Early diagnosis of lung cancer: evaluation of a community-based social marketing intervention
- 1Chest Clinic, Doncaster Royal Infirmary, Doncaster, UK
- 2Academic Unit of Respiratory Medicine, Department of Infection and Immunity, Medical School, University of Sheffield, Sheffield, UK
- 3Public Health, NHS Doncaster, Doncaster, UK
- 4Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
- 5Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
- Correspondence to Dr Victoria Athey, Chest Clinic, South Block, Doncaster Royal Infirmary, Armthorpe Road, Doncaster DN2 5LT, UK;
Contributors TKR, RS and AMT formed the research development and steering committee. VLA undertook all the data extraction with data analysis performed by SJW. The manuscript was predominantly drafted by VLA and TKR with all authors involved in its revision. The final draft was approved by all authors.
- Received 30 June 2011
- Accepted 15 September 2011
- Published Online First 2 November 2011
Background Poor UK lung cancer survival rates may, in part, be due to late diagnosis.
Objectives To evaluate the effectiveness of a mixed-method community-based social marketing intervention on lung cancer diagnoses.
Methods A public awareness campaign in conjunction with brief intervention training in general practices was piloted in six localities with a high lung cancer incidence. End points were self-reported awareness of lung cancer symptoms; intention to seek healthcare; chest x-ray referral rates in primary care; secular trends in the incidence of lung cancer and stage at diagnosis, compared before and after the intervention.
Results 21% (128/600) (95% CI 18% to 25%) of the targeted population recalled something about the campaign. Compared with a responder in the control area, the odds of a responder in the intervention area saying that they would visit their general practitioner and request a chest x-ray for a cough was 1.97 times (95% CI 1.18 to 3.31, p=0.01). Primary care chest x-ray referral rates increased by 20% in the targeted practices in the year following the intervention compared with a 2% fall in the control practices. The difference was highly significant, with an incidence rate ratio of 1.22 (95% CI 1.12 to 1.33, p=0.001). There was a 27% increase in lung cancer diagnoses in the intervention area compared with a fall in the control area. The incidence rate ratio was 1.42 (95% CI 0.83 to 2.44 p=0.199).
Conclusion This is encouraging early evidence that an awareness and early recognition initiative may facilitate lung cancer diagnosis.
- Early diagnosis
- lung cancer
- social marketing
- chest radiograph
- primary care
- systemic disease and lungs
- interstitial fibrosis
- clinical epidemiology
- bacterial infection
- infection control
- non-small cell lung cancer
- small cell lung cancer
Funding This work was funded by NHS Doncaster (Inequalities fund) and Yorkshire and the Humber Strategic Health Authority (Social marketing collaborative).
Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) VLA, RS, AMT, SJW and TKR received no support for the submitted work; (2) SJW receives occasional consultancy fees for statistical advice in medical negligence claims, payment for training courses on the design and analysis of quality of life measures to statisticians in the pharmaceutical industry and Takeda Plc and book royalties from publishers including John Wiley and Sons Ltd, Blackwell Publishing and Hayward Medical Communications. The department for which SJW works (ScHARR, University of Sheffield) has contracts and/or research grants with the NIHR, HTA and NICE and he is co-applicant on several NIHR portfolio studies. VLA, RS, AMT and TKR have had no relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) RS provides public health representation on the National Awareness and Early Diagnosis Initiative steering group. SJW is an independent member of the NICE Public Health Interventions Advisory Committee (PHIAC). VLA, TKR and AMT have no non-financial interests that may be relevant to the submitted work.”
Ethics approval The evaluation was discussed with the local research ethics committee who felt that it fell under the remit of service evaluation/audit and as a result did not require ethics approval.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Practice level data, used for the statistical analysis, is available from the corresponding author ( ) on request. Consent was not obtained but the presented data are anonymised and risk of identification is low.