Can a targeted intervention improve cancer symptom awareness and help-seeking among adults living in socioeconomically deprived communities? The Awareness and Beliefs About Cancer (ABACus) randomised controlled trial.

Problem

Cancer outcomes are poor in the UK’s socioeconomically deprived communities, with low symptom awareness and fatalistic beliefs about cancer contributing to prolonged help-seeking and advanced stage disease. We conducted the first trial of a facilitated cancer awareness intervention designed to improve cancer symptom knowledge, encourage positive beliefs about early cancer detection, and increase motivation to seek help among adults living in deprived communities. The theory-grounded intervention entails completion of a touchscreen questionnaire (cancer symptoms, screening, risk factors), with personalised results delivered by a trained lay advisor. We report the main trial findings for the primary and secondary quantitative outcomes.

Approach

Adults aged over 40 were recruited opportunistically in community and primary healthcare settings in socioeconomically deprived areas of Yorkshire and South Wales. Participants were randomised in a 1:1 ratio to the health check intervention or usual care control, and completed self-report measures at baseline, 2-weeks and 6-months. Cancer symptom recognition (primary outcome at 2-weeks, total score range 0-12), anticipated symptom presentation, barriers to presentation and beliefs about cancer were measured using the adapted Awareness and Beliefs about Cancer (Simon et al., 2012) at baseline, 2-weeks and 6-months post randomisation. State anxiety was assessed using the short-form State Trait Anxiety Inventory (Marteau and Bekker, 1992). Intervention effects were tested using multilevel linear regression adjusted for baseline score. Health economic data (implementation costs and healthcare resource use data) were also evaluated.

Findings

A total 234 participants were randomised, with high retention at 2-weeks (90%) and 6-months (85%). Participants were predominantly resident in areas of high deprivation (66% in 0-20% most deprived areas). There was no significant difference in total symptom recognition at 2-weeks [difference 0.57, 95% CI -0.03-1.17, p=0.06]. Intervention participants reported increased symptom recognition (difference 0.78, 95% CI 0.18-1.37, p<0.01) and earlier intended presentation (difference -1.96, 95% CI -3.02--0.91, p<0.001) at 6-months. Baseline ceiling effects in the primary outcome were observed across arms [intervention baseline mean=8.8, control mean=9.0]. Recognition of less well-known cancer symptoms (e.g. persistent tiredness, unexplained weight loss) was higher in the intervention group [2-weeks p<0.05, 6-months p<0.01]. Differences in perceived barriers, beliefs and state anxiety were not significant. Health economic outcomes are currently being analysed.

Consequences

The ABACus health check improved recognition of potential cancer symptoms, especially those that are less well-known, and did not cause unintended harm. Symptom knowledge was retained and earlier anticipated presentation occurred at longer-term follow-up. Effects on perceived barriers and beliefs about cancer were not observed, partly due to measurement problems. The health check intervention has the potential to achieve significant public health benefits by encouraging cancer symptom awareness and earlier help-seeking in deprived communities, especially for vague, common cancer symptoms that require expedited routes to diagnosis.