PRESS RELEASE
Improving participation in cancer screening should be a priority
LUGANO-COPENHAGEN, 6 October 2016 – Early diagnosis of cancer is linked to better survival rates. Unfortunately, participation rates for cancer screening worldwide are low even when screening programmes are free. The ESMO 2016 Congress is showcasing five studies (1) on this important area of cancer management which look at alternative ways to overcome barriers and improve screening rates
Professor J-F Morére who conducted the EDIFICE1 survey, intended to improve insight into participation in screening programmes in France, explains, “Population commitment and physician implication in promoting screening are both necessary criteria for reaching the recommended participation goals. In this Fourth Nationwide Observational Survey, we hypothesized that individual opinions may affect physicians’ and laypersons’ attitudes toward prescribing or participating in screening; we assessed physicians’ and laypersons’ opinions, focusing on colorectal (CRC), breast (BC), cervical (CC), prostate (PC) and lung (LC) cancer screening.”
“In general, screening was more reassuring than worrying, more so for physicians than for laypersons. The official guidelines for CRC and BC screening are a good setting for GPs’ medical practice. The most widely used screening programmes (CRC, BC, CC) enable GPs to make objective prescriptions, regardless of individual opinions. In the absence of guidelines (PC), prescription rates are correlated with physicians’ confidence in screening. Reassurance in screening was found to have a positive impact on laypersons’ participation rates.”
In Australia, a patient-centred approach to improving screening participation rates was the subject of a study2 by Dr Amanda Bobridge at the University of South Australia. She comments, “The aim of this study was to investigate enablers and barriers to cancer screening and how screening participation may be improved. An overwhelming percentage of respondents to our questionnaires would support a combined cancer screening service. Offering a combined, co-located service - a 'one stop cancer screening shop' - has the potential to address barriers to screening (such as time constraints), improve participation rates and maximize utilization of public health resources.”
A significant proportion of cancer patients across Europe are diagnosed with their disease as the result of an emergency presentation (EP) to acute secondary care services 3. This route to diagnosis is associated with poorer survival and worse patient experience. Previous work has shown that EP patients usually describe a long history of symptoms (>12 weeks), and that 70% had seen their general practitioner (GP) in the days and weeks prior to presentation. Tackling EP of cancer is important when improving the outcomes of patients across Europe. In the majority of cases there are opportunities for earlier diagnosis and hence prevention of EP. Dr. Tom Newsom-Davis led a one-year pilot of a nurse-led Acute Diagnostic Oncology Clinic (ADOC) in a district general hospital. Based in the oncology department with consultant supervision of every case, the service was targeted at primary care referrals.
Newsom-Davis describes the results of this pilot, “ADOC is a novel, effective and efficient pathway for patients who might otherwise be diagnosed as part of EP. This pilot shows the feasibility of a nurse-led service based in an oncology department, and a high level of user satisfaction. This model of acute diagnostic oncology clinic should be considered as an addition to existing outpatient cancer diagnostic pathways.”
Improvement in cancer detection and treatment has led to an important increase of the number of long-term cancer survivors, many of them being at risk of a second cancer. Facing the lack of information on cancer screening practices in this population, second cancer screening among 5-year female cancer survivors was analysed4 by Marc Bendiane in France. He says, “Survivor care plans are needed to increase awareness among patients and physicians of the importance of screening patients for second cancers, which are not a recurrence of the first one. New targeted interventions must be invented to improve the participation of cancer survivors in screening programmes.”
This study found an underutilisation of mammography screening in those cancer survivors (non- breast cancer), compared with women in the general population (78% vs 87%). The study concludes that programmes to raise awareness of the risks of second cancers (which are not recurrences of their first cancer) are needed among cancer survivors and physicians.
Professor Virgilio Sacchini of the University of Milan comments, “Breast cancer screening is the most important determinant of quality of life of cancer patients after surgery. Screening decreases the chances of axillary lymph-node involvement, avoiding axillary dissections, the most worrisome sequela of cancer surgery: the arm lymphedema. We know that breast cancer screening will need more personalisation in our era of genetics, but by increasing the awareness and compliance of mammography screening, we can better identify high risk patients to involve in more specific surveillance.”
Also in France, a study5 assessed smokers’ intentions to take part in a hypothetical lung cancer screening (LCS) programme. Two comprehensive multivariate stepwise logistic regression analyses were performed in current and in former cigarette smokers to identify factors associated with the intention to take part in a LCS programme. The study authors conclude that intending to take part in LCS programs is a complex decision; explanatory factors differ between current and former smokers. Among current smokers, intended participation in screening was strongly associated with the intention to quit smoking.
Professor Sacchini concludes, “The studies being presented at the ESMO 2016 Congress should help encourage doctors and patients to respond to screening programmes proposed by national health services. Screening tests may help diagnose cancer at an early stage, before symptoms appear. When cancer is found early, it may be easier to treat or cure. In this particular period of extreme evaluation of cost/effectiveness ratio, screening is still the best investment for the health of our populations.”
-END-
Notes to Editors
References
-
Abstract 1327 P “Opinion on cancer screening: impact on prescription and participation rates” will be presented by J.-F. Morère during a Poster Session on 9 October 2016, 13:00 to 14:00 in Hall E
Abstract 1325 PD “A ‘one stop cancer screening shop’, a way of improving screening participation rates?” will be presented by A Bobridge during a Poster Discussion Session on 8 October 2016, 16:30 to 17:30 in Room Helsinski
Abstract 1375 P “Acute diagnostic oncology clinic: tackling emergency presentations of cancer” will be presented by T. Newsom-Davis during a Poster Session on 9 October 2016, 13:00 to 14:00 in Hall E
Abstract 1367 PD “Second cancer screening among 5-years women cancer survivors (French national survey vican5)” will be presented by M.K. Bendiane during a Poster Discussion Session on 8 October 2016, 16:30 to 17:30 in Room Helsinski
Abstract 1381 P “Current or former smokers: who wants to be screened?” will be presented by S. Couraud during a Poster Session on 9 October 2016, 13:00 to 14:00 in Hall E
Disclaimer
This press release contains information provided by the authors of the highlighted abstracts and reflects the content of those abstracts. It does not necessarily reflect the views or opinions of ESMO and ESMO cannot be held responsible for the accuracy of the data. Commentators quoted in the press release are required to comply with the ESMO Declaration of Interests policy and the ESMO Code of Conduct .
About the European Society for Medical Oncology
ESMO is the leading professional organisation for medical oncology. Comprising more than 13,000 oncology professionals from over 130 countries, we are the society of reference for oncology education and information. We are committed to supporting our members to develop and advance in a fast-evolving professional environment.
Founded in 1975, ESMO has European roots and a global reach: we welcome oncology professionals from around the world. We are a home for all oncology stakeholders, connecting professionals with diverse expertise and experience. Our educational and information resources support an integrated, multi-professional approach to cancer treatment. We seek to erase boundaries in cancer care as we pursue our mission across oncology, worldwide.
Abstract for 1327P
Opinion on cancer screening: Impact on prescription and participation rates
Background
The aim of the EDIFICE surveys is to improve insight into screening programs in France. We hypothesized that individual opinions may affect physicians' and laypersons' attitudes toward prescribing or participating in screening, respectively; we assessed physicians' and laypersons' opinions, focusing on colorectal (CRC), breast (BC), cervical (CC), prostate (PC) and lung (LC) cancer screening.
Methods
The 4th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1463 individuals with no history of cancer (age 40-75 y; 726 men [m], 737 women [w]) was interviewed from 12 June-10 July 2014. A mirror survey on a representative sample of 301 physicians (201 general practitioners [GP, 131 m, 70 w] and 100 oncologists [65 m, 35 w]) was conducted from 9 July-8 August. We analyzed replies stating screening to be more reassuring than worrying.
Results
In general, screening was more reassuring than worrying, more so for physicians than for laypersons (CRC 65% vs 51%, CC 74% vs 62%, PC 59% vs 43%, P < 0.05; BC 71% vs 63%, LC 45% vs 43%; not significant [NS]). Among physicians, oncologists tended to consider screening as more reassuring than worrying (BC 83% vs 66%, P = 0.05; CRC 70% vs 63%, P = 0.05; CC 83% vs 70%, NS) except for PC (49% vs 64%, P = 0.05) and LC (44% vs 45%, NS). GP declared they would prescribe screening regardless of their own opinion, i.e., whether they believe it to be reassuring or worrying (CRC 81% vs 82%, respectively, BC 93% vs 88%, LC 21% vs 15%, NS), except PC (80% vs. 64%, P < 0.01). Participation rates tended to be higher among reassured than worried laypersons (CRC 71% vs 48%, PC 63% vs 36%; P < 0.05 and BC 98% vs 96%, CC 99% vs 98%, LC 12% vs 10%, NS).
Conclusions
Physicians tend to be more reassured by screening than laypersons, and oncologists more so than GP, with the exception of PC screening. The official guidelines for CRC and BC screening are a good setting for GPs' medical practice. The most widely used screening programs (CRC, BC, PC) enable GP to make objective prescriptions, regardless of individual opinions. In the absence of guidelines (PC), prescription rates are correlated with physicians' confidence in screening. Reassurance in screening has a positive impact on laypersons' participation rates.
Legal entity responsible for the study
EDIFICE surveys are funded by Roche
Funding
EDIFICE surveys are funded by Roche
Disclosure
Jean F. Morère,Sébastien Couraud, Jean-Yves Blay, Alexis B. Cortot, Laurent Greillier, Xavier B. Pivot, François Eisinger: Honorarium fees from Roche. C. Lhomel: Employee of Roche.
All other authors have declared no conflicts of interest.
Abstract for 1325PD
A ‘one stop cancer screening shop’, a way of improving screening participation rates?
Background
It is well established that cancer screening programs can reduce morbidity and mortality, however, research demonstrates that screening programs are underutilised by the target populations. Therefore the aim of this study was to investigate enablers and barriers to cancer screening and how screening participation may be improved.
Methods
Participants who were randomly selected from northern and western suburbs of Adelaide, Australia answered online or paper based questionnaires about health issues and service utilization. Data were collected from 10th August-20th December 2015, weighted for selection probability, age and sex and analysed using SPSSv20.
Results
2,895 questionnaires were sent, with 1,562 returned (54.1%). Respondents included 754 males and 808 females with a mean age of 54.1yrs (+ 15.2). Current cancer screening participation included cervical 34.4% (CI 32.1-36.8), bowel 34.1% (CI 31.7-36.4), breast 28.7% (CI 26.5-31.0) and prostate, 17.4% (CI 15.6-19.4). Commonly cited reasons for screening participation included; preventing sickness (CI 56.1%, 53.2-59.0), maintaining health (CI 51%, 48-53.9), free program (CI 30.9%, 38.2-33.6) and family history of cancer (20.9% (CI 18.7-23.4). The most common screening barrier was irrelevance of screening to the person (CI 20.8%, 17.2-24.8), with a small proportion stating time (CI 6.9%, 4.9-9.7) and cost restraints (CI 5.2%, 3.5-7.7). Ninety three percent (CI 91.7-94.2) of respondents thought cancer screening was beneficial, with the majority (85.3%, CI 83.4-86.9) supporting the concept of different types of screening being provided at the one site.
Conclusions
Participation rates in individually offered cancer screening programs (colorectal, breast, cervical) remain low. The enablers and barriers to screening participation cited in this study are in concert with those in the published literature, however, an overwhelming percentage of respondents would support a combined cancer screening service. Offering a combined, co-located service - a 'one stop cancer screening shop' has the potential to address barriers to screening (such as time constraints), improve participation rates and maximize utilization of public health resources.
Legal entity responsible for the study
SA Health, The University of Adelaide, the University of South Australia, The Queen Elizabeth Hospital, the Lyell McEwin Hospital and the Institute of Medical and Veterinary Science
Funding
SA Health
Disclosure
All authors have declared no conflicts of interest.
Abstract for 1375P
Acute diagnostic oncology clinic: tackling emergency presentations of cancer
Background
A significant proportion of cancer patients across Europe are diagnosed with their disease as the result of an emergency presentation (EP) to acute secondary care services. This route to diagnosis is associated with poorer survival and worse patient experience. Previous work has shown that EP patients usually describe a long history of symptoms (>12 weeks), and that 70% had seen their general practitioner (GP) in the days and weeks prior to presentation. Tackling EP of cancer is important when improving the outcomes of patients across Europe. In the majority of cases there are opportunities for earlier diagnosis and hence prevention of EP.
Methods
We ran a 1-year pilot of a nurse-led Acute Diagnostic Oncology Clinic (ADOC) in a district general hospital. Based in the oncology department with consultant supervision of every case, the service was targeted at primary care. Referral criteria: age >18 years, clinical or radiological suspicion of cancer, clinically unable to wait 2 weeks for a standard urgent suspected cancer referral. Patient demographics, clinic activity, investigations and diagnoses were recorded. Formal patient and GP feedback was sought from all users.
Results
Seventy-seven referrals were received, of which 46 (60%) fulfilled the criteria and were accepted. All were seen within 24 hours of referral. Median time from referral to definitive diagnostic test was 7.4 days (range 1-19), and 22 patients (48%) were diagnosed with cancer. Eleven patients (24%) required non-elective hospital admission. An average of 1.43 radiological and 0.20 endoscopic investigations were undertaken per patient, of which 58% were completed at the first clinic visit. A wide range of cancer diagnoses were made, including lung, myeloma, gastrointestinal, breast and lymphoma. Two patients declined or were too unwell to undergo biopsy. Patient and GP feedback showed a high level of user satisfaction.
Conclusions
ADOC is a novel, effective and efficient pathway for patients who might otherwise be diagnosed as part of EP. This pilot shows the feasibility of a nurse-led service based in an oncology department, and a high level of user satisfaction. This model of acute diagnostic oncology clinic should be considered as an addition to existing outpatient cancer diagnostic pathways.
Clinical trial identification
N/A
Legal entity responsible for the study
Chelsea & Westminster Hospital NHS Trust
Funding
Cancer Research UK Macmillan NHS England
Disclosure
All authors have declared no conflicts of interest.
Abstract for 1367PD
Second cancer screening among 5-years women cancer survivors (French National Survey VICAN5)
Background
Cancer survivors have an increased risk (36%) to develop cancer compared to the non-cancer population. Improvement in cancer detection and treatment has led to an important increase of the number of long-term cancer survivors, many of them being at risk of second cancer. Face to the lack of information on cancer screening practices in this population, we decided to study such practices among women cancer survivors using the VICAN5 data. We selected women because in France, organised breast cancer screening program has been implemented (mammography) since 2004 (every 2 years between 50 and 74 years) and national recommendations exist for cervical cancer screening (Pap smear) (every 3 years between 25 and 65 years).
Methods
VICAN5 is the first national French survey on life conditions, prevention practices and medical follow-up of cancer survivors five years after diagnosis. Data has been collected from patient questionnaire, personal medical file and medical insurance databases. Patient questionnaire includes questions on new cancer screening before interview. Univariates and multivariate analyses have been performed to compare cancer women to French non-cancer women regarding their screening practices.
Results
VICAN5 surveyed 1149 women including 654 (60%) women with non-breast cancer and 1011 (88%) with non-cervical cancer. We found an underutilization of mammography screening in the non-breast cancer group compared with women in the general population (78% vs 87%).Concerning report of Pap smear in the 3 past years, no significantly differences were found between non-cervical cancer survivors and the general population (83% vs 81%). Use of a Pap smear test is strongly associated with having had a screening mammography. Several associated factors with tertiary prevention practices was found such as psychological state (anxiety level), physical characteristics (BMI) and life style (tobacco use).
Conclusions
Survivorship care plans are needed to improve information of survivors, and to increase physicians' awareness of the importance of tertiary prevention, especially among the cancer survivors who are at high risk to develop a second cancer.
Legal entity responsible for the study
French National Institute of Health and Medical Research (Inserm)
Funding
French National Institute for Cancer (INCA)
Disclosure
All authors have declared no conflicts of interest.
Abstract for 1381P
Current or former smokers: Who wants to be screened?
Background
Lung cancer screening (LCS) with annual low-dose CT scans reduced specific and overall mortality in a selected population (age 55-74 yrs, current or former [quit < 15 yrs ago] smokers [> 30 pack-years]). Participation is key to successful screening programs. We assessed smokers' intention to take part in a hypothetical LCS program for smokers.
Methods
The EDIFICE French nationwide observational surveys assess behavior related to cancer screening programs. EDIFICE 4 was conducted from June 12 to July 10 2014 by phone interviews of a representative sample of 1602 subjects (age 40-75 yrs) using the quota method. To identify explanatory factors associated with the intention to take part in a LCS program, we performed 2 comprehensive multivariate stepwise logistic regression analyses: (i) in current and (ii) in former cigarette smokers (who quit < 15 yrs ago).
Results
Among those with no personal history of cancer (N = 1463), 263 current and 170 former cigarette smokers were analyzed in the 2 regression models; 36.4% and 26.3% respectively, intended taking part in a LCS program. In current cigarette smokers, the following were explanatory factors of the intention to take part: have been already screened for lung cancer (OR = 2.81; 95% CI [1.37-5.91]; P < 0.01); smokers < 30 pack-years (OR = 2.69 [1.21-6.30], P = 0.02); intention to stop smoking (OR = 1.96 [1.04-3.75], P = 0.04); low EPICE score (no precarity) (OR = 2.15; 95% CI [1.16-4.08], P = 0.02). In contrast, women (OR = 0.28; 95% CI [0.15-0.52], P < 0.01) were less inclined to undergo screening. Participation in other cancer screening programs, the Fagerström score, use of e-cigarettes, previous attempts to quit, and eligibility for screening were not significantly explanatory factors. Among former cigarette smokers, those with no comorbidities were less inclined to participate (OR = 0.31; 95% CI [0.11-0.74], P = 0.01) while other variables were not explanatory. Again, eligibility for screening was not significantly explanatory.
Conclusions
Intending to take part in LCS programs is a complex decision. Explanatory factors differ between current and former smokers but usual eligibility criteria are not significantly explanatory. Among current smokers, intended participation is strongly associated with the intention to quit smoking.
Legal entity responsible for the study
The EDIFICE surveys are funded by Roche
Funding
The EDIFICE surveys are funded by Roche
Disclosure
S. Couraud, L. Greillier, X. Pivot, J.-Y. Blay, J-F. Morère, F. Eisinger, A. B. Cortot: Honorarium fees from Roche. C. Lhomel: Employee of Roche. All other authors have declared no conflicts of interest.