Today is World Cancer Day 2022, the theme “Close the Care Gap” has been chosen to highlight and tackle the significant issue of cancer inequalities across the globe. Earlier this week, we looked at the problem and impact of cancer inequalities across Wales, focusing on the problems caused by deprivation and Wales’s distinctive geography.
Overcoming these problems over the medium to long term will depend on Government delivering strategic leadership, resources and structural changes. However short term improvements to cancer services, improvements that are targeted at cancer inequalities are being developed and tested across Wales.
Cancer Research Wales believes strongly in the need to eliminate the inequalities of cancer incidence and mortality, so much so it’s one of our strategic aims. With the generous support of the people of Wales, we are funding the below research projects. The evidence and insight they collect will help us better understand what works in the fight against cancer inequalities, improving the lives of people affected by cancer.
There is a large disparity in cancer survival between the most and least deprived areas in Wales, caused at least in part by late diagnoses.
It is well-known that diagnosing cancer as early as possible is vital to improving cancer survival rates, but unfortunately many people do not visit their GP when they notice something is wrong. This is a particular issue in Wales, where previous studies have shown that Welsh people wait longer to attend primary care services than other comparable countries.
Increasing awareness of cancer symptoms and encouraging people to visit their GP are very important. However, standard awareness campaigns do not usually reach a wide enough audience and often fail to reach communities with the greatest cancer risk.
Cancer Research Wales are funding a feasibility study for a new type of awareness campaign designed to reach deprived communities and more effectively spread messages around cancer.
Named TIC-TOC (Targeted Intensive Community-based campaign To Optimise Cancer awareness), this study is utilising a variety of methods to drive home awareness of vague cancer symptoms. In an area with high deprivation levels people with cancer concerns are encouraged to seek help from their GP. A key element of the study is the recruitment of local cancer champions. They deliver the messages of the campaign to the widest audience in an area of deprivation through their knowledge of local businesses, community hubs and other such places. The team from Cardiff University will also use more typical marketing methods such as advertising on local buses and in local pharmacies, social media posts and slots on local radio.
The TIC-TOC study is ongoing, results are not yet available. However, we hope the study will show that their suite of methods cut through to the community in an area of deprivation in ways that typical awareness campaigns have so far been unable to achieve. If so, it should result in more people visiting their GP and earlier cancer diagnoses. That should, in turn improve cancer survival rates and contribute to closing the cancer gap between deprived communities and more affluent ones.
Rapid Diagnostic Centres for Rural Communities
Early cancer diagnosis is vital for improving survival rates, while early detection of pre-cancerous conditions can stop cancer from ever developing at all. However, both of these rely on access to, and the availability of, diagnostic equipment and staff. Most of the Health Boards across Wales have set up, or are planning to open, Rapid Diagnostic Centres for this purpose. These centres act as ‘one-stop shop’, where people with vague cancer symptoms can have a range of tests at the same place on the same day, in order to provide results in the shortest time possible and avoid the cycle of repeat referrals from GPs.
Specialist diagnostic equipment is usually found in large hospitals along with the expert staff trained to use the equipment and analyse the results. In Powys there is no such large hospital, with patients having to travel to larger centres such as Shrewsbury or Merthyr Tydfil for cancer services.
There are distinct regional inequalities for cancer in Wales, with better access to cancer services contributing to South Wales outperforming the rest of the country. Access to diagnostic services can also influence referral behaviour of GPs; the easier the access, the more likely patients are to be referred. To address these issues, Cancer Research Wales are funding a study in Powys investigating how the benefits of Rapid Diagnostic Centres can be brought to a region with no large secondary care centre.
The study, which was recently awarded one of Cancer Research Wales’ Innovation Grants, will explore the feasibility of providing Rapid Diagnostic Centre services in the mostly rural community of Powys. The team will look at different methods for delivering the diagnostic capabilities, as well as the reduced waiting times, achieved in other Health Board areas, including options such as mobile diagnostic units.
We hope that following the conclusion of their work the team will be able to make recommendations to the NHS, ensuring that rural communities do not miss out on the benefits of Rapid Diagnostic Centres. This would hopefully begin to redress the disparity between South Wales and the rest of the country.
Around half of all cancer patients will initially visit their GP with vague cancer symptoms, such as unexplained weight loss or fatigue. It is vital therefore that GPs can recognise these symptoms and understand when and where to refer patients of concern.
Cancer Research Wales funded the WICKED study (Wales Interventions and Cancer Knowledge for Early Diagnosis) which surveyed GPs and other primary care staff to investigate their knowledge and experiences.
The team found that while most GPs were confident in recognising and dealing with ‘red flag’ cancer symptoms, this was often not the case for vague symptoms. There is evidence that the national guidelines for cancer referrals are not applied equally across Wales, with some GP’s preferring to use their own judgement.
The WICKED study demonstrated that for cancer primary care is something of a postcode lottery, where patients’ experiences will differ depending on which GP practice they attend.
Building on the WICKED study findings, the team – based in Bangor University – put together a workshop named ThinkCancer. This workshop comprised 3 parts:
First, training for GPs on the use of the cancer referral guidelines and recognising vague symptoms; Second, training for other GP practice staff to improve awareness of cancer symptoms; And third, setting up safety netting processes to ensure patients don’t miss out on the care they need.
The overall aim of the workshop is to improve the primary care experience for cancer patients closing this cancer care gap across Wales. This should prevent the current disparity between different primary care practices and ensure all Welsh patients can access high quality care.