Maureen SayerMaureen SayerHealth Improvement PractitionerHealth Improvement Practitioner

Cheshire and Merseyside Bowel Cheshire and Merseyside Bowel Cancer Screening ProgrammeCancer Screening Programme

Bowel CancerBowel Cancer

AimsAims• To Identify and discuss the early signs of To Identify and discuss the early signs of

Bowel cancerBowel cancer

• To give an overview of the Bowel Cancer To give an overview of the Bowel Cancer Screening ProgrammeScreening Programme

Bowel Cancer SymptomsBowel Cancer Symptoms

• Symptoms lasting 4-6 weeks need to be Symptoms lasting 4-6 weeks need to be investigatedinvestigated

• Any clients with symptoms should be Any clients with symptoms should be encouraged to see their GPencouraged to see their GP

Bowel Cancer SymptomsBowel Cancer Symptoms

• Bleeding from the RectumBleeding from the Rectum ( Back passage) ( Back passage)Bright Red or Dark Black blood Bright Red or Dark Black blood Found in or on Bowel Motion ,toilet paper or toilet Found in or on Bowel Motion ,toilet paper or toilet bowelbowel

• TirednessTirednessCaused by blood lossCaused by blood lossNeeds investigatingNeeds investigating

Bowel Cancer SymptomsBowel Cancer Symptoms

• Change of Bowel HabitChange of Bowel HabitChange from your normal patternChange from your normal patternConstipationConstipationDecreased Bowel MotionsDecreased Bowel MotionsDiarrhoeaDiarrhoeaMore frequent Bowel MotionsMore frequent Bowel MotionsMay alternateMay alternate

Bowel Cancer SymptomsBowel Cancer Symptoms

• Abdominal or Rectal PainAbdominal or Rectal Pain

• Abdominal LumpAbdominal Lump

Needs InvestigatingNeeds Investigating

Bowel Cancer SymptomsBowel Cancer Symptoms

• Nausea ( feeling Sick)Nausea ( feeling Sick)

• Unexplained loss of appetiteUnexplained loss of appetite

• Unplanned Weight LossUnplanned Weight Loss

Bowel Cancer Screening ProgrammeBowel Cancer Screening Programme Cheshire and Merseyside NHS North WestCheshire and Merseyside NHS North West

Bowel Cancer Screening ProgrammeBowel Cancer Screening Programme

• FOB testing will be offered to all men & FOB testing will be offered to all men & women aged 60-69 - 2 yearly. women aged 60-69 - 2 yearly.

• 70+ can request to join the BCSP but 70+ can request to join the BCSP but have to contact Regional Hub at Rugby have to contact Regional Hub at Rugby on theon thefree phone free phone 0800 707 60 600800 707 60 60

• Age Extension up to 75 in 2010Age Extension up to 75 in 2010

Public Health PerspectivePublic Health Perspective

• Bowel Cancer is the third most Bowel Cancer is the third most common cancer in the UKcommon cancer in the UK

• Approximately 34,900 new cases p.aApproximately 34,900 new cases p.a

• It is is the second largest cause of It is is the second largest cause of cancer deaths in the UK cancer deaths in the UK (Cancer Research UK, (Cancer Research UK,

2005. Cancerstats).2005. Cancerstats).

• In 2004 approximately 16,100 people In 2004 approximately 16,100 people died from bowel cancer in the UK, 737 died from bowel cancer in the UK, 737 deaths within Cheshire & Merseysidedeaths within Cheshire & Merseyside

• Life time risk of developing Bowel Life time risk of developing Bowel Cancer in the UK is about 1:18 for men Cancer in the UK is about 1:18 for men and 1:20 for womenand 1:20 for women

Public Health PerspectivePublic Health Perspective

Who is at risk of developing bowel Who is at risk of developing bowel cancer?cancer?

• Both men and women

• People who-

– Take little exercise

– Are overweight

– Have a diet high in red meat and low in vegetables, fruits and fibre

• People with a family history (CRC People with a family history (CRC Relatives)Relatives)

• Inflammatory Bowel DiseaseInflammatory Bowel Disease• Genetics-Genetics-

– Familial Adenomatous Polyposis Familial Adenomatous Polyposis (FAP)about 1% of cases(FAP)about 1% of cases

– Hereditary Non-Polyposis Colorectal Hereditary Non-Polyposis Colorectal Cancer (HNPCC) about 2-5% of cases Cancer (HNPCC) about 2-5% of cases

Who is at risk of developing bowel Who is at risk of developing bowel cancer? (continued)cancer? (continued)

Mental Health and Learning Mental Health and Learning DisabilitiesDisabilities

• SchizophreniaSchizophreniaRecent research shows that people with this Recent research shows that people with this condition are at increased risk of developing condition are at increased risk of developing bowel cancerbowel cancer

• Learning DisabilitiesLearning DisabilitiesIncreased risk is linked to obesity, poor diet, Increased risk is linked to obesity, poor diet, lack of physical activity ,exclusion from lack of physical activity ,exclusion from screening programmes. Mortality is linked to screening programmes. Mortality is linked to late presentation of symptoms.late presentation of symptoms.

• The risk of developing bowel cancer The risk of developing bowel cancer increases with age. increases with age.

• About 80% of people who get Bowel About 80% of people who get Bowel cancer are aged 60 and overcancer are aged 60 and over

Who is at risk of developing bowel Who is at risk of developing bowel cancer? (continued)cancer? (continued)

• In 2000 the Bowel Cancer screening Pilot In 2000 the Bowel Cancer screening Pilot began in Scotland (Dundee) and England began in Scotland (Dundee) and England (Rugby)(Rugby)

• Evidence from pilot studies showed that Evidence from pilot studies showed that early detection through regular Bowel early detection through regular Bowel Cancer Screening has a significant impact Cancer Screening has a significant impact upon overall survival ratesupon overall survival rates

• BCSP can reduce mortality (deaths) by BCSP can reduce mortality (deaths) by 16% in the population invited for 16% in the population invited for screeningscreening

Bowel Cancer Screening PilotBowel Cancer Screening Pilot

Health Inequalities of the BCSPHealth Inequalities of the BCSPPilotPilot

• Men were less likely to participate in FOBt

• Lower uptake in deprived areas.

• Poor uptake in Black and Ethnic Minority groups particularly Muslims.

• Ethnic groups more likely to DNA before colonoscopy.

• Other groups who may experience inequalities– Learning disabilities/ difficulties– Blind and Visual impairment – Deaf– People with mobility problems– Illiterate– Mental illness– Travellers– Homeless– Prison population

Health Inequalities of the BCSPHealth Inequalities of the BCSP

Responsibility for the BCSPResponsibility for the BCSP

• Cheshire & Merseyside NHS North Cheshire & Merseyside NHS North West have the lead responsibility for West have the lead responsibility for BCSP initially. Thereafter PCT’s will BCSP initially. Thereafter PCT’s will commission the programme.commission the programme.

• Operationally driven and managed by 1 Operationally driven and managed by 1 host Trust.( Aintree) This is the local host Trust.( Aintree) This is the local BCSP administration centre.BCSP administration centre.

• Endoscopy nurse-led screening Endoscopy nurse-led screening assessment clinics (community)assessment clinics (community)

Agreed ModelAgreed Model

SHA BCSP StatisticsSHA BCSP Statistics

• Screening population 327,683Screening population 327,683

• Assume 60% uptake based on pilot figures = Assume 60% uptake based on pilot figures = 196,610 of which,196,610 of which,

• Approximate 2% will have a positive FOBt = 3,932 Approximate 2% will have a positive FOBt = 3,932 of which,of which,

• 11% of FOBt positive patients will have cancer 11% of FOBt positive patients will have cancer =433.=433.

• 35% will have polyps requiring surveillance =137635% will have polyps requiring surveillance =1376

Proposed organisationProposed organisation

HUB

HUBHUB

HUB

HUB

• 5 Programme Hubs across England, based on IT Local Service Providers (LSP) undertaking call/recall and lab functions

• 1 Programme Hub for approx 20 screening centres

Overarching Structure:

Role of HUBRole of HUB

• To Manage call and recall for the screening To Manage call and recall for the screening programmeprogramme

• To provide a telephone help line for people To provide a telephone help line for people invited for screeninginvited for screening

• To dispatch and process test kitsTo dispatch and process test kits

• Send results letters to participants and notify Send results letters to participants and notify GPGP

• Book the first appointment at a nurse led clinic Book the first appointment at a nurse led clinic for patients with an abnormal test resultfor patients with an abnormal test result

• Coordinate Quality assurance activitiesCoordinate Quality assurance activities

Model in briefModel in brief

• Invitation letter is sent to participant Invitation letter is sent to participant from Rugby dispatch centre (HUB).from Rugby dispatch centre (HUB).

• Participants can opt out of the BCSP Participants can opt out of the BCSP by contacting Rugby on the free by contacting Rugby on the free phone 0800 707 60 60.phone 0800 707 60 60.

National HubNational Hub

• National hub send invitation to screening letter

• One week later an FOB screening kit which includes leaflets, sample sticks and a foil lined envelope are dispatched

Faecal Occult Blood Testing Faecal Occult Blood Testing KitKit

• Participants smear the stool sample onto the 2 Squares in the 1st flap indicated on the kit. This is repeated on 2 further days until all 6 Squares are completed

• Completed kit is returned by post to Rugby Completed kit is returned by post to Rugby within 2 weeks of the 1within 2 weeks of the 1stst sample being sample being smeared on the kit (foil-lined envelope smeared on the kit (foil-lined envelope supplied)supplied)

ResultsResults Negative resultNegative result

Unclear Result (1-4 of the squares are Unclear Result (1-4 of the squares are positive)positive)

Spoilt KitSpoilt Kit

Technical FailureTechnical Failure

Positive ( abnormal) ResultPositive ( abnormal) Result

Screening CentresScreening Centres

•They will provide nurse led clinics for patients They will provide nurse led clinics for patients with an abnormal test resultwith an abnormal test result

•Arrange colonoscopy appointments for Arrange colonoscopy appointments for patients with an abnormal test resultpatients with an abnormal test result

•Arrange alternative appointments for patients Arrange alternative appointments for patients in whom colonoscopy has failedin whom colonoscopy has failed

•Ensure appropriate follow-up or treatment for Ensure appropriate follow-up or treatment for patients after colonoscopypatients after colonoscopy

Screening CentresScreening Centres

•Provide information about the screening Provide information about the screening programme for the local health communityprogramme for the local health community

•Promote the screening programme to the Promote the screening programme to the

general public in their localitygeneral public in their locality

•Provide information and support for local Provide information and support for local people in completing the FOB test(on referral people in completing the FOB test(on referral from the programme hubfrom the programme hub

• Appointment arranged at Endoscopy Nurse screening assessment clinic if the FOBt is positive. The participant will receive:

• Counselling • A health questionnaire• Information• Consent• Preparation for the procedure • Bowel Cancer Screening-The

colonoscopy Investigation (leaflet)

Screening JourneyScreening Journey

Screening journeyScreening journey (Continued)(Continued)

• Referred to screening provider unit for colonoscopy

• Follow-up dependant on procedure results – Normal, sent a BCSP kit in 2 years– Polyps, surveillance by BCSP– Cancer detected cases referred to local

Multi Disciplinary Team (local Cancer Team)

• Cheshire & Merseyside commissioned by National office

• Aims to explore the sensory impaired people’s understanding of the process

• Identify actual or perceived difficulties

• Identify coping strategies to help them participate

• Qualitative study; made use of focus groups and interviews

Sensory Impairment ResearchSensory Impairment Research

• Engage support organisations to ensure wider spread of information

• Training ambassadors within deaf community

• Establish text phone and email helpline

• Target isolated individuals

• Easy to use language in leaflets

• More pictures in leaflets

Sensory Impairment Research Sensory Impairment Research – Findings– Findings

• Consider new design of FOBt kit

• Send sampling pots with FOBt kit

Sensory Impairment Research Sensory Impairment Research – Findings– Findings

• Make public the research report

• National office to review findings

• New strategies to be tested out in a follow-on project

Sensory Impairment Research Sensory Impairment Research – Next Steps– Next Steps

Contact DetailsContact Details

• Maureen Sayer Maureen Sayer

Health Improvement PractitionerHealth Improvement Practitioner

maureen.sayer@aintree.nhs.ukmaureen.sayer@aintree.nhs.uk

0151 529 30350151 529 3035