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NHS Kirklees Report

CAM Survey for NHS Kirklees

35 ENDELL STREET • LONDON • WC2H 9BA • TEL: 020 7240 7200 • FAX: 020 7240 7201 May 2010 Page 1 of• 34  Quadrant  Email: quadstaff@qcl.co.uk Website: www.qcl.co.uk


NHS Kirklees Report

STRUCTURE AND CONTENTS 1. NHS KIRKLEES CANCER AWARENESS SUMMARY

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2. UNDERSTANDING THE CANCER AWARENESS MEASURE The objectives of the CAM and scope of the questionnaire Interpretation and sample sizes Design and methodology of the Kirklees study

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3. KNOWLEDGE ABOUT CANCER Presence of cancer in respondents’ lives Awareness of cancer incidence (Q8) Awareness of symptoms (Q1, 2) Awareness of most common cancers (Q9)

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4. KNOWLEDGE OF FACTORS INFLUENCING CANCER Awareness of influencing factors (Q6, 7) Ranking of influencing factors (Q11)

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5. TREATMENT AND SCREENING Awareness and knowledge of screening programmes (Q10) Responsiveness to symptoms (Q3, 4) Barriers to seeking treatment (Q5)

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6. QUESTIONNAIRE The CAM questionnaire

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1. NHS KIRKLEES CANCER AWARENESS SUMMARY Knowledge about cancer: summary The Value of Personal Experience Three-quarters of all respondents in this NHS Kirklees survey knew someone who had suffered cancer. This personal experience grows understanding considerably, with positive effects on alertness to symptoms and seeking treatment quickly. People diagnosed with cancer can positively benefit their friends and family by sharing their experience. Embarrassment or not wanting to cause a fuss prevent people learning about cancer, especially as symptoms are not always apparent to other people. The use of other personal examples that people can identify with, can also be beneficial. Jade Goody’s experience may have grown awareness of cervical cancer and screening, while testicular cancer among sports stars like Lance Armstrong and John Hartson may have increased awareness among men. Both of these cancers are considered to be far more frequent by the public than is really the case. Symptoms must be more clearly associated with cancer Symptom awareness is dominated by the obvious – lumps or swelling, bleeding and pain. Those symptoms which creep up more slowly, or are harder to spot in friends and family, need a clearer association with cancer to get people taking them seriously. Symptoms such as changes to the skin, to bowel or bladder habits have lower salience in people’s minds, and result in people seeking diagnosis less quickly. People need the association spelt out for them, through both frontline healthcare professionals and education or marketing activities. Skin cancer is not taken seriously enough Skin cancer is the one clear example where incidence is grossly underestimated by the Kirklees public. The more prevalent non-melanoma skin cancers may not be as dangerous as melanomas, but members of the public aren’t usually qualified to make the distinction. The dangers of sunburn and skin cancer need to be made more tangible in people’s minds, as people don’t take it seriously enough.

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Knowledge about cancer: summary Smoking clouds other factors Smoking is the only influencing factor definitely recognised by more than half (57%) of NHS Kirklees respondents. The power of smoking’s association with cancer took decades to become socially established. Other lifestyle influences such as exercise levels, diet and alcohol consumption are not yet sufficiently accepted in people’s minds. Knowledge of the connection between HPV and cervical cancer is also not well-enough established yet. One in four prefer to leave it to chance Nearly a quarter of respondents consider chance to be the no.1 contributing factor. This group are not easy to classify by gender, age or education as they cross the spectrum. Symptom awareness helps drive speed of response As a general rule, people are more likely to seek treatment quickly for the swift arrival of an alarming symptom, such as bleeding or difficulty swallowing. However, awareness of lumps or swelling, and the change in appearance of a mole as cancer signs mean that these get quicker responses than many other symptoms. Of greater concern are more slow-moving and less alarming symptoms. People need reassurance that they can seek a doctor’s opinion on things like a cough, a change in bowel habits or weight loss. People fear both a positive and a negative diagnosis A major barrier to seeking a doctor’s appointment is fear of what might be found: people are afraid to be told they might have cancer, but also fear wasting the doctor’s time if it transpires that they don’t have it. Communication of the risks of not seeking diagnosis could include both the personal risks, and the impact on others: if people considered the cost to their friends, family and society of not being diagnosed quickly it may push them to seek appointments earlier.

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2. UNDERSTANDING THE CANCER AWARENESS MEASURE The scope of the CAM questionnaire This report summarises the results of the Cancer Awareness Measure (CAM) survey conducted in the NHS Kirklees area in February 2010, as part of a series of surveys within the Yorkshire Cancer Network. This particular report is a summary of findings in the NHS Kirklees area, and should be read in conjunction with the main CAM report for the broader Yorkshire Cancer Network. This is because the larger research sample size for the whole network allows more detailed analysis and interpretation. The smaller sample size within each PCT means that some conclusions are not statistically valid at PCT level, and as a result some of the key conclusions about cancer awareness in Yorkshire can only be found in the main report. The objective of the study is to benchmark NHS Kirklees adultsʼ awareness of possible cancer symptoms, anticipated time taken to seek diagnosis, and perceived barriers to seeking an appointment. The questionnaire follows a standardized design for the Cancer Awareness Measure adopted across the NHS, and a copy can be found at the end of this report. In summary, the CAM questionnaire assesses:· · · · · · · ·

Awareness of possible signs of cancer: respondents are first asked to name as many as they can without prompting, and are then asked if they agree with a range of named signs being possible symptoms of cancer Time taken to seek an appointment: if they experienced each of the signs discussed, respondents are asked how long they would wait before seeking a doctorʼs appointment. Barriers to seeking an appointment quickly: respondents are asked what would prevent them from doing so Awareness of possible factors influencing cancer: respondents are first asked to name as many as they can without prompting, and are then asked if they agree with a range of possible influences on a personʼs chance of developing cancer Expectation of the incidence of cancer: respondents are asked to estimate how many people in every 100 will develop cancer at some point in their lives. Awareness of the most common cancers in men and women: respondents are asked to name what they think is the first, second and third most common cancer for each gender. Awareness of NHS screening programmes: respondents are asked if they are aware of national screening programmes for breast, cervical and bowel cancers, and the age at which they are offered. Ranking of cancer influencing factors: respondents are asked to rank lifestyle, chance, aging, environment and genetics in the order in which they believe they have an influence on a personʼs chance of getting cancer.

This CAM survey has been administered in the same way as a series of national and regional CAM studies, so enabling like-for-like comparison between this region and others. Such comparison is not included in this report.

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Sample sizes, and reliability of comparison The sample size of a piece of quantitative research is extremely important, along with how the sample is collected, in determining how confidently we can draw conclusions from the results. We are only surveying a portion of the population, so the smaller the sample size we use, the greater the possibility that our sample profile varies from that of the population as a whole. Researchers refer to the “statistical significance” of a result, and the “confidence interval” around that level of significance. Typically we are looking to be at least 95% sure that a result we are seeing in the data would be representative of the population being researched as a whole (the level of statistical significance). But in order to be so sure, we need some leeway: a number of percentage points either side of a result that is called the confidence interval. Confidence intervals are greatest on a 50% result, and least when the result is closer to 0% or 100%. As a guide to how we have interpreted the results of the CAM survey for NHS Kirklees, the table below shows confidence intervals on a 50% result for each of the major target groups used in this report.

All respondents

Confidence interval +/- on a 50% result 405 4.9

Gender Male Female

201 204

6.9 6.9

75 69 78 66 48 58 11

11.3 11.8 11.1 12.1 14.1 12.9 29.5

Ethnic origin White Non-White

352 50

5.2 13.9

Level of education 17 or younger Post 17

262 143

6.1 8.2

Sample size

Age Group U24 25-34 35-44 45-54 55-64 65-74 75+

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Owner occupier Renting or other

248 156

6.2 7.8

Working status In employment Not in employment

218 185

6.6 7.2

Marital status Single Living with partner Separated/Widowed/Divorced

128 189 85

8.7 7.1 10.6

Please note: groups in italics have been aggregated from smaller groups to create more reliable sample sizes for analysis. Results for smaller groups will be quoted only where they are significant.

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Data weighting This analysis has used unweighted data. The random location sampling, and quotas used are designed to give as representative a sample as possible of the population being surveyed. Weighting simply adjusts any shortfalls in sampling, and analysis of the sample has shown that quotas were achieved in line with targets. TARGET

ACHIEVED

difference

Gender Male Female

49% 51%

50% 50%

+1% -1%

Age 16-24 years old 25-34 years old 35-44 years old 45-64 years old 65+ years old

15% 12% 23% 30% 19%

19% 17% 19% 28% 17%

+4% +5% -4% -2% -2%

Marital Status Single Living with partner Divorced/Separated/Widowed

31% 51% 19%

32% 47% 21%

+1% -4% +2%

Property Ownership Owner occupier Other

70% 30%

61% 39%

-9% +9%

Ethnicity White Non-white

89% 11%

87% 13%

-2% +2%

Design and methodology of the NHS Kirklees area study This CAM study was conducted among 365 individuals aged 16+, living within NHS Kirklees, from 8th January to 2nd March 2010. Respondents were sampled using random location sampling, where interviewers visited selected areas of the PCT and interviewed a representative selection of the population.

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3. KNOWLEDGE ABOUT CANCER Personal experience of cancer Of the 405 respondents in our sample, 14 claimed to have had cancer themselves (4%) and 25 (7%) claimed that their partner had had it. All in all, the proportion of respondents with any experience of cancer through personal experience, family or someone they knew was 75%. The very high presence of cancer in people’s personal lives proves to be a powerful driver of increased alertness, throughout the various measures in this survey. Conversely, those with no personal experience of cancer in their lives demonstrate lower awareness, knowledge and responsiveness across the board. Younger, or single people were most likely to be in this latter group. This is commented on in more detail in the main report for the Yorkshire Cancer Network. Table 1: Experience of cancer in Kirklees people’s lives Have had cancer… Themselves Partner Member of close family

4% 7% 47%

Other family member Close friend Other friend

19% 23% 10%

Any = 75%

Awareness of the incidence of cancer Question 8 in the CAM asks respondents to indicate what proportion of every 100 people is likely to suffer from cancer in their lifetime. According to the Cancer Research UK website, the estimated actual figure is just over one in three. Respondents in NHS Kirklees tend to over-estimate incidence, with the average being given at 42 per 100 people. This is higher than the overall figure of 36 per hundred for Yorkshire as a whole. This NHS Kirklees score rises to 45 per 100 amongst the female population. However, one in five (19%) estimate incidence at 65 or more. This suggests that there is a perceived increased prevalence of cancer sufferers amongst the Kirklees population.

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Awareness of cancer symptoms The CAM questionnaire covers people’s awareness of cancer symptoms, and of the most common forms of cancer. If people are very aware of symptoms and cancer types, they could be expected to be more alert for signs of cancer in themselves or friends and family. For awareness of cancer symptoms, the CAM uses both unprompted and prompted awareness. The unprompted awareness measure (Q1) simply asks people to name as many signs or symptoms as they can. This kind of question is likely to identify those symptoms which are at the front of people’s minds, either because of well-established associations (e.g. lumps might mean a tumour), or personal experience. However, an unprompted question like this will not reflect how people might react to a symptom if they saw or felt it – this is the role of the prompted awareness question (Q2). Unprompted awareness of cancer symptoms (Q1) Despite the many possible symptoms of cancer, the average respondent only suggested just under two (1.8) in response to Q1. There were however sixteen different types of symptom suggested by respondents overall. The most mentioned symptom is lumps or swelling, mentioned by three-fifths of respondents living in NHS Kirklees. Bleeding and unexplained weight loss were mentioned by around a quarter each. Chart 1

Q1: Unprompted mentions of possible cancer signs Lumps/swelling Bleeding Unexplained weight loss Nothing Pain Change in a mole Tiredness Bowel/bladder change Other

Bruising Cough/hoarseness Generally unwell Loss of appetite Nausea Feeling weak Difficulty swallowing Blurred vision Sore that doesn't heal 0 10 20 30 40 50 60 70

0 10 20 30 40 50 60 70

Percentage of respondents mentioning

Percentage of respondents mentioning

Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405 Symptoms which might be easier to ignore for a period of time were less well cited. Tiredness was only mentioned by one in thirteen, feeling generally unwell by one in twenty five and loss of appetite by one in fifty. Only 1% mentioned feeling weak as a cancer symptom. Page 10 of 34

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Despite being associated with one of the top four cancer types (Breast, Lung, Prostate, Colorectal), a change in bowel or bladder habits was only mentioned by one in thirteen, and a cough or hoarseness by one in twenty. There are significant differences in symptom awareness across gender within the NHS Kirklees area. Women are significantly more likely to spontaneously mention a lump than men, with more than two thirds (68%) or women mentioning this compared to only just over a half of men (51%). This suggests that work done to promote breast checking is having some success. However, there is work needed to raise symptom awareness with males as one quarter (24%) were unable to spontaneously name any symptoms. Also of some concern is the high level of non-response amongst those of non-white ethnic groups. Two-fifths of those in this group were unable to mention any symptoms. Whether the respondent lives alone or with a partner also seems to have a significant impact on spontaneous awareness. In particular, those living with their partner were significantly more likely to see bleeding and weight loss as symptoms with nearly a third stating these compared to only one in seven of those who live alone. This implies that these symptoms are something that can be discussed with/noticed by relatives and loved ones. Prompted awareness of cancer symptoms (Q2) The second CAM question asks respondents whether they think any of eight specific symptoms may be a sign of cancer. Unlike the first, unprompted question on symptoms, this question doesn’t rely on respondents having a clear list of symptoms at the front of their minds. However, by the second question, the respondent is fully aware that this is a questionnaire about cancer and its symptoms, and may therefore be more alert to the link between a symptom and cancer than they might be ordinarily. Every symptom in the list was recognised by more than three-fifths of respondents as a possible sign of cancer. As with the unprompted question, a lump or swelling was recognised by most, at 93% of respondents in NHS Kirklees. Unlike in the unprompted question, the second most recognised sign was a change in the appearance of a mole, at 85%. This compares starkly with its 12% score in Q1, suggesting that this sign of cancer isn’t at the front of everyone’s minds, but that recent growing awareness about the risks of sunburn and skin cancer were planting the right seeds of knowledge in people’s minds.

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Unexplained weight loss was mentioned by just over four-fifths ( 81%), whilst bleeding and a persistent change in bowel or bladder habits were mentioned by just under four-fifths (79% and 78% respectively). Just under seven in ten mentioned persistent pain and difficulty swallowing, and a sore that doesn’t heal was mentioned by 64%. The pattern of lower awareness amongst non-white ethnic groups continues even when prompted. Across all symptoms, awareness was lower for than those from non-white rather than white ethnic groups. This is particularly pronounced for unexplained weight loss (83% vs. 64%), a change in bowel/bladder habits (80% vs. 62%) and change in appearance of a mole (88% vs. 70%). This again suggests that non-white ethnic groups continue to require education in recognising cancer symptoms Chart 3

Q1&2: Unprompted vs prompted mentions of possible cancer signs Lumps/swelling Change in apearance of a mole Unexplained weight loss Bleeding Change in bowel/bladder habits Pain Difficulty swallowing Unprompted (Q1) Prompted (Q2)

Sore that doesn't heal Cough/hoarseness 0

10

20

30

40

50

60

70

80

90

100

Percentage of respondents Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405 Awareness of the most common cancers (Q9) The CAM asks respondents which they think are the most prevalent cancers among men, and women. Respondents are asked to identify the most common, second and third most common cancers for each gender. While it is important for respondents to be aware of the cancer risks among their opposite sex, for this section we have concentrated on awareness of men’s cancers among men, and of women’s cancers among women.

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Women’s awareness of common cancers Breast cancer is accurately identified by more than seven in ten (71%) of female respondents in NHS Kirklees as the most common among women. In all, it is identified by 91% of women as one of their top three. Cervical cancer was mentioned by the second highest number (63%), despite being twelfth most common. This increased level of alertness may be due to awareness of screening tests, and wellpublicised cases such as that of Jade Goody. Most mentions were as the second most common cancer (42%), due to the high level of awareness of breast cancer. Skin cancers, the second most prevalent form in women, do not make the top three, being mentioned by only a quarter (25%). This may reflect the high proportion of non-melanoma skin cancers compared to malignant melanomas, but is still cause for concern given the significant risks associated with the latter. Lung and Ovarian cancers make up the other most frequent cancers among women. Lung cancer is only mentioned by 32% as being among the top three by women. Ovarian cancer gets low recognition, with only 16% of women citing it as one of the top three. Chart 4

Q9: Unprompted mentions of the most common cancers among women Percentage of all FEMALE respondents mentioning this in their top 3

Breast Cervical Lung Skin Ovarian Bowel Uterus Throat Stomach Liver Oral Leukeamia Bladder Lymphoma Brain

No. of new UK cases diagnosed in 2006

Breast Cervical Lung Skin Ovarian Bowel Uterus Throat Stomach Liver Oral Leukeamia Bladder Lymphoma Brain

Most common Second most common Third most common 0 10 20 30 40 50 60 70 80 90 100

0

10000 20000 30000 40000 50000

Source: 2010 CAM survey, NHS Kirklees. Base: female respondents. Sample size: 204. Diagnoses: Cancer Research UK data

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Men’s awareness of common cancers Prostate cancer gets the most mentions overall as one of the top three among men, still only mentioned by just over half (55%). It received high numbers of mentions as the most common, 41%. Prostate cancer is in fact the second most prevalent among men behind skin cancer. Lung cancer, the third most common cancer amongst men, gets the second highest number of mentions overall at 54%. Testicular cancer was third most mentioned overall at 36% contrasting with the real incidence ranking of twelfth. As with women’s raised alertness to cervical cancer, celebrity cases of testicular cancer among sportspeople in particular may have helped awareness. Bowel cancer, despite being nearly as prevalent as lung cancer was only fourth most mentioned with just over a third (34%) saying this. Although awareness of the incidence of skin cancer is low amongst women, it is particularly low amongst men. Only 15% of men recognised this despite having the highest number of cases diagnosed in 2006. The overall levels of awareness of the top cancers among men are notably lower than for women (where nearly all mentioned breast cancer). The overall weakness of these scores suggests that these kinds of communications with men are less successful than with women. Chart 5

Q9: Unprompted mentions of the most common cancers among men Percentage of all MALE respondents mentioning this in their top 3

Prostate Lung Testicular Bowel Skin Throat Stomach Breast Liver Pancreatic Bladder Brain Leukeamia Oral

No. of new UK cases diagnosed in 2006

Prostate Lung Testicular Bowel Skin Throat Stomach Breast Liver Pancreatic Bladder Brain Leukeamia Oral

Most common Second most common Third most common 0 10 20 30 40 50 60 70 80 90 100

0

10000 20000 30000 40000 50000

Source: 2010 CAM survey, NHS Kirklees. Base: male respondents. Sample size: 201. Diagnoses: Cancer Research UK data Page 14 of 34

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4. KNOWLEDGE OF FACTORS INFLUENCING CANCER Awareness of influencing factors In the same way as for awareness of the different types of cancer, the CAM asks respondents if they know what things affect the chances of someone getting cancer, firstly as a spontaneous, and then as a prompted question. The respondent is first asked to name as many possible factors as they can, before being asked about eleven specific examples. Unprompted awareness of influencing factors (Q6) On average, respondents in NHS Kirklees were only able to spontaneously mention 1.8 things that might affect the chances of getting cancer. However, smoking stood out as the most recognised contributory factor, mentioned by nearly three-fifths (57%) of respondents. Aside from smoking, only drinking was mentioned by over a fifth of respondents. Chart 6

Q6: Unprompted mentions of factors influencing the chance of getting cancer Smoking Drinking Diet Family history Overweight Sunburn Not enough exercise Pollution

Stress Radiation Food additives Older age High fat diet Infections Contraceptive pill / HRT Many sexual partners 0 10 20 30 40 50 60 70

0 10 20 30 40 50 60 70

Percentage of respondents mentioning

Percentage of respondents mentioning

Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405 The high unprompted awareness of smoking as a potential cause of cancer perhaps suggests a simplified understanding and categorisation of cancer in people’s minds. The gap between the first and second-most mentioned factors is more pronounced than in Yorkshire as a whole. Smoking had over double the number of respondents mentioning it than the second mostmentioned factor in Yorkshire (59% vs. 28%), however the gap is wider in NHS Kirklees (57% vs. 21%). This suggests that in NHS Kirklees respondents have made the connection between smoking and cancer, but the message that there are many other contributory factors still needs to be delivered and understood.

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The influence of family history and genetics was surprisingly less widely mentioned among men, and more among women (9% of men mentioned it, versus 16% of women). This could suggest a raised awareness of the hereditary nature of breast, ovarian and womb cancers among women. This is not the only disparity between males and females. Men are also less likely to mention factors including smoking (54% vs. 60%) and drinking (16% vs. 25%). Several important lifestyle factors got very low levels of spontaneous awareness, including being overweight (mentioned by one in seventeen) and not enough exercise (mentioned by one in twenty). No respondents at all in NHS Kirklees mentioned a high number of sexual partners, despite the recent publicity associated with the cervical cancer vaccine. Prompted awareness of influencing factors (Q7) Like the prompted question on cancer signs, this question carries the risk of having presensitised the respondent to the subject: people will be more likely to realise that all the factors mentioned could contribute, so they may agree with a greater number than they would have done before the survey. Chart 7

Q7: Prompted awareness of factors influencing cancer risk Strongly agree Agree Not sure Disagree Strongly disagree

Smoking Passive Family Sunburn Overweight HPV Alcohol Older Exercise Meat Fruit 0

10

20

30

40

50

60

70

80

90

100

Percentage of respondents Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405 Nearly nine in ten (89%) respondents agreed (either strongly or at all) that smoking could increase the chance of getting cancer. Of the eleven percent who didn’t agree, nine percent weren’t sure and two percent disagreed. This may suggest that there is possibly still a small proportion of respondents who have not made the connection between smoking and cancer. Page 16 of 34

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A passive lifestyle was agreed with as a possible cause by more than four fifths (82%) when prompted (which when contrasted with the 4% who mentioned it spontaneously, suggests this does not enjoy the same level of importance in people’s minds). Nearly two-thirds (64%) agreed that a family history or genetics could be a cause, followed by 62% who agreed that sunburn, and 57% who agreed that being overweight might be a factor. Just over two-fifths felt that HPV was an influence. While 45% agreed it may be a factor, a greater percentage (49%) were not sure, suggesting considerable ignorance to the message. Alcohol (43%) and ageing (42%) were next most suggested as being potential factors. Issues around exercise and eating enough fruit and vegetables both had comparable numbers of people not sure as agreeing. This may be because the question related to Government guidelines: i.e. 5x30 mins exercise a week, and eating 5 portions of fruit and vegetables a day. People may still feel these are fairly extreme levels of activity, that they can get away with less or they simply do not understand the message in relation to cancer: six in ten (60%) of respondents either disagreed or didn’t know if failing to achieve the 5x30 exercise target was a risk. For the 5a-day target the number that disagreed/were unsure was similar at 63%. Chart 8

Q6&7: Unprompted vs prompted mentions of factors influencing cancer Smoking Passive (or not enough exercise) Family Sunburn Overweight Older Unprompted mentioning (Q6) Prompted agreeing (Q7)

Alcohol HPV 0

10

20

30

40

50

60

70

80

90

100

Percentage of respondents Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405

Ranking of influencing factors (Q11) NHS Kirklees respondents were asked to rank a list of five factors which may influence a person’s chance of getting cancer. These were: lifestyle, chance, ageing, environmental factors, and genetic inheritance. Page 17 of 34

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Of these, the majority of respondents put lifestyle as the most important influencing factor with nearly half of respondents ranking it first. Very few people ranked it second, third or fourth, but a resistant 22% believed it to be the least important of the five. Looking at the five influencing factors on a weighted basis, giving most weight to a first-place mention, then to a second place mention and so on puts chance in second place in the importance attached to it. Nearly a quarter (24%) put it first. Despite a third (32%) ranking chance fifth, opinions were evenly spread about how much influence it has otherwise, and nearly three fifths (59%) of respondents put it in their top three. This suggests that a significant group believe that cancer risk is more about luck than management. Chart 9

Q11: Ranking of factors influencing cancer risk First Second Third Fourth Fifth

Lifestyle Chance Aging Genetic Environment 0

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30

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70

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Percentage of respondents Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405 Ageing was seen as the third most important factor, with the most consistent scores across the five rankings. Nearly three fifths (59%) of respondents put it in their top three. With only 5% putting genetics top, a third (32%) still ranked this as the most important factor. Despite this, genetics is ranked fourth overall. With nearly three quarters (72%) ranking Environment putting it third, fourth or fifth, it ranks fifth overall.

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5. TREATMENT AND SCREENING Awareness and knowledge of screening programmes (Q10) Respondents were asked if they know whether the NHS offers screening programmes for breast, cervical and bowel cancers, and the age at which people are first invited for screening (women only, in the case of the first two). The breast and cervical cancer screening programmes were well known among respondents, with 85% and 89% being aware respectively. This rises to 87% and 93% among female respondents. Bowel cancer screening however had only 29% of respondents aware in Yorkshire as a whole, so it is good news for Kirklees that this is significantly higher in this PCT (36%) with aware. However, more than four in ten (45%) did not know whether it was offered or not, so there is still work to be done in raising this awareness. For both breast and cervical cancer screening, awareness of the programmes is significantly higher amongst those from a ‘white’ rather than ‘non-white’ ethnic background (87% vs. 70% for breast, 91% vs. 72% for cervical). Chart 10

Q10: Awareness of NHS cancer screening programmes Yes Don’t know No

Breast

Cervical

Bowel

0

10

20

30

40

50

60

70

80

90

100

Percentage of respondents Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405

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While awareness of bowel cancer screening was low generally (36%), it rose to nearly half (47%) for those aged 55 and over. This suggests effective targeting of the message, as screening is currently only offered to those aged 60-69, but that levels of awareness are still too low. A significant concern is the low level of awareness amongst non-white ethnic groups, with 60% not knowing. Respondents were asked at what age they thought breast, cervical and bowel cancer screening started. Encouragingly, they were likely to estimate screening starting either correctly, or at a younger age than is actually the case. For breast cancer, the average age respondents thought screening started was 38; significantly lower than the real start age of 50. For bowel cancer, the start age for screening was again under-estimated, at 45 years old versus the actual age of 60. For cervical cancer, the average respondent responded correctly to screening starting at 25 years old. Responsiveness to symptoms (Q3, 4) Following on from the first two questions on symptom awareness, respondents are asked how quickly they would be likely to contact their doctor, to seek an appointment. Again, the propensity of people to react quickly may be influenced by being exposed to this research study and being forced to focus on the subject of cancer, so the speed of response should be interpreted as a best-case scenario. Question 3 lists nine different potential cancer signs, all of which had previously been discussed in the questionnaire, and respondents are asked how long they would be likely to take to seek an appointment, with options ranging from 1-3 days, to a year, or never. Question 4 repeats this scale, for any sign the respondent might think is a cancer symptom. Although a lump or swelling was the most well-known possible sign of cancer, the symptom that respondents would seek an appointment most quickly for is bleeding. More than four in ten (43%) of respondents claim they would call their doctor within three days if they experienced this, more quickly on average than their response time to any general sign of cancer. On average, the response time would be just over 7 days. A lump or swelling was seen as the next most urgent, with an average response time of just over 9 days.

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Chart 11

Q3&4: How quickly people would seek a doctor’s appointment if they experienced these signs 1-3 days 4-6 days 1 week 2 weeks 1 month over 1 month never

Bleeding Any cancer sign Difficulty swallowing Lump/swelling Change in a mole Pain Sore that won't heal Bowel/bladder change Persistent cough Weight loss 0

10

20

30

40

50

60

70

80

90

100

Percentage of respondents Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405 Difficulty swallowing and pain were seen as the next most urgent, with average response times of ten and eleven days respectively. The average response time for a change in a mole was a little higher at thirteen days. Across the vast majority of symptoms, response time was quicker than in Yorkshire as a whole. This is particularly the case with a persistent cough, where NHS Kirklees respondents would make an appointment on average 4 days sooner than. The more sudden and alarming the onset of a symptom, the faster the response would be, but that symptoms with high levels of known association with cancer provoke a quicker response. Barriers to seeking treatment (Q5) After discussing how quickly respondents would seek an appointment, they were then asked what might put them off seeking one, even if they thought the symptom might be serious. This question puts the respondent in the situation where they are aware of the symptom and its risks, to understand what the final hurdle might be.

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The most significant barrier to seeking medical advice in NHS Kirklees appears to be the emotional barrier of worrying about what the doctor might find. More than four in ten (42%) of respondents said this would often or sometimes prevent them from making an appointment. Chart 12

Q5: What would put people off seeking a doctor’s appointment? Often Sometimes No Don't know

Worried what doctor would find Worry about wasting doctor's time Too embarrassed Difficult to make appointment Too scared Too busy Other things to worry about Not confident talking about symptom Difficult to talk to doctor Difficult to arrange transport 0

10

20

30

40

50

60

70

80

90 100

Percentage of respondents Source: 2010 CAM survey, NHS Kirklees. Base: all respondents. Sample size: 405 Other significant emotional barriers are being too scared (37%) or embarrassed (39%). Emotional influences are invariably the greatest barriers to public behaviour change, and therefore require the greatest efforts on the part of healthcare professionals. People seem to fear finding out the diagnosis, whether it is good news or bad. Two-fifths (40%) of respondents cited difficulty in getting an appointment as being often or sometimes a barrier, while 34% said they might be too busy, and 19% might have trouble getting transport. Citing physical barriers like this can often be a person’s way of expressing what is in fact an emotional barrier and present problems for public services as they are expensive barriers to overcome. However, health centre access or registration may be an issue in NHS Kirklees, as well as a lack of knowledge about the availability of NHS drop-in centres.

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6. QUESTIONNAIRE

Cancer Research UK Cancer Awareness Measure (CAM)

This survey instrument (CAM) was developed by Cancer Research UK, University College London, Kings College London, and University of Oxford in 2007-2008.

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NHS Kirklees Report

There are many warning signs and symptoms of cancer. Please name as many as you can think of:

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The following may or may not be warning signs for cancer. We are interested in your opinion: Yes

No

Don’t know

Do you think an unexplained lump or swelling could be a sign of cancer? Do you think persistent unexplained pain could be a sign of cancer? Do you think unexplained bleeding could be a sign of cancer? Do you think a persistent cough or hoarseness could be a sign of cancer? Do you think a persistent change in bowel or bladder habits could be a sign of cancer? Do you think persistent difficulty swallowing could be a sign of cancer? Do you think a change in the appearance of a mole could be a sign of cancer? Do you think a sore that does not heal could be a sign of cancer? Do you think unexplained weight loss could be a sign of cancer?

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If you had unexplained pain how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

Never

If you had unexplained bleeding how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

Never

If you had a cough or hoarseness how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

Never

If you noticed a change in bowel or bladder habits how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

Never

If you had difficulty swallowing how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

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Never

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If you noticed a change in the appearance of a mole how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

Never

If you had a sore that did not heal how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

Never

If you had unexplained weight loss how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

Never

If you had a symptom that you thought might be a sign of cancer how soon would you contact your doctor to make an appointment to discuss it? 1-3 days

4-6 days

1 week

2 weeks 1 month

6 weeks 3 months 6 months 12 months

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Never

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Sometimes people put off going to see the doctor, even when they have a symptom that they think might be serious. These are some of the reasons people give for delaying. Could you say if any of these might put you off going to the doctor?

Yes often

Yes sometimes

No

Don’t know

I would be too embarrassed I would be too scared I would be worried about wasting the doctor’s time My doctor would be difficult to talk to It would be difficult to make an appointment with my doctor I would be too busy to make time to go to the doctor I have too many other things to worry about It would be difficult for me to arrange transport to the doctor’s surgery I would be worried about what the doctor might find I wouldn’t feel confident talking about my symptom with the doctor Other (please specify)

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What things do you think affect a person’s chance of getting cancer?

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Medical scientists suggest that these are some of the things that can increase the chance of getting cancer. How much do you agree that each of these can increase the chance of getting cancer? Strongly disagree

Disagree

Not sure

Agree

Strongly agree

Smoking any cigarettes at all Exposure to another person’s cigarette smoke Drinking more than 1 unit of alcohol a day Eating less than 5 portions of fruit and vegetables a day Eating red or processed meat once a day or more Being overweight (BMI over 25) Getting sunburnt more than once as a child Being over 70 years old Having a close relative with cancer Infection with HPV (Human Papillomavirus) Doing less than 30 mins of moderate physical activity 5 times a week

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Here is a picture of 100 people. Out of 100 people, how many do you think will develop cancer at some point in their life?

___ ___ ___ people out of 100 will develop cancer at some point in their life

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What do you think is the most common cancer in men?

What do you think is the second most common cancer in men?

What do you think is the third most common cancer in men?

What do you think is the most common cancer in women?

What do you think is the second most common cancer in women?

What do you think is the third most common cancer in women?

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Yes

No

Don’t know

Is there an NHS breast cancer screening programme? If yes, at what age are women first invited for breast cancer screening? ________ Is there an NHS cervical cancer screening programme (smear tests)? If yes, at what age are women first invited for cervical cancer screening? _______ Is there an NHS bowel cancer screening programme? If yes, at what age are people first invited for bowel cancer screening? _________

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Please put the following things in order of how much you think they contribute to cancer in the UK: Lifestyle (e.g. smoking, diet, physical activity) Chance Aging Environmental factors (e.g. pollution, radiation) Genetic inheritance (e.g. runs in the family) 1. _____________________________ (Most important) 2. _____________________________ 3. _____________________________ 4. _____________________________ 5. _____________________________ (Least important)

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http://www.kirklees.nhs.uk/fileadmin/documents/News/CAM_findings_for_Kirklees  

http://www.kirklees.nhs.uk/fileadmin/documents/News/CAM_findings_for_Kirklees.pdf

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