Effectiveness of signs and symptoms campaigns for lung cancer

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Effectiveness of `signs and symptoms' campaigns for lung cancer: a rapid review

Ross Gordon, Christopher Magee, Sandra Jones, Lyn Phillipson, Lance Barrie

An Evidence Check review brokered by The Sax Institute for the Cancer Institute NSW October 2012

This rapid review was brokered by The Sax Institute.

This report was prepared by: Ross Gordon, Christopher Magee, Sandra Jones, Lyn Phillipson and Lance Barrie Centre for Health Initiatives, University of Wollongong.

October, 2012.

? Cancer Institute NSW, 2012

This work is copyright. No part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968.

Enquiries regarding this report may be directed to: Knowledge Exchange Program The Sax Institute Level 2, 10 Quay Street Haymarket NSW 2000 PO Box K617 Haymarket NSW 1240 Australia T: +61 2 95145950 F: +61 2 95145951 Email: knowledge.exchange@.au

Suggested Citation: Gordon R, Magee C, Jones S, Phillipson L, Barrie L. Effectiveness of `signs and symptoms'campaigns for lung cancer: an Evidence Check rapid review brokered by The Sax Institute (.au) for the Cancer Institute NSW, 2012.

Disclaimer: This Evidence Check review was produced using the Evidence Check methodology in response to specific questions from the commissioning agency. It is not necessarily a comprehensive review of all literature relating to the topic area. It was current at the time of production (but not necessarily at the time of publication). It is reproduced for general information and third parties rely upon it at their own risk.

Contents

EXECUTIVE SUMMARY ............................................................................................................ 5 1 Introduction .................................................................................................................... 8

Lung cancer `signs and symptoms' ..................................................................................... 9 The present review................................................................................................................... 9 2 Methods........................................................................................................................ 11 Literature review..................................................................................................................... 11 Methods for assessing the quality of evidence................................................................ 12 3 Results ........................................................................................................................... 13 Overview of lung cancer `signs and symptoms' interventions..................................... 13 `Signs and symptoms' interventions ? breast, colorectal, and prostate cancer ...... 17 4 Discussion ..................................................................................................................... 21 5 Gaps in the literature ................................................................................................... 23 6 Recommendations....................................................................................................... 24 References ........................................................................................................................... 25 Appendices Appendix A. Quality grading...................................................................................................... 27 Appendix B. Lung cancer interventions with a `signs and symptoms' component ....... 28 Appendix C. Breast, colorectal and prostate cancer interventions with a `signs and

symptoms' component ....................................................................................... 31

EXECUTIVE SUMMARY

Lung cancer has the lowest survival rate of all cancers in adults, with only 13% of affected individuals in Australia surviving for five or more years following a diagnosis. It is generally recognised that early diagnosis of lung cancer could be an important factor in improving both the survival rate and patients' quality of life. One way to facilitate the early diagnosis of lung cancer is to improve people's awareness of the signs and symptoms of the disease (e.g. a persistent cough, coughing up blood, fatigue, and weight loss) and encourage them to attend their general practitioner (GP) for investigation of potential symptoms.

The objective of this rapid review was to identify and examine lung cancer `signs and symptoms' interventions which have been developed in Australia and OECD countries with similar healthcare settings (i.e. New Zealand (NZ), Canada, and the United Kingdom (UK)). This involved assessing the effectiveness of these interventions on influencing knowledge, attitudes, beliefs, and help seeking behaviours (e.g. GP visits) in the general community and at-risk groups (e.g. smokers, individuals from a low socio-economic background, culturally and linguistically diverse (CALD) communities. In addition, the effectiveness of interventions designed to influence the knowledge, attitudes, beliefs, and behaviours of health professionals was also examined.

A review of the academic and grey literature resulted in the identification of eight lung cancer `signs and symptoms' interventions: `I'll tackle it soon' (UK), `3 Week Cough' (UK), `Be Clear on Cancer' (UK), `Cough, cough, cough' (NZ), `The Sooner the Better' (NZ), `The Australian Lung Foundation' (various programs; Australia), `Find Cancer Early' (Australia), and `Detect Cancer Early' (UK). The primary aim of all of these interventions was to raise awareness of the signs and symptoms of lung cancer, and increase help seeking behaviour (e.g. seeking help from a GP or other healthcare professional). The interventions typically targeted a single sign and symptom (i.e. a persistent cough lasting for three weeks or more). However, the `Be Clear on Cancer' intervention publicised additional lung cancer signs and symptoms such as coughing up blood, breathlessness, fatigue, chest/shoulder pain.

The evidence for the effectiveness of these interventions was very limited. For example, only two of the eight interventions had any evaluation data (`I'll tackle it soon', and `3 Week Cough'). These data did indicate that the interventions had positive effects. For example, `I'll tackle it soon' led to a significant increases in GP visits for lung cancer, along with a 20% increase in chest x-rays and a 27% increase in lung cancer diagnoses. The `3 Week Cough' intervention similarly led to a 23% increase in GP attendances for patients with a cough or other symptoms of lung cancer. Unfortunately, in addition to being limited in quantity, the quality of the evidence was assessed as being low.

There was also no indication of whether these `signs and symptoms' interventions led to changes in knowledge, attitudes, or beliefs. There were no data examining the effectiveness of these interventions on relevant at-risk populations such as individuals from lower socio-economic groups, indigenous groups, or CALD communities. Furthermore, although some of the interventions indicated that they included a component targeted towards health professionals, there are no published data examining the effects of these health professional components. As a consequence, it is not possible to determine whether lung cancer `signs and symptoms' interventions are effective in influencing health professionals' knowledge, attitudes, beliefs, and relevant behaviours.

The very limited data for lung cancer `signs and symptoms' interventions led to an expansion of the review to also encompass `signs and symptoms' interventions for other relevant cancers such as breast cancer, prostate cancer, and colorectal cancer (a preliminary search was also

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EXECUTIVE SUMMARY

conducted for chronic obstructive pulmonary disease interventions, but recent published data were not available). This resulted in the identification of 11 relevant interventions for which evaluation data were available: five of these were for breast cancer, four for colorectal cancer, and two for prostate cancer.

These interventions did focus on increasing awareness of cancer signs and symptoms, but had a range of other goals such as increasing visits to GPs and screening, and increasing detection rates of cancer. The evaluation data were considerably more detailed for these cancers relative to lung cancer. Several of the interventions led to significant improvements in knowledge and awareness of cancer signs and symptoms. For example, the `Be Clear on Cancer' colorectal cancer campaign led to approximately 50% increase in awareness of symptoms (e.g. `blood in poo'). The `Learn, Share and Live' intervention led to an increase in the percentage of women who indicated that they had recently been screened for breast cancer (from 40% to 68%). Furthermore, the `Screen for Life' intervention was associated with a 19.3% increase in screening rates for colorectal cancer between 2002 and 2008. There was also evidence of increases in visits to healthcare professionals. For example, `Be Clear on Cancer' led to a 48% increase in GP visits for colorectal cancer signs and symptoms.

Unfortunately, the quality of the evaluation data was generally low. Therefore, although these interventions generally had positive effects on the outcome measures these need to be interpreted with caution. In particular, there is a need for more rigorous research designs (e.g. randomised control trials (RCTs), or well-designed observational studies that yield extremely large and consistent estimates of the magnitude of an intervention effect) to better determine the effectiveness of these interventions. Furthermore, as per the lung cancer `signs and symptoms' interventions, evaluation data did not identify factors that influenced the effectiveness of these interventions, or whether effectiveness varied according to socio-economic or CALD status.

The results of this rapid review indicate that very few `signs and symptoms' interventions for lung cancer have been developed and trialled in Australia, NZ, the UK and Canada. Based on the available data it is concluded that:

Question 1a. `Signs and symptoms' interventions may be effective influencing knowledge, attitudes, beliefs and help seeking behaviours such as visits to a GP or taking up screening. However the evidence base is limited, especially in relation to lung cancer, with some limited evidence from other cancer interventions suggesting a positive effect.

Question 1b. There is very limited published evidence of the effectiveness of lung cancer `signs and symptoms' interventions targeted towards at risk population groups.

Question 2. There is insufficient evidence to make any conclusions regarding interventions targeted towards health professionals

Based on the available evidence, the following recommendations are made for developing lung cancer `signs and symptoms' interventions in NSW.

1. Interventions should be based on rigorous formative research with target population groups and stakeholders to generate understanding and useful insights regarding knowledge, attitudes, and behaviours, and explore issues, influences and barriers to increasing awareness and changing behaviour

2. Segmentation of target populations ? beyond simple demographic based approaches, but using formative research to identify psychographic audience segments can facilitate targeted and tailored intervention messages

3. Capacity building and training with relevant stakeholders such as healthcare professionals can be helpful to alleviate concerns over resources and build support for intervention aims and objectives

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