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Transcript Document

Local Awareness and Early Detection Initiative (LAEDI)

Dr Nicola Robinson MacMillan GP 29/04/2020

Workshop Aims

To understand why early detection is important 2.

To look at ways to increase early detection – Local Awareness and Early Detection Initiative (LAEDI)

Where you can help

3. To consider the challenges to early detection and how to address them 4. To identify other conditions where LAEDI could help with early detection

Why early detection?

 Late diagnosis of cancer accounts for up to 10,000 avoidable deaths per annum  Up to 100,000 years of life lost per annum in England from treatable cancer  23% of all cancers diagnosed via emergency presentations  Treatment costs 4 times higher with late diagnosis  By 2021, 65% increase in costs of treating cancer (to £13.1bn) unless we do something different (RCGP) Ref: NHS Outcomes Framework 2011

A Reduced years lost The Pathogenesis of Bowel Cancer Dukes’ Stage B C ‘D’

Polyp >50 years - 1 in 4 have polyps

Survival 5 years after treatment 93%

1 in 10 change to invasive cancer

77% 48% 7%

With permission from

Professor S Halloran

Bowel Cancer Screening Programme England’s Programme

2 yearly (2006 – Sept 2013)

10m 13m Dukes Stage Symptomatic A B C ‘D’

11% 35% 26% 29%

Early Cancer Detection England Screening 36% 40%

20% 4% Test Kits Out Test Kits In +ve Screens

Colonoscopies

Cancers Advanced Adenomas Polypectomy rate

210,000 17,114 19,384 48% 11.6 million 214,000 Cancer Prevention

Local Awareness and Early Detection Initiative

Supporting GPs to make best use of all available resources Peer to peer support LAEDI Practice specific data review

12 10 8 6

MacMillan GP to GP education visit

Wessex region

(% change per practice, 2012 to 2013) 4 2 0 -2 % increase % increase bowel screening (% of eligible population) detection rates (% of cancer diagnosis via the 2ww oathway % increase Conversion Rates (% of 2ww referal found to be cancer)

LAEDI intervention results in improved uptake and accuracy of diagnosis

Visited Practice Average England

Early detection: the challenges

Bowel cancer screening seems to work well… …but only for those who do the test!

Those who need the test most… … are typically those who don’t do it!

I need to encourage patients to take the test… …they are my patients but…    I don’t have a list of those who don’t do the test.

I don’t have the time to see, speak or write to them.

I mustn’t bully, coerce or persuade them.

It must be their choice!

Southern Hub

Prevalence uptake per invitation episode by social deprivation (IMD)

80 70 60 50 40 30 20 10 0

1st invitation uptake 2nd invitation uptake 3rd invitation uptake Cumulative uptake

1st IMD quintile 2nd IMD quintile 3rd IMD quintile 4th IMD quintile 5th IMD quintile

Uptake in Portsmouth

66.4% Response No Response 33.9%

The challenges

55% on average engaged at the start, benefit of LAEDI GP visit, and a further 10% engaged through reminder letter What about the remaining 35%??

• • • •

Group Discussion

How can we raise awareness and uptake amongst those patients who haven’t responded to LAEDI?

Can we do more to raise awareness with GPs, do rates of early diagnosis vary for different age groups eg younger patients diagnosed later?

How can patients be motivated and empowered to make lifestyle changes?

What other areas could benefit from roll out of the LAEDI approach?

Wessex Strategic Clinical Networks and Clinical Senate

Early detection & LAEDI: where next?

Next steps, roll out LAEDI to:  Acute Kidney Disease (AKI)  1.8m people diagnosed in England  a further 1m undetected cases  45,000 premature deaths per year (Ref: NHS Kidney Care)  Serious Mental Illness (SMI)  People with SMI die on average 20 years earlier  1 in 3 of avoidable deaths in England per annum affected by SMI Ref: NHS Outcomes Framework 2011  Where else could we have the greatest impact on years of life lost through the application of LAEDI?

Reduced health costs

Acute Kidney Injury (AKI) • NHS spent £1.64bn treating renal problems in 2009-10, up 23% on previous year • AKI costs more per year than skin and lung cancer combined In 2009-10: • AKI spend = £434m to £620m • Lung cancer spend = £276m • Skin cancer spend = £115m • Prevention of 30% of AKI cases would save £130- £186m per year • AKI patient bed days averaged 18 days compared to 7 days in non-AKI patients • Reducing AKI by 10% would save 5,000 bed days Ref: The Economic Impact of Acute Kidney Injury, Marion Kerr, HSJ, 27 Jan 2011