The former North of England Cancer Network, now part of the Northern England Strategic Clinical Networks, worked with the Department of Health, Public Health England and Cancer Research UK on two regional pilots for Be Clear on Cancer: ‘blood in pee’ (bladder and kidney cancers) and oesophago-gastric. 

The Government having stated its ambition to prevent 5,000 avoidable deaths, the Cancer Network created a local initiative to ‘save 1000 lives’ across its footprint. Goals for both national and local teams were aligned. Locally, the team had to tackle low levels of awareness of cancer symptoms. 

The Department of Health, Public Health England and Cancer Research UK (CRUK) were looking for areas with a high incidence and mortality of specific cancer types and a willingness to host pilot ‘Be Clear on Cancer’ campaigns. 

Objectives for the regional pilots were three-fold. Firstly, the team wanted to test the ‘blood in pee’ and oesophago-gastric cancer campaigns, to see if they were suitable for scaling up to a national level. This included learning about the subtleties of each campaign and starting to formulate plans for a wider roll out should evaluation results prove positive. 

Secondly, they wanted to use the campaigns locally as a catalyst and an opportunity to review the patient pathways, bring secondary and primary care colleagues together and to focus on cancers of particular interest in the Northern area. 

Both the central and local teams already had structures and processes in place to look at early diagnosis, including steering groups, expert panels and programme delivery boards. This system was built on for the regional pilots. 

As a pilot, listening to feedback and being responsive to it were essential. Although certain elements of the pilots were fixed, others could be shaped, for example stakeholder engagement. As activity started and people presented with symptoms, new aspects of evaluation came to light were added to the list of metrics. 

Clearly defined roles and responsibilities enabled the teams to work quickly and to the same end. Weekly calls between the Network and CRUK, supplemented by fortnightly calls with the various partners, kept information flowing. 

Recognition of ‘blood in pee’ as a warning sign rose from 41% to 65% post-campaign. There was a 32 per cent increase in GP visits for macroscopic haematuria, a 28% increase in urgent GP referrals for suspected urological cancer and significant growth in bladder and kidney cancers diagnosed following an urgent referral. 

The national ‘blood in pee’ campaign strengthened regional results. 

There were a number of learning points. The first of these involved risks. Leaders within the Network were prepared to take calculated risks in supporting pilot campaigns without knowing what the impact would be. 

The ‘blood in pee’ campaign involved the Network’s first direct mailing, a collaboration between the central team and local cancer managers. 

The Network hosted a local oesophago-gastric pilot campaign based on persistent heartburn/ indigestion and food sticking. It was decided to focus on just one symptom, dyspepsia, for regional activities. 

Heartburn is a common symptom and the GPs wanted more help with potential early signs of cancer. The Network provided insight from the local pilot, working with clinicians to develop guidance.  A GP representative said that this referral guidance had been a key part of the pre-campaign communications.  Just knowing it was available was reassuring.