Introduction The first national ‘Be Clear on Cancer’ lung cancer campaign ran for 6 weeks from May 2012 with the message ‘Been coughing for 3 weeks? Tell your doctor’. During this time there was a 32% increase in 2 week wait (2 WW) referrals, with approximately 700 additional cancers diagnosed compared to 2011.
Method We studied the effect of the 6 week campaign in 2013 on 2 WW referrals to Imperial College NHS trust, comparing with referrals in the 6 week period prior to the campaign. We assessed quality of the referral based on completeness of the 2 WW proforma (scored out of 10), and the outcome of the referral. Direct radiology referrals were not included.
Results The campaign period was 2nd July to mid-August 2013. We studied from 15th May until 15th August 2013. Our referrals increased by 52% during the campaign (25 vs 38). The referral quality was unchanged (average score 6.24 pre-campaign and 6.65 during the campaign, p = 0.41). The proforma was used in 20/25 referrals pre-campaign and 30/38 during the campaign. Table 1 shows the results of the patient information section. Patients received less information during the campaign (p=ns).
Diagnoses There were more referrals diagnosed with lung cancer pre-campaign than during it (37.5% vs 13.9% p = 0.055). One patient in the campaign group was diagnosed with lymphoma. The pre-campaign group had normal investigations in 16.7% patients, with other diagnoses made in 45.8% compared to the campaign group which had 22.2% (p = 0.6) and 61.1% (p = 0.25) respectively.
There was no significant increase in referrals with a cough as the only symptom (7/25 vs 11/38 p = 0.95).
In the campaign group, in patients diagnosed with lung cancer, we found a significant improvement in referral score compared to those without cancer (8 vs 4.87, p = 0.01). There was no change in the pre-campaign group.
Conclusion Our 2 WW referrals increased during the campaign but fewer patients were diagnosed with lung cancer and more received a non-cancer diagnosis. During the campaign, referral forms for those without cancer were poorly completed which may represent pressure on GPs to refer coughs through the 2 WW pathway despite low suspicion.