Health

“If somebody does say, look I’m trying to stop, then I would support them “

“You’ve got to be really careful that you don’t give the indication that if you give up smoking you’re suddenly going to be better”

“If somebody indicates themselves that they’re thinking about quitting then I do offer and say that we have smoking cessation and if they want someone could come and speak with them”

Asked if you ever discuss smoking status with lung cancer patients 47% of respondents answered ‘Never’ or ‘Not very often’ Asked why: 10% responded: “Its not my role” 32% responded: “Already asked by someone else”

It’s Not all Doom & Gloom Updated HEAT Target Data Area

Stage 1

Stage 2

Stage 3

Stage 4

Unknown

8.6%

22.9%

7.5%

23.3%

48.3% 48.3% 52.4%

4.5%

North of Scotland

15.8% 12.5%

South East Scotland

16.9%

8.3%

23.0%

48.7%

3.2%

West of Scotland

16.5%

9.3%

22.6%

46.4%

5.2%

NHS Scotland

4.3%

Source: ISD Detect Cancer Early Data. Patients diagnosed from 01 January 2012-31 December 2013 as at 01 July 2014

Fiona Duff DCE-Lung Cancer Strand Project Manager 01383-565161/565456 [email protected]