Awareness & Early Diagnosis Clinical Advisory Group (CAG) FINAL MEETING Output from Workshop Discussions on Implementing the Cancer Strategy.

1. DRIVING
IMPROVEMENTS
IN EARLY
DIAGNOSIS –
LATEST RESEARCH
AND EVIDENCE
AEDI CAG MEETING
12TH JULY 2017
Sara Hiom
DIRECTOR OF EARLY DIAGNOSIS AND HEALTH
PROFESSIONAL ENGAGEMENT
CANCER RESEARCH UK

2. HOW WE’RE WORKING TO IMPROVE EARLY DIAGNOSIS
First pre-
cancerous
indicator
First
development of
cancer
First
symptom
First
presentation/
clinical
appearance
Investigation
of related
symptoms
Referral to
secondary care
First
specialist
visit
Diagnosis/
referral to
treatment
Start of
treatment
Potential screening interval Primary care interval Secondary care interval
Early
biomarkers
Screening Symptomatic Treatment
Early
biomarkers
Treatment
CanTest
Catalyst
award
EDAG
Early
Diagnosis
Advisory
Group
Lung
Matrix
Cytosponge

3. REGIONAL VARIATION IN STAGE AT DIAGNOSIS
SOCIOECONOMIC FACTORS
AGE
GENDER
ETHNICITY
ADDITIONAL
DRIVERS OF
VARIATION
UNADJUSTED ADJUSTED FOR CANCER
TYPE
DATA HAS INCREASED OUR UNDERSTANDING

4. WE KNOW MORE ABOUT THE DIFFERENT ROUTES TO DIAGNOSIS
ALL CANCERS BOWEL CANCER

5. 0
25,000
50,000
75,000
100,000
125,000
150,000
Oct-09
Jan-10
Apr-10
Jul-10
Oct-10
Jan-11
Apr-11
Jul-11
Oct-11
Jan-12
Apr-12
Jul-12
Oct-12
Jan-13
Apr-13
Jul-13
Oct-13
Jan-14
Apr-14
Jul-14
Oct-14
Jan-15
Apr-15
Jul-15
Oct-15
Jan-16
Apr-16
Jul-16
Oct-16
GP Urgent Referrals (from Waiting time data)
GP Urgent Referrals Patients beginning treatment following GP Urgent Referral2009 2016
WE KNOW MORE ABOUT THE DIFFERENT ROUTES TO DIAGNOSIS

6. WE KNOW WE HAVE LESS IMAGING EQUIPMENT AND FEWER TRAINED
STAFF IN THE UK

7. 7
CANCER ALLIANCES AND IMPACT ON EARLY DIAGNOSIS
– Ultimate aim to achieve an increase in
stage 1 & 2 diagnoses
• Also decreasing the proportion of
emergency presentations
– This will be achieved through:
• Ensuring 75% uptake of bowel screening
programme
• Innovative approaches for supporting
patient navigation and GP education
• NG12 implementation
• Diagnostic direct access

8. 8
CRUK USE EVIDENCE TO ENCOURAGE AND IMPLEMENT CHANGE
• EARLY DIAGNOSIS STRATEGY – INFORMED BY INTELLIGENCE
• LOCAL LEVEL DATA – DISSEMINATED THROUGH FACILITATOR PROGRAMME
• STRATEGIC GP LEADS AND ALLIANCE PRIMARY CARE CLINICAL LEADS
• EARLY DIAGNOSIS ADVISORY GROUP (EDAG)
• INTERNATIONAL CANCER BENCHMARKING PARTNERSHIP (ICBP)
• ACE PROGRAMME FINDINGS

9. 9
EARLY DIAGNOSIS STRATEGIC PRIORITIES
Diagnose bowel cancer earlier through screening
Ensure appropriate recognition, management and referral of patients in
primary care
Ensure swift access to, and reporting of, diagnostic tests.
Public awareness: ensure prompt help-seeking by the public

10. UPTAKE OF BOWEL CANCER SCREENING IS POOR
10
– Bowel screening (gFOBT) is about 10 years
old now, but uptake remains lower than
other national screening programmes
– Bowel cancer mortality is 25% lower in
those who’ve taken part in bowel
screening (gFOBT)
– There are significant inequalities in uptake
related to:
• Deprivation
• Sex (lower in men)
• Age
0%
20%
40%
60%
80%
100%
Uptake of National Screening Programmes (England)
Bowel (FOBT) Breast (50-70) Cervical (25-64)

11. BOWEL CANCER SCREENING
11
– Bowel screening uptake looks set to
improve through:
• Implementation of FIT in England and
Scotland
– We’re supporting these changes
through:
• Publication of GP good practice guide
• Be Clear On Cancer: Bowel screening
regional pilot (Jan – March 2017)
Advertising: Jan – Mar 17
Bowel Cancer Screening Regional Pilot
NORTH WEST ENGLAND: JAN – MAR 17
Direct mail: Feb – Mar 17

12. 12
LOCAL INTELLIGENCE DATA – ALLIANCE PROFILES
ALLIANCE PROFILES
ALLIANCE PROFILES PRODUCED FROM
AGGREGATED CCG LEVEL DATA

13. THE FACILITATOR PROGRAMME
Supporting
cancer
prevention
Increasing
screening uptake
Improving
recognition and
referral of
symptomatic cancers
Diagnostic
access and
capacity

14. STRATEGIC GP LEADS ALLIANCE PRIMARY CARE CLINICAL LEADS
Provide strategic
primary care
clinical leadership
and educational
resource at
regional level
Support SCNs in
improving cancer
pathways and
reducing variation
in care provision
through the
sharing of best
practice and
innovation
Enhance CRUK’s
relevance in
primary care by
enabling CRUK to
engage with and
influence primary
care in a
systematic way
EXPERTISE
COMMITMENT
ENERGY
ENTHUSIASM
CREDIBILITY The SGPL programme has been effective in driving quality improvements at Network/Alliance
level and supporting the implementation of these changes throughout large and complex
geographies.
Provide strong
primary care clinical
leadership to the
Cancer Alliance,
ensuring primary
care perspectives
are integral to
planning, pathways
and transformation
Be an effective
influencer within
the Alliance and
across
professional
groups
Develop
networks of
primary care
clinical leads
and be a
conduit for
broader
engagement

15. The National
Awareness and
Early Diagnosis
Initiative
(NAEDI)
Population
Research
Committee
(PRC)
Early Diagnosis Advisory Group
(EDAG)
More reactive Faster pace
2013
2) Fund short-term research projects to address the gaps and/or reinforce the evidence base
on early diagnosis
1) Identify important areas, where the ED evidence is currently lacking or needs
strengthening, in order to translate that research and influence policy and drive positive
change
3) Debate and advise CRUK on broader issues and challenges in earlier diagnosis of cancer
Advisory role
WE’RE FUNDING POLICY RELEVANT RESEARCH THROUGH EDAG

16. EDAG OUTPUTS HAVE HELPED TO FILL RESEARCH GAPS
EDAG commissioned work:
• Building evidence base for the early diagnosis of
cancer (ABC-DEEP)
• Two week referral (Henrik Moller)
• Cancer Policy Programme (LSHTM)
Open call projects this year on:
• Radiographer reporting
• Diagnostic pathways in colorectal cancer
• GP-patient communication
• GP direct access to diagnostic tests
Results suggest…
 Use of the urgent referral pathway is effective
Compared with patientsfrom practices with intermediate referral rates
• Patients from high referring practiceshad a 4%improved mortality rate
• Patients from low referring practiceshad a 7%worse mortality rate
Conclusion: General practicesthat consistently have a low propensity to use urgent referrals
could consider increasing its use to improve the survival of their patients with cancer
 Coverage in 13 major national newspapers
 Television - ITV news
 Sky Radio
AIM: ASSESS VARIATION IN TWO-WEEK REFERRAL
PATHWAYS AND CANCER SURVIVAL IN ENGLAND
(HENRIK MØLLER)
headline presentation
Published in BMJ
Results suggest…
 Use of the urgent referral pathway is effective
Compared with patientsfrom practices with intermediate referral rates
• Patients from high referring practiceshad a 4%improved mortality rate
• Patients from low referring practiceshad a 7%worse mortality rate
Conclusion: General practicesthat consistently have a low propensity to use urgent referrals
could consider increasing its use to improve the survival of their patients with cancer
 Coverage in 13 major national newspapers
 Television - ITV news
 Sky Radio
AIM: ASSESS VARIATION IN TWO-WEEK REFERRAL
PATHWAYS AND CANCER SURVIVAL IN ENGLAND
(HENRIK MØLLER)
headline presentation
Published in BMJ

17. THE INTERNATIONAL CANCER BENCHMARKING PARTNERSHIP
17
19 jurisdictions in 6 countries
8 cancers
PHASE 2

18. Exploring the role of
pharmacies & other
primary care
professionals in
diagnosing cancer
earlier
Trialling
electronic
decision
support tools
for GPs
Testing straight to
test and direct
access diagnostic
pathways for lung
and colorectal
cancer
Exploring pathways
for patients with
vague but concerning
symptoms
Increasing
bowel screening
uptakeProactively
identifying
people at high
risk of lung
cancer
Projects across England
building the knowledge base
on effective ways to:
Effect a shift from late
to early stage cancer
diagnosis
Decrease the number
of cancers diagnosed
via emergency
presentation
Improve patient
experience
Around 6
5
3
Year programme
Report published
Report for the five
MDC pilots due 2018Both lung and colorectal
cancer pathways reports
published
Report
publishedProject summaries
published
Report due
Autumn 2017
Report due July
2017
Find the reports at www.cruk.org/ace
Email the team at ACEteam@cancer.org.uk
The reports include:
• Analysis of straight to test and
direct access approaches
• One-stop diagnostic clinics
• Interventions to engage with bowel
screening non-responders
• GP and patient information leaflets
• Radiology decision support tools
THE ACE PROGRAMME

19. THE ACE PROGRAMME
• ACE 2 is piloting six
projects trialling a
new diagnostic
pathway for patients
with vague symptoms –
an approach
incorporating a
Multidisciplinary
Diagnostic Centre as
in Denmark.

20. LOOKING TO THE FUTURE
20
– Evaluating ACE: ensure appropriate recognition, management and referral of patients in primary care
– Implementing good practice
– Diagnostics: ensure swift access to, and reporting of, appropriate diagnostic tests
– Greater diagnostic capacity
– Improved diagnostic efficiency
– Improved skills mix in workforce and networking of specialists
RESEARCH FUNDING
POPULATION RESEARCH
COMMITTEE (PRC)
Supports research on cancer prevention,
screening and early diagnosis.
Programme grants, project grants,
Postdoctoral fellowships and Catalyst
award.
EARLY DETECTION
New funding streams for Early
Detection research opening July 2017.
£20 million by 2021.
Project awards and Programme
awards.
EARLY DIAGNOSIS
ADVISORY GROUP (EDAG)
Policy focussed funding for research that adds
to the evidence base impacting on policy and
practice for earlier cancer diagnosis.
Commissioned research and open calls for
projects.

21. Cancer clinical priority work programme:
- MOU between CRUK and RCGP
- Behaviour Change and Cancer Prevention e learning module. http://www.cancerresearchuk.org/health-
professional/early-diagnosis-activities/cruk-rcgp-partnership/behaviour-change-and-cancer-prevention-
course
- Regional interactive workshops for GPs, Cascade events and Faculty workshops.
http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/cruk-rcgp-
partnership/about-the-cruk-rcgp-partnership
Thursday 19th October 2017, Mercure Maidstone Great Danes Hotel, Maidstone.
This one day RCGP accredited free workshop will increase awareness and knowledge of primary care cancer
control, improve knowledge and understanding of NG12, and provide up to date knowledge on prevention and
early diagnosis of cancer.
Further details and registration will soon be available on the RCGP website

22. THANK YOU
SARA.HIOM@CANCER.ORG.UK