An evaluation of a national mass media campaign to raise public awareness of possible lung cancer symptoms in England in 2016 and 2017

Susan Ball, Chris Hyde*, Willie Hamilton, Chloe J. Bright, Carolynn Gildea, Kwok F. Wong, Lizz Paley, Helen L. Hill, Vivian Mak, Jodie Moffat, Lucy Elliss-Brookes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: A two-phase ‘respiratory symptoms’ mass media campaign was conducted in 2016 and 2017 in England raising awareness of cough and worsening shortness of breath as symptoms warranting a general practitioner (GP) visit. Method: A prospectively planned pre–post evaluation was done using routinely collected data on 15 metrics, including GP attendance, GP referral, emergency presentations, cancers diagnosed (five metrics), cancer stage, investigations (two metrics), outpatient attendances, inpatient admissions, major lung resections and 1-year survival. The primary analysis compared 2015 with 2017. Trends in metrics over the whole period were also considered. The effects of the campaign on awareness of lung cancer symptoms were evaluated using bespoke surveys. Results: There were small favourable statistically significant and clinically important changes over 2 years in 11 of the 15 metrics measured, including a 2.11% (95% confidence interval 1.02–3.20, p < 0.001) improvement in the percentage of lung cancers diagnosed at an early stage. However, these changes were not accompanied by increases in GP attendances. Furthermore, the time trends showed a gradual change in the metrics rather than steep changes occurring during or after the campaigns. Conclusion: There were small positive changes in most metrics relating to lung cancer diagnosis after this campaign. However, the pattern over time challenges whether the improvements are wholly attributable to the campaign. Given the importance of education on cancer in its own right, raising awareness of symptoms should remain important. However further research is needed to maximise the effect on health outcomes.

Original languageEnglish
Pages (from-to)187-195
Number of pages9
JournalBritish Journal of Cancer
Issue number2
Publication statusPublished - 1 Feb 2022

Bibliographical note

Funding Information:
SB is supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula.

Funding Information:
We gratefully acknowledge the Administrative support from Jenny Lowe and literature searching from Sophie Robinson at the University of Exeter. Jennie Fergusson, Marketing Planning Lead at PHE who facilitated access to marketing results answered the author’s questions and provided formative feedback on the early draft. Emma Logan and Karen Eldridge at PHE delivered the campaign and contributed to the design of the evaluation. Kantar ( provided marketing media analysis. Isobel Tudge, Ravneet Sandhu, Jennifer Lai, Chris Lawrence (retired), Catherine Welham and Columbus Ohaeri (former NCRAS), NCRAS analysts who completed the initial analysis. Prof. Michael D. Peake and Dr. Thomas Round for their clinical guidance and support during the design, development and evaluation of the campaign. Prof. Georgios Lyratzopoulos, Senior Cancer Epidemiologist who offered advice and made formative comments on earlier drafts of the manuscript. Osa Adeghe, BCoC Project Officer at PHE who facilitated improved drafts and provided administrative support and quality assurance. Past and present members of the Be Clear on Cancer Steering Group for their support and guidance throughout the lifecycle of the campaign and its evaluation. This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England (PHE). We also warmly thank the survey participants for their time. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

Publisher Copyright:
© 2021, The Author(s).


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