Bowel and Lung Cancer
Awareness in South of Tyne
and Wear
Street and Door Knocking Interviews
Report v1
Prepared for Nonnie Crawford
November 2011
Report prepared by:
Dr Judith Welford
Public Sector Research Executive
Public Knowledge
Part of Dipsticks Research Limited
The Mill
Hexham Business Park
Burn Lane
Hexham
Northumberland
NE46 3RU
Tel: 01434 613273
Email: Judith@publicknowledge.eu
Fax: 01434 611161
Twitter: @PKResearchNE46
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Contents
1. Executive Summary ....................................................................................... 5
2. Background and Objectives ............................................................................. 7
3. Methodology ................................................................................................. 9
4. Data Processing and Analysis ......................................................................... 12
5. Respondent Characteristics ............................................................................ 14
5.1. Age and Gender ......................................................................................... 14
5.2. Working Status, Marital Status, Education, Housing Tenure, Vehicle Ownership and
Socio-Economic Grade....................................................................................... 15
5.3. Ethnicity, Language and Length of Time Living in the UK ................................. 18
5.4. Smoking Behaviour .................................................................................... 19
5.5. Personal Experience of Cancer ..................................................................... 21
6. Full Summary of Results ................................................................................ 23
6.1. Bowel Cancer Awareness Measure ................................................................ 23
6.1.1. Awareness of the Signs and Symptoms of Bowel Cancer .............................. 23
6.1.2 Help Seeking Behaviour – Bowel Cancer ...................................................... 29
6.1.3. Age People Develop Bowel Cancer ............................................................. 31
6.1.4. Factors Affecting the Chances of Developing Bowel Cancer ........................... 33
6.1.5. Confidence Noticing Bowel Cancer Symptoms ............................................. 38
6.2. Lung Cancer Awareness Measure ................................................................. 40
6.2.1. Awareness of the Signs and Symptoms of Lung Cancer ................................ 40
6.2.2. Help Seeking Behaviour – Lung Cancer ...................................................... 46
6.2.3. Age People Develop Lung Cancer .............................................................. 48
6.2.4. Factors Affecting the Chances of Developing Lung Cancer ............................ 50
6.2.5. Confidence Noticing Lung Cancer Symptoms ............................................... 55
6.3 Delays to Visiting the Doctor and Communications .......................................... 56
6.3.1. Delays to Visiting the Doctor ..................................................................... 56
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6.3.2. Communications ..................................................................................... 60
7. Conclusions .................................................................................................. 62
8. Appendices .................................................................................................. 64
8.1. Final Questionnaire .................................................................................... 64
8.2. Required and Achieved Quotas .................................................................... 74
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1. Executive Summary
Public Knowledge was commissioned by NHS South of Tyne and Wear to conduct research
to assess baseline levels of cancer awareness within the most deprived wards of
Sunderland, South Tyneside and Gateshead using the site specific bowel and lung cancer
awareness measures. In total, 1,277 face-to-face street and door-knocking interviews were
conducted with a broad range of respondents between September and October 2011.
Respondents were most likely to spontaneously mention a change in bowel habits (22%)
and blood in stools (17%) as symptoms of bowel cancer, and unhealthy/poor diet (24%)
and smoking (13%) as risks that may increase the chance of developing bowel cancer.
However awareness of the symptoms and risks of bowel cancer was extremely poor within
the sample. Just under half of all respondents (45%) were unable to name any symptoms of
bowel cancer and just over half (54%) were unable to spontaneously name any risks which
may increase the chances of developing bowel cancer.
Relatively low awareness of the age at which people first develop bowel cancer is evident
and although 67% say they would initiate contact with a doctor within a week to discuss a
symptom they thought might be a sign of bowel cancer, 55% said they are not confident
that they would notice a symptom of bowel cancer.
Spontaneous awareness of the signs and symptoms of lung cancer is somewhat better than
bowel cancer awareness. Just around four-fifths of the sample were able to name at least
one symptom of lung cancer (79%). The most common symptoms spontaneously
mentioned by respondents were a persistent cough (38%) and shortness of breath (26%).
When prompted, there were high levels of agreement that most of the signs listed could be
symptoms of cancer; however, there were lower levels of agreement that a persistent
shoulder pain (47%) and changes in the shape of your fingers or nails (25%) could be a
symptom of lung cancer.
Awareness of the causes of lung cancer is superficially more positive than awareness of
bowel cancer risk, with only 7% unable to spontaneously name any risks spontaneously.
However, whilst 81% spontaneously mentioned the most common risk – being a smoker –
57% of the sample were only able to name this risk and no other.
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Again, although 66% of respondents said they would initiate contact with their doctor within
a week to discuss a symptom they thought might be lung cancer, 43% of the sample said
they are not confident that they would notice a symptom of lung cancer.
Awareness of the age at which people are most likely to develop lung cancer is also low with
almost three-fifths (57%) saying they think cancer is unrelated to age and only 8%
correctly answering that someone aged 70 years is most likely to develop lung cancer in the
next year.
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2. Background and Objectives
According to the Office for National Statistics, one in three people in the UK develop cancer
across the course of their lives and around one in four people who develop cancer will die as
a result. Statistics have shown that the UK has lower levels of cancer survival in comparison
with other Western Countries; an issue which needs to be tackled.
Consequently, at the end of 2007, the Department of Health launched the Cancer Reform
Strategy which outlined actions to improve UK wide cancer services within the NHS and
reduce inequalities in incidence, access to services and outcomes. The reform has set a clear
direction in terms of UK cancer services and by 2012 it is hoped that the UK’s cancer services
will be amongst the best in the world. To help achieve these objectives the National
Awareness and Early Diagnosis Initiative (NAEDI) and the National Cancer Equality Initiatives
(NCEI) were launched.
A key component of the work undertaken by NAEDI is highlighting the importance of raising
awareness of cancer within the general population. This is crucial as one of the main factors
associated with a delay in seeking help for cancer is a failure to recognise early cancer
symptoms and later diagnosis is strongly associated with poorer survival rates. The work
undertaken by the NCEI focuses on identifying and bridging inequalities within cancer in
terms of key indices (gender, age, ethnicity, socio-economic status, religious belief, disability,
sexual preference and language). This will allow targeted interventions to be implemented,
focusing on the most vulnerable groups of the population.
To aid this process the Cancer Awareness Measure (CAM) was designed and extensively
validated by Cancer Research UK. This measure has now been extensively used nationally to
assess awareness of the warning signs and symptoms of cancer, knowledge of the types and
incidence of cancer, awareness of the screening programmes for bowel, breast and cervical
cancer and health seeking behaviours and barriers to seeking GP consultation. In addition to
the generic CAM, site specific versions of the CAM have been designed to assess awareness
of the signs, symptoms and risks of specific types of cancer, specifically bowel, ovarian, lung,
breast and cervical cancer.
Lung cancer is the second most commonly diagnosed cancer in the UK and bowel cancer the
third, with 40,806 new cases of lung cancer and 39,991 new cases of bowel cancer diagnosed
in 2008. Mortality rates associated with lung and bowel cancer are also high with lung cancer
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the cause of 23% of cancer related deaths in 2008 and bowel the cause of 10%. 1
In terms of cancer mortality rates, lung and bowel cancer are the most common cancers in
all three PCTs that comprise NHS South of Tyne and Wear. Furthermore, deaths due to lung
cancer are higher in Sunderland, Gateshead and South Tyneside than the national average.2
Whilst the gap in mortality rates between the three PCTs and England is narrowing, further
understanding of awareness levels and promotion of health seeking behaviours and
screening amongst NHS South of Tyne and Wear’s population is crucial.
In order to gain a more in-depth understanding of public awareness of these two common
types of cancer, Public Knowledge were commissioned to conduct research with a sample of
the most deprived populations of Sunderland, South Tyneside and Gateshead using the
validated site specific bowel and lung cancer awareness measures.
This report details the baseline levels of bowel and lung cancer awareness amongst a
sample of the most deprived populations of Sunderland, South Tyneside and Gateshead.
1
http://info.cancerresearchuk.org/cancerstats/
Sunderland Joint Strategic Needs Assessment http://www.sunderland.gov.uk/index.aspx?articleid=5328; South
Tyneside Joint Strategic Needs Assessment http://www.southtyneside.info/article/13283/Joint-Strategic-NeedsAssessment-JSNA; Gateshead Joint Strategic Needs Assessment
http://www.gateshead.gov.uk/Care%20and%20Health/jsna.aspx
2
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3. Methodology
A face-to-face street and door-knocking interview methodology was used to assess baseline
levels of bowel and lung cancer awareness across the most deprived areas served by NHS
South of Tyne and Wear using the validated site specific bowel and lung CAMs (please see
Appendix 8.1).
The main body of the survey was divided into four sections: demographics, the bowel
cancer survey, the lung cancer survey, and a suite of questions on barriers to visiting the
doctor and communications. In order to negate any bias that may occur from presenting
one of the site specific measures first, two versions of the questionnaire were printed and
used, one with the bowel cancer survey first and the second with the lung cancer survey
first.
A face-to-face methodology was selected as most appropriate as cancer is an emotive and
sensitive subject, and therefore, better suited to discussion in person. All interviewers were
fully briefed prior to data collection, which ensured they were knowledgeable and able to
confidently answer any questions posed by respondents at the end of the survey. A face-toface methodology was also advantageous as it allowed interviewers to hand out information
leaflets at the end of the survey which is particularly important given that the overall
objective of this research is to increase awareness of cancer. To encourage response, all
interviewers were also provided with a signed verification letter supplied by NHS South of
Tyne and Wear.
The data was collected from the 10 most deprived wards served by NHS South of Tyne and
Wear, as shown in Table 1.
Table 1: The 10% most deprived wards served by NHS South of Tyne and Wear
Local Authority Area
Ward
Sunderland
Hendon
Southwick
Redhill
Castle
South Tyneside
Bede
Biddick and All Saints
Simonside and Rekendyke
Bridges
Felling
Dunston and Teams
Gateshead
Number living in the
most deprived decile
10,377
8,690
12,351
10,322
7,052
9,109
9,106
6,605
7,299
8,035
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Table2: Sample requirements by ward based on a sample of 1,180 interviews
Local Authority
Area
Ward
Sunderland
Hendon
Southwick
Redhill
Castle
Bede
Biddick and All
Saints
Simonside and
Rekendyke
Bridges
Felling
Dunston and Teams
South Tyneside
Gateshead
TOTAL
% of
sample
Number of
interviews
No of doorknocking
days
No of street
days
10%
10%
10%
10%
10%
120
112
112
120
120
10
0
0
10
10
0
7
7
0
0
10%
120
10
0
10%
10%
10%
10%
120
120
116
120
1,180
interviews
10
10
3
10
0
0
5
0
73 days
19 days
100%
All data was collected by experienced interviewers in accordance with the MRS code of
conduct. The main sample data was collected between 21st September and 19th October
2011 on a combination of week and weekend days. In accordance with the MRS code of
conduct, for quality purposes, 10% of the data submitted by each interviewer was backchecked to ensure that the data was collected when and where specified and that the
interviewers were polite and considerate.
In total, 1,277 interviews were completed. A breakdown of the interviews achieved
according to location, in addition to associated confidence levels at the 95% confidence
level, are presented in Table 3.
Table 3: Sample size and confidence level
Area
Sunderland
South Tyneside
Gateshead
TOTAL
Number
of interviews
459
424
394
Margin of error at
95% confidence
+/-4.57%
+/-4.76%
+/-4.9%
1,277
+/-2.74%
Confidence in data increases as sample size increases. Overall confidence in the data set as
a whole is very reliable, with a margin of error of +/-2.74% based on a 95% confidence
level. The margin of error in the three PCT areas all fall between +/-4.57% and +/-4.9%, all
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of which are above the 5% maximum recommended by our Consultant Statistician, Ken
Baker, and are thus considered to be reliable sub-samples.
Quotas were imposed to ensure that the data was representative of each area in terms of
age, gender and ethnicity. Whilst achieved quotas largely match those required, oversampling resulted in some skewed quotas and the final data was weighted to the sociodemographic profile of each area according to gender, age and ethnicity within each
location. Required and achieved percentages are shown in Appendix 8.2.
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4. Data Processing and Analysis
The data collected was input at Public Knowledge’s head office in Hexham and 20% of the
data input by each individual was checked for accuracy. Data for the open questions (e.g.
spontaneous awareness of the symptoms and causes of bowel and lung cancer) were input
into the code frames specified within the bowel and lung CAM toolkits.
Throughout the report the research findings have been illustrated using easy to read colour
charts, which provide an immediately accessible graphical overview of the answers given by
respondents. The charts are clearly labelled and the corresponding question from the
questionnaire included at the bottom of each chart for ease of reference, in addition to the
‘base’ or sample size for each question. Please note, charts show weighted percentages,
however base sizes on each chart are unweighted and show the actual number of
responses.
Within this report any mention of ‘significance’ refers to statistical significance. Statistical
significance is used to refer to a result that is unlikely to have occurred by chance and in
this case is tested using chi-square. Significance can be calculated to different percentages,
with higher percentages representing more noteworthy responses.
This data has been assessed for statistical significance according to the following variables:

PCT – Gateshead, South Tyneside, Sunderland

Gender – male, female

Age – 18-24, 25-34, 35-44, 45-54, 55-64, 65 +

Gender by age

SEG – AB, C1, C2, D, E

Ethnicity – White, BME

Smoking – yes, no

Amount smoked per day – 0-10, 10-20, 20 +

Personal experience of cancer – self, partner/close family
member/close friend, other family member/other friend, no

Length of time before contacting the doctor (bowel/lung) – less
than a week, more than a week, never/don’t

Confidence identify bowel/lung cancer symptoms – confident, not
confident
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The main report explores the findings obtained in the total sample and at the individual NHS
area level (Sunderland, South Tyneside and Gateshead). The data is presented graphically in
all cases and any notable variation has been discussed in the text. Please note, where 0% is
charted this represents a number of respondents less than 1% of the sample.
Please note that this report is accompanied by data tables and raw data files
where further information can be found, if required.
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5. Respondent Characteristics
5.1. Age and Gender
The age and gender of respondents within the sample as a whole is shown in Table 4.
Table 4: Primary demographics of respondents
Demographic Characteristics
Gender
Age
Male
Female
18-24 years
25-34 years
35-44 years
45-54 years
55-64 years
65 years plus
All data
Sunderland
South Tyneside
Gateshead
50%
50%
12%
16%
17%
18%
15%
22%
50%
50%
13%
16%
16%
18%
15%
22%
50%
50%
13%
15%
17%
18%
15%
22%
50%
50%
11%
16%
18%
18%
15%
22%
As already mentioned, the final dataset was weighted to match the socio-demographic
profile of the three PCTs comprising NHS South of Tyne and Wear in terms of age, gender
and ethnicity.
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5.2. Working Status, Marital Status, Education, Housing Tenure, Vehicle
Ownership and Socio-Economic Grade
Tables 5 and 6 show the secondary demographics of the sample (working status, marital
status, education, housing tenure, vehicle ownership and SEG) and this is discussed further
on the subsequent pages.
Table 5: Secondary demographics of respondents
Demographic characteristics
Working
status
Marital
status
Educational
qualification
Housing
Tenure
Vehicle
ownership
All data
Sunderland
Gateshead
25%
25%
30%
7%
5%
3%
3%
1%
48%
28%
11%
10%
4%
38%
18%
12%
12%
8%
4%
4%
1%
2%
South
Tyneside
39%
26%
17%
7%
8%
1%
1%
1%
0%
42%
39%
8%
9%
2%
0%
42%
20%
18%
8%
1%
4%
2%
4%
0%
Unemployed
Retired
Employed full-time
Employed part-time
Full-time homemaker
Disabled or too ill to work
Still studying
Self-employed
Prefer not to say
Married/living with spouse
Single/never married
Divorced
Widowed
Married/separated from partner
Prefer not to say
No formal qualifications
O Level or GCSE (Grade D - G)
O Level or GCSE (Grade A - C)
Other qualification
ONC/BTEC
A-levels or highers
Degree or higher degree
Prefer not to say
Still studying
Higher education qualification
below degree level
Rent from Local
Authority/Housing Association
31%
27%
24%
8%
5%
3%
2%
0%
0%
43%
35%
10%
9%
3%
0%
43%
18%
13%
10%
5%
5%
3%
2%
1%
1%
1%
1%
0%
61%
60%
67%
57%
Own outright
Own mortgage
Rent privately
Other (e.g. living with
family/friends)
Prefer not to say
Squatting
No
Yes, one
Yes, more than one
Prefer not to say
15%
9%
8%
18%
8%
5%
9%
10%
8%
18%
10%
11%
6%
0%
0%
63%
31%
6%
0%
8%
0%
0%
60%
30%
9%
-
5%
1%
64%
33%
2%
1%
4%
65%
29%
6%
-
29%
29%
23%
10%
2%
5%
2%
37%
41%
10%
9%
3%
49%
16%
9%
9%
4%
6%
4%
1%
1%
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Table 6: Secondary demographics of respondents – Socio-economic Grade
Social Class
A
B
C1
C2
D
E
All data
Sunderland
South
Tyneside
Gateshead
0%
5%
11%
17%
21%
46%
0%
6%
10%
18%
23%
43%
2%
10%
15%
18%
55%
8%
14%
17%
21%
40%
Working Status
Just under a third of the sample (32%) are employed, be that full-time (24%), part-time
(8%) or self-employed (0%). More than a quarter of the sample are retired (27%), which is
largely reflective of the proportion of the sample aged 65 years and above. Just under a
third of the sample report unemployment (31%), which is substantially higher than the
current national average of 8.1%3. A further 5% are full-time homemakers and 3% are
disabled or too ill to work.
Respondents in South Tyneside were more likely to be unemployed (39%), whilst those in
Sunderland were significantly more likely to report being in full-time employment (30%).
Respondents aged 18-24 years (44%), 35-44 years (45%) and those aged 45-54 years
(44%) were significantly more likely to report being unemployed which largely reflects the
continuing situation in the current UK economy.
Female respondents were significantly more likely to be full-time homemakers (10%) or
working part-time (11%), whilst male respondents were significantly more likely to be
working full-time (28%).
Marital Status
The largest proportion of the sample are married and living with their spouse (43%), whilst
just over a third are single/never married (35%). One in ten are divorced, 9% are widowed
and 3% are separated. This breakdown is largely reflective of the UK population as a
whole,4 based on 2001 census returns.
Labour Market Statistics for October 2011, Office of National Statistics:
http://www.ons.gov.uk/ons/publications/all-releases.html?definition=tcm:77-21589
4 Based on 2001 ONS census data:
http://neighbourhood.statistics.gov.uk/dissemination/viewFullDataset.do;jsessionid=ThSDT89SqbTpTv16n1ZNwxs
8LTxTgnNn1ynnhh575ysMGZbdhmQb!264286414!1321008434266?JSAllowed=true&Function=&%24ph=60_61_62
&CurrentPageId=63&step=4&productId=9&instanceSelection=05&timeId=1&containerAreaId=276699&startColum
n=1&revisionStatus=&numberOfColumns=13&javaScriptEnabled=true&selectable=false&metadataInNewWindow=t
3
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Respondents aged 18-34 years were significantly more likely to be single (84% of 18-24
year olds and 52% of 25-34 year olds). Older respondents were significantly more likely to
be married (53% of 35-44 year olds, 49% of 45-54 year olds and 50% of 55-64 year olds),
whilst those over 65 years of age were more likely to be widowed (35%) or divorced (14%).
Educational Qualifications
The largest proportion of the sample report having no formal qualifications (43%) which is
notably higher than the UK average of around 30% and only 3% hold a degree or higher
degree which is substantially lower than the UK average of almost 20%.5 O Levels or GCSEs
were the most common qualifications held by respondents (31% have O Levels or GCSEs at
Grade A-G).
Respondents from Gateshead were significantly more likely to say they have no formal
qualifications (49%) compared to those from Sunderland (38%) and South Tyneside (42%).
Older respondents were significantly more likely to have no formal qualifications (53% of
those aged 55-64 years and 60% of those aged 65 years and above) as were those
classified as socio-economic grade E (64%) and smokers (49%).
Living Arrangements
More than three-fifths of the sample (61%) rent from the local housing authority or housing
association which is substantially higher than the national average of 17.7%.6 Renting from
the local housing authority is most prevalent in South Tyneside (67%). 15% of the total
sample own their home outright, 9% have a mortgage, 8% rent privately and 6% live with
family or friends.
Unsurprisingly, older respondents aged 55 years and above are significantly more likely to
own their own home outright (25% of 55-64 year olds and 32% of those aged 65 and
above), whilst younger respondents were significantly more likely to report living with
family or friends (30% of 18-24 year olds).
rue&optionalMetadataShown=true&disclaimerShown=false&headingTruncationEnabled=true&dropdownSelectionEn
abled=true&overrideCellFormat=&footnoteDisplayEnabled=true&language=English&showTotals=false&unhide=fals
e&paginate=off&paginateCols=6&page=1&sortId=0&sortFunction=off&sortType=0&sortOrder=0&lastCutID=&lastC
utType=&tableTitle=&selectedType=&selectedID&nsjs=true&nsck=true&nssvg=false&nswid=1280
5 http://www.statistics.gov.uk/census2001/profiles/commentaries/people.asp
6 Based on figures from the Survey of English Housing 2007-2008
http://www.communities.gov.uk/publications/corporate/statistics/housingengland200708
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Vehicle Ownership
Car ownership is relatively low with almost two-thirds of the sample (63%) reporting that
they do not own a vehicle, whilst just under a third 31% say they own only one vehicle. Car
ownership is lowest amongst those aged 65 years and above, with 73% saying they do not
own a vehicle.
Socio-Economic Group
In terms of social class, the largest proportion of the sample falls into group E (46%), with
those in South Tyneside significantly more likely to fall into this group (55%).
5.3. Ethnicity, Language and Length of Time Living in the UK
Respondents were also asked about ethnicity, language spoken at home and length of time
spent living in the UK (Tables 7).
Table 7: Ethnicity, language and length of time spent living in the UK
Demographic characteristics
Ethnicity
Language spoken
at home
Length of time
living in the UK
(years)
All data
Sunderland
South
Tyneside
93%
5%
1%
1%
95%
0%
Gateshead
White
Asian
Black
Mixed
Chinese/Other
English
Urdu
94%
3%
2%
1%
0%
97%
0%
95%
2%
1%
2%
0%
98%
0%
Gujarati
Other
Prefer not to
say
Less than 10
years
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
More than 70
year
0%
2%
1%
4%
0%
1%
0%
1%
1%
3%
5%
15%
14%
17%
17%
15%
1%
5%
17%
13%
18%
17%
15%
3%
6%
15%
14%
16%
15%
16%
4%
4%
15%
15%
16%
18%
14%
15%
14%
15%
15%
94%
4%
2%
98%
0%
0%
As can be seen in Table 7, overall 94% the sample is white and quotas were imposed on the
data to ensure a representative spread in terms of ethnicity in the three NHS areas.
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Overall, 97% of the sample speaks English as their first language at home and there was
little variation in this according to location.
Other languages were only spoken by a minority of respondents including three respondents
who speak Urdu, three who speak Gujarati and 16 respondents who speak another
language.
The length of time that respondents have lived in the UK varies considerably. As might be
expected this is strongly correlated with age of the respondent and white respondents are
more likely to have lived in the UK for longer than BME respondents.
5.4. Smoking Behaviour
Figure 1a shows the proportion of people who said that they currently smoke cigarettes.
This question is an addition to the validated CAM measure and is considered important in
order to allow an analysis of the relationship between smoking and cancer awareness.
Figure 1a: Smoking Behaviour
45%
47%
43%
46%
55%
Yes
All data
57%
53%
54%
No
Sunderland
South Tyneside
Gateshead
D12. Do you currently smoke any cigarettes at all?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
In total, 45% of the sample said they currently smoke cigarettes, which is notably higher
than the national average of 21%7. There was no significant difference in smoking
prevalence between locations.
ONS Publication, Smoking and Drinking Amongst Adults, 2009: A Report of the 2009 General Lifestyle Survey
(2011)
7
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There is some variation according to gender with males significantly more likely to say they
smoke (49%) than females (41%). Younger respondents (those aged 18-24 years) are also
significantly more likely to smoke (54%), as are those classified as socio-economic group E
(56%).
Respondents who said they smoke cigarettes were asked how many cigarettes they smoke
each day (Figure 1b).
Figure 1b: Frequency of Smoking
0-5 a day
4%
7%
7%
9%
19%
15%
5-10 a day
10-15 a day
21%
18%
20%
15-20 a day
13%
20-25 a day
25 or more a day
All data
25%
17%
6%
Sunderland
15%
South Tyneside
25%
22%
22%
18%
9%
8%
24%
26%
27%
22%
Gateshead
D12a. Which of the following best describes how many cigarettes you
smoke a day?
Base: All respondents who smoke - 569. Sunderland - 215, South Tyneside - 184, Gateshead 170
The largest proportion of respondents report smoking between 10 and 15 cigarettes a day
(24%), however a relatively large proportion of respondents (31%) smoke more than 20
cigarettes a day. Male respondents were significantly more likely to report smoking more
than 20 cigarettes a day (39%) than females (23%).
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5.5. Personal Experience of Cancer
Respondents were also asked about their own personal experience of cancer (Figure 2).
Figure 2: Personal Experience of Cancer
50%
Close family member
26%
28%
29%
21%
Other family
member
Other friend
Close friend
Partner
You
6%
7%
5%
6%
4%
4%
5%
3%
16%
16%
18%
14%
15%
16%
18%
12%
None
Not sure
Prefer not say
All data
56%
61%
59%
28%
22%
0%
0%
0%
34%
29%
1%
1%
1%
1%
Sunderland
South Tyneside
Gateshead
D13. Have you, your family or close friends had cancer?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
Only 4% of the sample have had cancer themselves, but a large proportion of the total
sample have some personal experience of cancer through a relative, friend, partner or their
own experience (71%). Respondents were most likely to say a close family member had
previously had cancer (56%) and respondents from South Tyneside were significantly more
likely to give this response (61%).
Unsurprisingly, younger respondents were less likely to have personal experience of cancer,
whilst those aged 65 years and above were significantly more likely to say they had
previously had cancer themselves (8%) or that their partner had previously had cancer
(16%).
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6. Full Summary of Results
6.1. Bowel Cancer Awareness Measure
6.1.1. Awareness of the Signs and Symptoms of Bowel Cancer
The first question in the main section of the bowel cancer survey asked respondents to
name as many warning signs and symptoms of bowel cancer as they were able (Figure 3a)
using an open format question. Responses were coded into the code frames specified within
the site specific bowel CAM toolkit.
The most common symptoms of bowel cancer spontaneously named by the sample were a
change in bowel habits (22%) and blood in stools (17%). Back passage bleeding (9%),
abdominal pain (6%) and weight loss (4%) were also mentioned by a number of
respondents and smaller proportions of the sample also spontaneously mentioned feeling
bloated and back passage pain (each mentioned by 2%).
Due to low percentage levels of awareness (1% or lower) the following symptoms specified
within the bowel CAM toolkit have been excluded from Figure 3a: abdominal cramps, bowel
not emptying, tiredness/amnesia, nausea, lumps, loss of appetite, generally feeling unwell
(all mentioned by 1%), abdominal swelling (n=6), lower back pain (n=4) and change in
stool colour (n=1).
Spontaneous awareness of the signs and symptoms of bowel cancer is low amongst the
sample as a whole and just under half of all respondents (45%) were unable to name any
signs or symptoms of bowel cancer indicating a need for increased education in terms of
awareness. Respondents from Sunderland were significantly more likely to be unable to
name any symptoms of bowel cancer (57%); however ‘don’t know’ responses were also
high in South Tyneside (35%) and Gateshead (42%).
This poor level of symptom awareness is also reflected by the mean number of signs and
symptoms spontaneously named by respondents which was 1.
Females were more likely to spontaneously name a change in bowel habits (25%) compared
to males (18%), whilst males were somewhat, though not significantly, more likely to give
the response ‘don’t know’ (48%). Variation by age is more noticeable. Unsurprisingly,
younger respondents (aged 18-24 years) were significantly less likely to spontaneously
name a number of the most common bowel cancer symptoms including specifically a
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change in bowel habits (4%), blood in stools (7%) and back passage bleeding (4%).
Respondents aged 18-24 years (68%) and 25-34 years (52%) were also more likely to be
unable to name any symptoms of bowel cancer, as were those categorised in socioeconomic group E (48%), smokers (50%) and those with no personal experience of cancer
(58%).
There is a clear correlation between confidence noticing a bowel cancer symptom and
spontaneous awareness of bowel cancer symptoms. Respondents who said they were
confident they would notice a symptom of bowel cancer were significantly more likely to
spontaneously name many of the most common symptoms of bowel cancer including a
change in bowel habits (30%), blood in stools (22%), back passage bleeding (13%) and
abdominal pain (9%). In contrast, those who said they were not confident they would notice
a symptom of bowel cancer were significantly more likely to be unable to name any
symptoms of bowel cancer (55%).
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Figure 3a: Spontaneous awareness of the signs and
symptoms of bowel cancer
22%
18%
24%
23%
17%
14%
19%
18%
Change in bowel
habits
Blood in stools
9%
7%
Back passage
bleeding
3%
Abdominal pain
Weight loss
Feeling bloated
Back passage pain
8%
6%
14%
8%
7%
4%
3%
5%
4%
2%
2%
2%
2%
2%
1%
2%
2%
23%
21%
26%
21%
Other
Nothing
2%
1%
2%
3%
45%
Don't Know
All data
35%
Sunderland
South Tyneside
57%
42%
Gateshead
Q1. There are many warning signs and symptoms of bowel cancer.
Please name as many as you can think of.
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
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In total, 23% of the sample also mentioned ‘other’ signs and symptoms not listed in the
bowel CAM toolkit. Figure 3b details the ‘other’ responses obtained.
Figure 3b: Spontaneous awareness of the signs and
symptoms of bowel cancer - other responses
52%
Bleeding
47%
45%
51%
53%
49%
52%
Pain (various
mentions)
Bad Stomach
Drinking Alcohol
64%
3%
2%
4%
2%
1%
1%
1%
Other
All data
10%
17%
17%
Sunderland
27%
South Tyneside
Gateshead
Q1. There are many warning signs and symptoms of bowel cancer.
Please name as many as you can think of.
Base: All respondents who gave 'other' responses - 291. Sunderland - 96, South Tyneside - 110,
Gateshead - 85
WARNING LOW BASE SIZES
The most common ‘other’ symptoms of bowel cancer named by the sample were unspecified
bleeding (52%) and unspecified pain (51%). Although general mentions of bleeding and
pain cannot be coded into the very specific code frames specified in the bowel CAM toolkit,
it is important to note that unspecified bleeding and pain are the third and fourth most
commonly mentioned symptoms by respondents. This suggests that whilst respondents are
identifying important symptoms, they have difficulties being more specific, feel it
unnecessary to be more specific about these symptom or are embarrassed to go into more
detail.
In addition to the data presented in Figure 3b, there were many other possible symptoms of
cancer named within the sample, both correctly and incorrectly attributed, such as bacteria,
indigestion, high blood pressure, fainting and heartburn.
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In the second question respondents were read a list of potential signs and symptoms and
were asked whether they thought each of these could be a sign of bowel cancer. The
percentage of ‘yes’ responses to this question are shown in Figure 4.
Figure 4: Prompted awareness of the signs and symptoms
of bowel cancer
89%
89%
88%
91%
88%
88%
91%
86%
86%
86%
88%
85%
Blood in your stools
Bleeding from your
back passage
Change in bowel
habits
80%
79%
82%
80%
80%
76%
85%
78%
Unexplained weight
loss
Pain in your back
passage
76%
70%
Persistent pain in
your abdomen
75%
71%
67%
73%
72%
68%
63%
76%
65%
Tiredness/anaemia
A lump in your
abdomen
A feeling that your
bowel does not
completely empty
All data
85%
57%
66%
64%
Sunderland
South Tyneside
78%
Gateshead
Q2. The following may or may not be warning signs of bowel cancer.
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
Respondents were most likely to agree that blood in your stools (89%) and bleeding from
your back passage (88%) could be a symptom of bowel cancer, despite only 17% and 9%
spontaneously mentioning these in the previous question.
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A change in bowel habits (86%), unexplained weight loss (80%) and pain in your back
passage (80%) were also symptoms which respondents were most likely to agree could be
signs of bowel cancer.
Respondents were least likely to agree that a lump in your abdomen (68%) and a feeling
that your bowel does not completely empty after using the lavatory (66%) could be a sign
of bowel cancer.
Prompted agreement with each of the symptoms listed was considerably higher than
spontaneous awareness, and respondents agreed with a mean number of 7.05 symptoms
out of a possible 9.
Some variation is evident according to geographical sub-sample, gender and age.
Respondents from South Tyneside were significantly more likely to agree that many of the
listed symptoms including bleeding from your back passage (91%), persistent pain in your
abdomen (85%), a feeling that your bowel does not completely empty (78%) and pain in
your back passage (85%) could be a sign of bowel cancer compared to those from
Sunderland and Gateshead. Female respondents were also significantly more likely to agree
with most of the listed symptoms, as were those aged 45-64 years and non-smokers. In
contrast, younger respondents (aged 18-24 years) were more likely to give the response
‘don’t know’ when asked about each of the symptoms listed.
Again, there was also an association between confidence identifying cancer symptoms and
agreement that each of the listed symptoms could be a sign of bowel cancer.
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6.1.2 Help Seeking Behaviour – Bowel Cancer
Respondents were then asked how soon they would contact a doctor to make an
appointment if they had a symptom they thought might be a sign of bowel cancer.
Responses are shown in Figure 5 below.
Figure 5: Length of wait before contacting the doctor to
discuss bowel cancer symptoms
32%
1-3 days
12%
10%
13%
12%
4-6 days
17%
1 week
11%
12%
9%
11%
11%
14%
10%
9%
2 weeks
1 month
6 weeks
3 months or more
Never
Don’t know
2%
2%
2%
2%
2%
1%
1%
1%
1%
35%
35%
39%
20%
19%
23%
4%
5%
4%
6%
7%
3%
6%
All data
Sunderland
South Tyneside
Gateshead
Q3. If you had a symptom that you thought might be a sign of bowel
cancer how soon would you contact your doctor to make an appointment
to discuss it?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
As Figure 5 shows, respondents were most likely to say that they would contact their doctor
within 1-3 days if they had a symptom that they thought was a sign of bowel cancer (35%)
and 67% said they would contact their doctor within a week. However 17% also said they
would wait a month or longer.
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Some geographical variation is evident and respondents from Sunderland would wait 17.4
days on average compared to 16 days for those in South Tyneside and 10 days for those in
Gateshead.
Some important variation is also apparent according to gender, age and ethnicity. Males
would wait considerably longer (18.5 days) than females (10.9 days). Positively, the group
most at risk of developing bowel cancer (65 years and above) said they would wait the
shortest time before contacting their doctor to discuss a bowel cancer symptom (9.9 days
on average), however males aged 65 years and above would wait longer on average (11.5
days) than females (8 days). BME respondents also said they would wait considerably
longer (22.7 days on average) when compared to white respondents (14.1 days).
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6.1.3. Age People Develop Bowel Cancer
In the following question, respondents were asked who is most likely to develop bowel
cancer in the next year. Figure 6 shows the responses given.
Figure 6: Expectation of the age people develop below
cancer
A 20 year old
1%
1%
1%
A 40 year old
3%
A 60 year old
9%
10%
13%
21%
23%
20%
19%
57%
52%
56%
Bowel cancer is
unrelated to age
Don't know
All data
63%
13%
14%
10%
15%
Sunderland
South Tyneside
Gateshead
Q4. In the next year, who is most likely to develop bowel cancer?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
According to the bowel CAM toolkit, the risk of developing bowel cancer increases with age,
with over 8 in 10 cases of bowel cancer occurring in people aged over 60, therefore a 60
year old is most likely to develop bowel cancer in the next year. As such, 21% of the
sample answered correctly.
The largest proportion of the sample selected the answer ‘bowel cancer is unrelated to age’
(57%), revealing a distinct lack of awareness. Respondents in Gateshead were significantly
more likely to think bowel cancer is unrelated to age (63%).
Male respondents were significantly more likely to say a 60 year old is most likely to
develop bowel cancer (24%) compared to females who are more likely to think that bowel
cancer is unrelated to age (60%). Positively, those who are most at risk of developing bowel
cancer (those aged 65 years and above) were significantly more likely to give the response
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‘a 60 year old’ (27%), however even the largest proportion of this age group think bowel
cancer is unrelated to age (56%).
Interestingly, respondents who said they were confident they would notice a sign of bowel
cancer were significantly more likely to think that bowel cancer is unrelated to age (64%).
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6.1.4. Factors Affecting the Chances of Developing Bowel Cancer
Respondents were then asked what factors they think affect the chances of developing
bowel cancer using an open question. The most common responses received, as coded into
the code frames specified within the bowel CAM toolkit, are shown in Figure 7a below.
Figure 7a: Spontaneous awareness of factors that may
increase the chances of developing bowel cancer
Unhealthy/poor diet
Smoking
Drinking alcohol
Diet high in fat
Family history/relatives with cancer
Not doing enough exercise
Lifestyle
Genes
Bad luck
Other
Nothing
13%
10%
13%
16%
9%
7%
11%
9%
7%
2%
6%
13%
5%
8%
2%
6%
3%
3%
3%
3%
3%
2%
3%
2%
2%
2%
1%
3%
2%
2%
2%
2%
4%
6%
3%
2%
1%
1%
2%
0%
24%
24%
27%
23%
54%
57%
53%
53%
Don't Know
All data
Sunderland
South Tyneside
Gateshead
Q5. What things do you think affect a person's chances of developing
bowel cancer?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
The most common response, given by 24% of the total sample, was unhealthy/poor diet.
Smoking (13%) and drinking alcohol (9%) were also common risk factors mentioned by the
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sample. Smaller proportions also spontaneously named the following factors: a diet high in
fat (7%), family history/relatives with cancer (5%), not doing enough exercise (3%),
lifestyle (3%), genes (2%) and bad luck (2%).
Due to low percentage levels of awareness (1% or lower) the following risks specified within
the bowel CAM toolkit have been excluded from Figure 7a: older age, not eating enough
fibre, eating red or processed meat, not eating enough fruit and vegetables (all mentioned by
1%), pollution (n=6), being overweight (n=6), stress (n=4) and having a bowel disease
(n=1).
In total, over half of the sample (54%) said they could not name any factors that can cause
bowel cancer. Females (57%) were significantly more likely to be unable to name any bowel
cancer risk factors, as were those classified as socio-economic grade E (62%), respondents
aged 18-24 years (66%) and smokers (58%). Additionally, those who said they were not
confident they would notice a symptom of bowel cancer were significantly more likely to be
unable to mention any bowel cancer risk factors (65%).
The difficulty respondents had naming any bowel cancer risk factors is reflected by the
mean number of risks mentioned by respondents which was 0.78.
Again, there is an evident connection between confidence identifying bowel cancer
symptoms and awareness of bowel cancer risk factors. Respondents who said they were
confident they would notice a symptom of bowel cancer were significantly more likely to
spontaneously name a variety of risk factors including an unhealthy/poor diet (33%),
smoking (21%), drinking alcohol (16%), a diet high in fat (15%), not doing enough exercise
(4%) and lifestyle (4%).
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Only 4% of the sample named ‘other’ causes of bowel cancer not specified within the bowel
CAM toolkit, and these are shown in Figure 7b.
Figure 7b: Spontaneous awareness of factors that may
increase the chances of developing bowel cancer - other
responses
8%
10%
Poor Health
15%
6%
Previous history of
cancer
Warning sign given
not risk
11%
4%
4%
7%
4%
Drugs
14%
78%
75%
79%
85%
Other
All data
Sunderland
South Tyneside
Gateshead
Q5. What things do you think affect a person's chances of developing
bowel cancer?
Base: All respondents - 48. Sunderland - 26, South Tyneside - 12, Gateshead - 10
WARNING LOW BASE SIZES
The most common ‘other’ responses given by the sample were poor health (8%) and
previous history of cancer (6%). A number of other possible risks were given by the sample
including: living in the city, bad digestion, being a man, being unhygienic, slimming,
generally being unwell, nature and irritable bowel syndrome.
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A prompted question was used next to assess awareness of factors which may increase the
chances of getting bowel cancer. Respondents were asked: ‘The following may or may not
increase the chance of developing bowel cancer. How much do you agree that each of these
can increase the chance of developing bowel cancer?’ Figure 8 shows the percentage of
‘agree’ and ‘strongly agree’ responses only.
Figure 8: Prompted awareness of factors that may cause
bowel cancer
Having a bowel disease
60%
Having a close relative with bowel cancer
43%
49%
51%
59%
41%
55%
50%
49%
53%
48%
47%
55%
39%
45%
46%
49%
41%
45%
44%
44%
49%
37%
44%
43%
50%
41%
41%
44%
37%
42%
Having diabetes
Eating less than 5 portions of fruit and
vegetables a day
Being over 70 years old
Eating red or processed meat once a day
or more
Drinking more than 1 unit of alcohol a
day
Being overweight
Doing less than 30 mins of moderate
physical activity 5 times a week
Sunderland
70%
55%
57%
53%
56%
52%
63%
Having a diet low in fibre
All data
69%
77%
South Tyneside
Gateshead
Q6. How much do you agree that each of these can increase the chance
of developing bowel cancer?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
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Respondents were most likely to agree that the following factors were causes of bowel
cancer: having a bowel disease (69%), having a diet low in fibre (55%) and having a close
relative with bowel cancer (52%).
There were low levels of agreement for each of the following: being over 70 years old
(47%), eating red or processed meat once a day or more (46%), drinking more than 1 unit
of alcohol a day (44%), being overweight (44%) and doing less than 30 minutes of
moderate physical activity 5 times a week (41%).
There was little significant variation according to gender; however some is evident
according to age, socio-economic grade and ethnicity. Respondents aged 18-24 years were
significantly less likely to strongly agree with each of the listed risks, whilst those classified
as socio-economic grade E were significantly more likely to give the response ‘not sure’.
BME respondents were more likely to ‘agree’ that many of the listed risks could increase the
chances of developing bowel cancer.
There was also a strong correlation between confidence identifying bowel cancer symptoms
and agreement with each of the listed risks. Respondents who said they were not confident
they would notice a symptom of bowel cancer were significantly more likely to be unsure or
disagree that each of the listed risks could increase the chances of developing bowel cancer.
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6.1.5. Confidence Noticing Bowel Cancer Symptoms
The final question in the section on bowel cancer asked respondents how confident they are
that they would notice a symptom of bowel cancer. Responses given are shown in Figure 9.
Figure 9: Confidence noticing bowel cancer symptoms
9%
Very confident
13%
10%
14%
30%
30%
Fairly confident
Not very confident
30%
Not at all confident
Don't know
All data
7%
40%
38%
40%
38%
37%
15%
14%
13%
6%
5%
5%
5%
Sunderland
South Tyneside
Gateshead
Q7. How confident are you that you would notice a bowel cancer
symptom?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
More than half of all respondents (55%) said they are not confident that they would notice a
bowel cancer symptom (15% said ‘not at all confident’ and 40% said ‘not very confident’).
Some distinctive geographical variations are evident and respondents from Sunderland were
more likely to say they are not confident they would notice a bowel cancer symptom (70%)
compared to those in South Tyneside (44%) and Gateshead (52%).
Given that bowel cancer is most likely to affect those aged 60 or over and that screening is
concentrated amongst this age group, the relationship between age and confidence is of
interest. Unsurprisingly, younger respondents are less confident they would notice a bowel
cancer symptom (68% of those aged 18-24 years said they were ‘not very’ or ‘not at all’
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confident). In contrast, respondents aged 65 years and above were significantly more likely
to say they are ‘fairly’ confident they would notice a symptom of bowel cancer (37%).
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6.2. Lung Cancer Awareness Measure
6.2.1. Awareness of the Signs and Symptoms of Lung Cancer
Respondents were also asked a suite of questions specifically with regards to signs,
symptoms and risks of lung cancer.
Respondents were firstly asked to spontaneously name as many signs and symptoms of
lung cancer as they could using an open question format. These open responses were coded
into the code frames specified within the lung CAM toolkit and these coded responses are
shown in Figure 10a.
The most common symptom of lung cancer spontaneously named by the sample was a
persistent cough, mentioned by 38% of the sample. This result suggests that respondents
are more likely to be aware of relevant symptoms when asked about specific types of
cancer. It is evident from past experience that when asked about general cancer symptoms
in the generic CAM, few respondents spontaneously mention coughing and hoarseness and
respondents are less likely to agree that a persistent cough or hoarseness could be a sign of
cancer when prompted. For example, only 11% of NHS South of Tyne and Wear’s sample
spontaneously mentioned a cough or hoarseness as a symptom of cancer when the area’s
generic CAM was conducted in May 2011.
Shortness of breath (26%), coughing up blood (24%), chest pain (14%), tiredness or lack
of energy (8%), weight loss (8%) and difficulty breathing (8%) were also common
symptoms identified by respondents. Smaller proportions of the sample also mentioned
persistent chest infections (3%) and stridor (2%).
Some signs and symptoms specified within the lung CAM toolkit code frame were only
mentioned by very small proportions of the sample (1% or less) and therefore have not
been shown in Figure 10a. These include: excess sputum, feeling unwell, a tight chest,
yellow or grey skin tone and a painful cough (all mentioned by 1%), loss of appetite (n=6),
back pain (n=6), an ache or pain when breathing (n=6), shoulder pain (n=6), fluid in the
lungs (n=3), a hoarse voice (n=3), worsening or change of an existing cough (n=2) and
enlarged lymph nodes (n=1).
In total, just over a fifth of respondents said they could not name any signs or symptoms of
lung cancer (21%) and respondents who said they are not confident they would notice a
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symptom of lung cancer were significantly more likely to be unable to name any symptoms
of lung cancer spontaneously (25%). However, respondents were marginally more able to
spontaneously name signs and symptoms of lung cancer than bowel cancer which is
reflected in the mean number of symptoms mentioned, 1.67.
There was little notable variation by geographical area although respondents from
Sunderland were significantly more likely to spontaneously mention tiredness or lack of
energy (11%), weight loss (13%) and difficulty breathing (10%). Respondents aged 18-24
years were more likely to be unable to name any signs or symptoms of lung cancer (27%)
and respondents aged 65 years and above were significantly more likely to spontaneously
mention shortness of breath (33%), however there was little other notable variation by age.
Smokers were significantly less likely to spontaneously name a persistent cough (35%)
compared to non-smokers (41%).
Those who said they were confident they would notice a symptom of lung cancer were
significantly more likely to spontaneously name a number of the most common symptoms
of lung cancer including a persistent cough (41%), coughing up blood (27%), chest pain
(18%) and a tight chest (2%).
NHS South of Tyne and Wear – Bowel and
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Figure 10a: Spontaneous awareness of the signs and
symptoms of lung cancer
Persistent cough
Shortness of breath
Coughing up blood
8%
Chest pain
Tiredness or lack of energy
Weight loss
Difficulty breathing
Persistent chest infection
Stridor (unexplained, loud, high pitched
sound when breathing)
13%
8%
11%
4%
10%
8%
13%
4%
6%
8%
10%
6%
7%
3%
2%
3%
3%
2%
2%
2%
1%
Other
Nothing
Don't Know
All data
Sunderland
14%
1%
1%
1%
26%
27%
25%
25%
24%
25%
21%
27%
38%
39%
41%
35%
21%
25%
26%
26%
22%
21%
23%
19%
23%
South Tyneside
Gateshead
Q1. There are many warning signs and symptoms of lung cancer. Please
name as many as you can think of.
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
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Figure 10b presents the ‘other’ responses given by respondents which are not listed in the
bowel CAM toolkit code frame.
Figure 10b: Spontaneous awareness of the signs and
symptoms of lung cancer - other responses
Pain
22%
17%
Coughing
Bleeding
Infection / Illness
Coughing Up Phlegm / Mucus
Lack of Mobility
Bad Chest
Risk Given
Lumps
COPD
Vomiting
1%
5%
6%
42%
30%
31%
37%
41%
19%
22%
9%
9%
6%
7%
11%
6%
9%
1%
7%
4%
5%
3%
3%
3%
8%
1%
2%
7%
2%
1%
1%
1%
1%
1%
1%
2%
Other
All data
15%
32%
Sunderland
13%
10%
11%
19%
South Tyneside
Gateshead
Q1. There are many warning signs and symptoms of lung cancer. Please
name as many as you can think of.
Base: All respondents - 316. Sunderland - 117, South Tyneside - 111, Gateshead - 88
WARNING LOW BASE SIZES
The most common ‘other’ symptoms mentioned by respondents were unspecified pain
(32%), coughing (general mention) (31%) and unspecified bleeding (15%). Again, these
responses were too general to code into the specified lung CAM code frames.
There were also many other possible signs or symptoms of lung cancer referred to by
respondents including a sore throat, slowing down, bloating, trembling and spluttering.
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Respondents were next read a list of possible warning signs and symptoms and were asked
whether they thought each could be a sign of lung cancer. The percentage of ‘yes’
responses given are shown in Figure 11.
Figure 11: Prompted awareness of the signs and symptoms
of lung cancer
Coughing up blood
A persistent shortness of breath
Worsening or change in an existing cough
An ache or pain when breathing
A painful cough
Persistent chest pain
A cough that does not go away for two or
three weeks
An unexplained loud, high pitched sound
when breathing
A persistent (3 weeks or longer) chest
infection
62%
Persistent tiredness or lack of energy
Unexplained weight loss
56%
48%
Loss of appetite
Persistent shoulder pain
Changes in the shape of your fingers or
nails
All data
Sunderland
25%
22%
28%
25%
South Tyneside
51%
47%
43%
54%
46%
96%
98%
94%
95%
92%
94%
90%
91%
88%
86%
89%
90%
85%
85%
83%
86%
85%
83%
88%
86%
83%
80%
87%
83%
82%
73%
88%
87%
77%
74%
82%
76%
76%
77%
71%
69%
74%
70%
70%
67%
75%
66%
91%
68%
Gateshead
Q2. The following may or may not be signs for lung cancer.
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
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Respondents were most likely to agree that coughing up blood (96% agreement overall)
could be a sign of lung cancer, despite only 24% mentioning this spontaneously at the
previous question. There was also high levels of agreement that each of the following could
be a symptom of lung cancer: a persistent shortness of breath (92%), worsening or change
in an existing cough (88%), an ache or pain when breathing (85%), a painful cough (85%),
persistent chest pain (83%) and a cough that does not go away for two or three weeks
(82%).
Respondents were least likely to agree that loss of appetite (56%), persistent shoulder pain
(47%) and a change in the shape of your fingers or nails (25%) could be a warning sign of
lung cancer.
Agreement that each of the signs listed could be a symptom of cancer was somewhat higher
for lung cancer than bowel cancer as the mean score indicates, respondents agreed on
average with 10.32 out of the possible 14 symptoms.
Respondents from Sunderland were significantly more likely to disagree that many of the
symptoms listed could be a sign of lung cancer, whilst respondents from South Tyneside
were significantly more likely to agree.
There was little consistent variation by age group; however there was some noticeable
differences according to gender. Females were more likely, though not always significantly
more likely, to agree that many of the possible signs listed could be a symptom of lung
cancer. In contrast, males were significantly more likely to give the response ‘don’t know’
when asked about many of the listed symptoms, specifically unexplained weight loss (23%),
a persistent chest infection (11%), a cough that does not go away (10%) and loss of
appetite (26%).
Respondents with no personal experience of cancer were significantly more likely to answer
‘don’t know’ when asked about most of the listed symptoms. Again, there is also a
correlation between confidence in recognising lung cancer symptoms and agreement that
each of the symptoms listed could be a sign of cancer. Respondents who said they are not
confident they would notice a lung cancer symptom were significantly less likely to agree
that each of the symptoms listed could be a sign of lung cancer.
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6.2.2. Help Seeking Behaviour – Lung Cancer
The following question in the lung cancer section of the survey asked respondents about
help seeking behaviour. Respondents were asked how long they would wait before
contacting their doctor to discuss a symptom they thought might be a sign of lung cancer
(Figure 12).
Figure 12: Length of wait before contacting the doctor to
discuss lung cancer symptoms
32%
1-3 days
11%
11%
11%
12%
4-6 days
1 week
2 weeks
1 month
6%
13%
14%
13%
12%
10%
14%
10%
3%
4%
2%
3%
4%
3%
3 months or more
3%
4%
1%
Never 0%
1%
2%
4%
4%
Don’t know
3%
4%
All data
Sunderland
20%
18%
19%
35%
37%
35%
24%
6 weeks
South Tyneside
Gateshead
Q3. If you had a symptom that you thought might be a sign of lung
cancer, how soon would you contact your doctor to make an appointment
to discuss it?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
More than a third of the sample said they would wait 1-3 days before contacting their doctor
to discuss a symptom they thought might be a sign of lung cancer (35%) and two-thirds
(66%) would contact their doctor within a week. However 17% said they would wait longer
than a month and 1% (n=16) said they would never contact their doctor to discuss a
symptom they thought might be a sign of lung cancer.
Respondents from Sunderland would wait the longest before contacting their doctor (16
days on average) compared to those from South Tyneside (13.6 days) and Gateshead (13.9
days).
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The mean scores indicate some differences according to gender, with males saying they
would wait longer before contacting the doctor (18.6 days) compared to females (10.6
days). No consistent pattern emerges in terms of length of wait in relation to age although
the oldest age bracket (65 years and above) would, on average, wait a shorter period of
time before contacting their doctor (11.8 days) which is positive.
On average, smokers said they would wait longer before contacting their doctor to discuss a
symptom that might be lung cancer (16.2 days) compared to non-smokers (13.2 days), and
the heaviest smokers (those smoking 20 cigarettes a day or more) would wait 20.6 days on
average before making contact.
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6.2.3. Age People Develop Lung Cancer
In the next section respondents were asked: ‘In the next year, who is most likely to develop
lung cancer?’ Responses are shown in Figure 13.
Figure 13: Expectation of the age people develop lung
cancer
A 30 year old
5%
7%
5%
3%
A 50 year old
A 70 year old
17%
18%
19%
14%
8%
10%
7%
8%
57%
55%
58%
58%
Lung cancer is
unrelated to age
Don't know
All data
12%
10%
11%
16%
Sunderland
South Tyneside
Gateshead
Q4. In the next year, who is most likely to develop lung cancer??
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
According to the lung CAM toolkit, individuals under the age of 40 years are rarely
diagnosed with lung cancer. The risk of lung cancer increases with age and most cases
occur in individuals aged over 65, peaking in individuals aged 75-84 years; therefore a 70
year old is most likely to develop lung cancer in the next year. As such, only 8% of the
South of Tyne and Wear sample answered correctly.
The majority (57%) think lung cancer is unrelated to age, whilst 17% opted for a 50 year
old and 5% a 30 year old.
No significant variation is evident according to geographical location; however some is
apparent according to gender with males significantly more likely to give the correct answer
(11%) compared to females (6%). Those most at risk of developing lung cancer (65 years
and above) were no more likely to give the correct response than other age groups.
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Despite saying they were confident they would notice a symptom of lung cancer,
respondents who said they were confident were significantly more likely to think that lung
cancer is unrelated to age (66%).
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6.2.4. Factors Affecting the Chances of Developing Lung Cancer
The next set of questions assessed respondents’ knowledge of risk factors that may increase
the chances of developing lung cancer. An open format question was used and responses
were coded into the code frames specified in the lung CAM toolkit. Coded responses are
shown below in Figure 14a.
Figure 14a: Spontaneous awareness of factors that may
increase the chances of developing lung cancer
86%
86%
87%
85%
Being a smoker
Work environment
Air pollution
Exposure to chemicals
Drinking alcohol
Passive smoking
Genes
Unhealthy/poor diet
Unhealthy lifestyle
Close relative with lung cancer
Lack of exercise
Other
Nothing
Don't Know
All data
11%
13%
11%
7%
6%
4%
5%
8%
6%
4%
8%
6%
4%
3%
6%
4%
4%
4%
3%
4%
3%
3%
2%
4%
3%
2%
3%
3%
1%
2%
0%
2%
1%
0%
0%
1%
1%
1%
1%
0%
7%
7%
7%
7%
0%
0%
0%
1%
7%
8%
7%
6%
Sunderland
South Tyneside
Gateshead
Q5. What things do you think affect a person's chance of developing lung
cancer?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
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The most common risk factor spontaneously mentioned was ‘being a smoker’, with 86% of
respondents giving this response. However in total, 57% of the sample were only able to
name this and no other factors.
Whilst smoking is clearly top of mind as a lung cancer risk factor, spontaneous mentions of
other possible risk factors were much less frequent. Smaller proportions of the sample
spontaneously named work environment (11%), air pollution (6%), exposure to chemicals
(6%), drinking alcohol (4%), passive smoking (4%), genes (3%), unhealthy/poor diet
(3%), unhealthy lifestyle (1%), having a close relative with lung cancer (1%) and lack of
exercise (1%).
Due to low percentage levels of awareness (0% or lower) the following risks specified within
the lung CAM toolkit have been excluded from Figure 14a: stress (n=5), exposure to radon
gas (n=3), being overweight (n=2), history of lung disease (n=2), secondary cancer site
(n=2) and past cancer history (n=1).
In total, 7% of the sample said they could not think of any risk factors that may affect a
person’s chances of developing lung cancer. Those aged 65 years and above were
significantly more likely to give this response (11%), as were those classified as socioeconomic grade E (9%) and those who said they were not confident they would notice a
symptom of lung cancer (11%).
However, awareness of lung cancer risk factors is somewhat higher than awareness of
bowel cancer risk factors with a mean number of 1.34 lung cancer risks named by
respondents.
Some further variation is apparent according to gender and age. Males were significantly
more likely to spontaneously name work environment as a possible risk factor (14%) and
older respondents (those aged 65 years and above) were significantly less likely to name
being a smoker (79%).
Respondents who said they are not confident they would notice a symptom of lung cancer
were significantly less likely to spontaneously name a number of the most common lung
cancer risk factors including being a smoker (83%), air pollution (4%) and drinking alcohol
(3%).
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In total, 7% of the sample also mentioned ‘other’ risk factors not coded within the lung CAM
toolkit. These other responses are shown in Figure 14b.
Figure 14b: Spontaneous awareness of factors that may
increase the chance of developing lung cancer - other
responses
24%
Chance
16%
24%
14%
11%
13%
Drugs
Infection / Illness
23%
15%
8%
Area of residence
3%
34%
8%
10%
10%
7%
19%
43%
41%
Other
39%
All data
Sunderland
South Tyneside
49%
Gateshead
Q5. What things do you think affect a person's chance of developing
lung cancer?
Base: All respondents - 88. Sunderland - 30, South Tyneside - 30, Gateshead - 28
WARNING LOW BASE SIZES
The most common ‘other’ risk factor spontaneously named was chance (24%), followed by
area of residence (15%), drugs (11%) and infection or illness (10%). A total of 37
respondents also mentioned ‘other’ factors which included poison, age, general abuse, sun
beds, foreign cigars and drinking too much coffee and tea.
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The next question in the survey used a prompted format to assess awareness of factors
which may increase the chances of developing lung cancer. Respondents were asked: ‘The
following may or may not increase the chance of developing lung cancer. How much do you
agree that each of these can increase the chance of developing lung cancer?’ The ‘strongly’
agree’ and ‘agree’ responses are shown in Figure 15.
Figure 15: Prompted awareness of factors that may
increase the chances of developing lung cancer
Being a smoker
94%
96%
90%
96%
Exposure to another person’s cigarette
smoke
90%
95%
85%
90%
Exposure to chemicals
90%
95%
83%
92%
Air pollution
70%
77%
Having a previous history of cancer such
as head and neck cancer
70%
73%
88%
74%
72%
71%
76%
Exposure to radon gas
72%
81%
66%
69%
Having had treatment for any cancer in
the past
64%
73%
55%
62%
Having a close relative with lung cancer
Sunderland
91%
84%
92%
77%
79%
Chronic Obstructive Pulmonary Disease
All data
84%
92%
South Tyneside
Gateshead
Q6. How much do you agree that each of these can increase the chance
of developing lung cancer?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
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Respondents were most likely to agree that being a smoker can increase the chance of
developing lung cancer (94% overall agreement), mirroring the most common spontaneous
risk factor mentioned in the previous question. There was also high levels of agreement that
exposure to another person’s cigarette smoke (90%) and exposure to chemicals (90%
agreement) could increase the chances of developing lung cancer.
Respondents were least likely to agree that having a close relative with lung cancer (64%)
could increase a person’s chances of developing lung cancer.
Agreement that each risk factor listed could increase the chances of developing lung cancer
was relatively high and on average respondents agreed with a mean number of 7.29 risks
out of a possible 9.
Respondents from Sunderland were more likely to agree that each of the listed risk factors
could increase the chances of developing lung cancer compared to respondents from South
Tyneside and Gateshead, however respondents from Gateshead were significantly more
likely to ‘strongly agree’ with each of the listed risk factors.
There was little consistent variation according to socio-demographic profile, although
younger respondents (aged 18-24 years) were more likely to give the response ‘not sure’
when asked about many of the risk factors listed, as were those categorised as socioeconomic grade E, and non-smokers were more likely to strongly agree that all of the listed
risks could increase the chances of developing lung cancer.
Again there is a clear correlation between confidence identifying lung cancer symptoms and
agreement that the listed risk factors can increase the chances of developing lung cancer.
Respondents who said they were confident they would notice a symptom of lung cancer
were significantly more likely to strongly agree that each of the listed risk factors could
increase the chances of developing lung cancer.
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6.2.5. Confidence Noticing Lung Cancer Symptoms
Finally in this section of the lung cancer survey respondents were asked how confident they
are that they would notice a symptom of lung cancer. Responses are shown in Figure 16.
Figure 16: Confidence noticing lung cancer symptoms
16%
10%
13%
Very confident
26%
34%
Fairly confident
38%
35%
Not very confident
28%
10%
Not at all confident
Don't know
All data
6%
5%
4%
3%
3%
5%
Sunderland
45%
33%
36%
33%
17%
South Tyneside
Gateshead
Q7. How confident are you that you would notice a symptom of lung
cancer?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
In total, just over half of the sample (54%) said they are ‘very confident’ or ‘fairly confident’
that they would notice a symptom of lung cancer, however more than two-fifths said they
were ‘not very’ or ‘not at all’ confident.
Respondents from Gateshead (61%) were more likely to say they are confident they would
notice a symptom of lung cancer compared to respondents in South Tyneside (58%) and
Sunderland (44%).
Unsurprisingly, younger respondents were significantly more likely to say they are ‘not at all
confident’ they would notice a symptom of lung cancer (17%), in contrast to respondents
aged 65 years and above, who were significantly more likely to say they were ‘fairly
confident’ (44%).
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6.3 Delays to Visiting the Doctor and Communications
6.3.1. Delays to Visiting the Doctor
Respondents were next read a list of reasons why people might put off going to see a
doctor, even when they think the symptoms might be serious, and were asked if any of
these reasons would cause them to delay contact. Figure 17 shows the ‘yes’ responses only.
Figure 17: Delays to Visiting the Doctor
I would be worried or scared about what
the doctor might find
7%
It would be difficult to make an
appointment with my doctor
I would be too embarrassed
I would be worried about wasting the
doctor's time
I would be too busy to make time to go to
the doctors
My doctor would be difficult to talk to
I wouldn't feel confident talking about my
symptoms with the doctor
All data
Sunderland
3%
2%
9%
10%
10%
6%
6%
9%
4%
5%
4%
3%
4%
3%
3%
2%
1%
2%
3%
1%
1%
2%
1%
1%
1%
1%
1%
South Tyneside
Gateshead
D14. Could you say if any of these might put you off going to the
doctor?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
There were relatively low levels of agreement that the listed reason would put respondents
off visiting the doctor, however respondents were most likely to say they would put off
going to the doctor because they would be worried or scared about what the doctor might
find (9%) or because it would be difficult to make an appointment (6%). Respondents from
Gateshead were significantly more likely to say they would put off going to the doctor
because of difficulties making an appointment (9%).
Respondents aged 65 years and above were significantly more likely to say each of the
listed reasons would not put them off visiting the doctor.
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Respondents who said any of the listed reasons would put them off visiting their doctor
were then asked a follow-up open format question in an attempt to identify ways in which
the NHS can help the public overcome these barriers. Given the low number of ‘yes’
responses to the initial barrier list and high proportion of ‘don’t know’ responses to the open
question, responses have not been graphed but a range of verbatim comments have been
provided. In many cases respondents described why the particular reason was a barrier
rather than suggesting how this barrier could be overcome.
I would be too embarrassed: Is there anything the NHS could do to help you
overcome this barrier?
“People other than doctors to talk to.”
“If it was about bowels I would probably be embarrassed.”
“Because I smoke, I will get a lecture.”
“Don't like going to the doctor.”
“The internet would make it easier.”
“The doctor coming to see me, rather than me going to him.”
“No one wants to talk about their bowel movements.”
I would be worried about wasting the doctor’s time: Is there anything the NHS
could do to help you overcome this barrier?
“The fact you only have a 10 min slot you need more time, should be longer.”
“Sometimes they make you feel as if you are wasting your time - better doctors.”
“No, just the way I am.”
“There are so many waiting rules you feel you should not be there. Be more
relaxed.”
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“Don't know – it’s just the way I was brought up.”
My doctor would be difficult to talk to: Is there anything the NHS could do to help
you overcome this barrier?
“I can't understand what my doctor says.”
“English speaking doctors preferred.”
“I don’t like talking to them about anything as they talk down to you.”
“There’s a language barrier. It’s difficult to understand each other. There’s nothing
to be done.”
“My doctors don't understand me. I need a translator for delicate issues.”
It would be difficult to make an appointment with my doctor: Is there anything the
NHS could do to help you overcome this barrier?
“After 8am would be better, if you don’t get through then you can’t get an
appointment, must be a fairer way of doing it.”
“You wait for a week to see a doctor, there should be a much better system in
place.”
“It takes a few days. Have to ring up at 8.30, you should be able to pre-book but
you can't.”
“Extend opening hours so people can get an appointment.”
“It takes one week to see the doctor. You have to catch the appointments before
8am and very often you can't get through and all appointments are gone. There
should be a system where you can call in all morning.”
“A drop in system would be better, more doctors and emergency sessions.”
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I would be too busy to make time to go to the doctor: Is there anything the NHS
could do to help you overcome this barrier?
“I work long awkward hours and can't get appointments to fit and have children to
watch.”
“I just don't have time unless it's really necessary.”
“Nothing, just have to find the time to go. It’s up to me.”
“Make appointments until 10pm.”
“No, unless its open till 8pm.”
I would be worried or scared about what the doctor might find: Is there anything
the NHS could do to help you overcome this barrier?
“If doctors were more pleasant.”
“If doctors had more time to make you feel at ease.”
“More reassuring doctors.”
“More awareness so we're pre-warned.”
“Give us more info on what’s going to happen e.g. treatments etc if diagnosed with
cancer.”
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6.3.2. Communications
In order to help NHS South of Tyne and Wear tailor their communication material by place,
all respondents were shown a list and asked which places they visit regularly (Figure 18).
Figure 18: Frequently visited places
92%
94%
86%
96%
Supermarket
72%
78%
66%
72%
Shopping centre (i.e. Metro, Bridges,
Galleries)
43%
44%
41%
42%
Local pubs or bars
Local library
Council offices
Local leisure centre
Community centre
None of the above
All data
Sunderland
22%
15%
23%
29%
20%
15%
19%
28%
17%
10%
25%
17%
13%
9%
18%
12%
2%
3%
2%
1%
South Tyneside
Gateshead
D14. Do you regularly visit any of the following places?
Base: All respondents - 1,277. Sunderland - 459, South Tyneside - 424, Gateshead - 394
Respondents were most likely to say that they frequently visit the supermarket (92%),
shopping centres (72%) or local pubs/bars (43%). Respondents from Gateshead were
significantly more likely to say they regularly visit the supermarket (96%), the local library
(29%) and their Council Offices (28%).
Male respondents were significantly more likely to say they frequently visit local pubs or
bars (50%) compared to females (35%), whilst female respondents were more likely to say
they regularly visit the supermarket (95%), shopping centres (80%) and their Council
Offices (24%).
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In terms of targeting those most at risk of developing bowel and lung cancer, respondents
aged 65 years and above were more likely to say they regularly visit the supermarket
(94%), but were significantly less likely to say they regularly visit shopping centres (62%),
local pubs or bars (24%) or their local leisure centre (4%).
Younger respondents (those aged 18-24 years) were significantly less likely to say they
regularly visit the supermarket (84%) but were significantly more likely to say they
regularly visit local pubs or bars (62%) and the local leisure centre (30%).
Respondents who said they were not confident they would notice a symptom of lung cancer
and/or bowel cancer were significantly more likely to say they regularly visit local pubs or
bars (45% of those who said they were not confident they would notice a symptom of bowel
cancer and 46% of those who said they were not confident they would notice a symptom of
lung cancer).
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7. Conclusions
Overall, awareness levels of the symptoms and risks of bowel and lung cancer are low
amongst the sample, although awareness of the symptoms and risks of lung cancer is
slightly higher than for bowel cancer.
Just under half of the sample (45%) were unable to spontaneously name any signs of bowel
cancer and almost two-fifths (38%) were unable to name any signs of lung cancer. When
prompted there were high levels of agreement that many of the bowel and lung cancer
symptoms listed could be a sign of cancer, however there was a distinct lack of concern with
regard to ‘a feeling that your bowel does not completely empty after using the lavatory’,
‘persistent shoulder pain’ and ‘changes in the shape of your fingers or nails’.
Spontaneous awareness of the factors that may increase the chances of developing bowel
cancer is extremely poor. More than half of the sample (54%) was unable to name any
bowel cancer risks which is reflected in the mean number of symptoms mentioned which
was 0.78. Only 7% were unable to name any risks of lung cancer, although this figure is
somewhat deceiving as 57% were only able to name smoking as a risk.
Although around two-thirds of the sample said they would contact a doctor within a week to
discuss a symptom they thought might be bowel (67%) and lung cancer (66%), a high
proportion of the sample are not confident they would notice a bowel or lung cancer
symptom and as already mentioned, spontaneous symptom awareness is poor within the
sample. More than half the sample (55%) said they were not confident they would notice a
symptom of bowel cancer and 43% are not confident they would notice a symptom of lung
cancer.
Awareness levels are generally lowest amongst males, who show poor awareness of bowel
cancer symptoms particularly and are more likely to wait longer on average than females
before contacting a doctor. Awareness is also low amongst those aged 18-24 years, which is
unsurprising given that both lung and bowel cancer are most likely to occur in older people,
and those classified as socio-economic grade E.
Spontaneous symptom awareness was slightly higher amongst those most at risk of
developing bowel and lung cancer, which is positive, and on average those aged 65 years
and above would initiate contact with a doctor to discuss a possible bowel or lung cancer
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symptom sooner than other age groups. However there is still room for substantial
improvement in the knowledge of those aged 65 years and above.
Symptom awareness was poorest amongst respondents from Sunderland and those from
Sunderland also more likely to wait longer on average before contacting a doctor to discuss
symptoms of both bowel and lung cancer. Confidence was also lowest in this area and 53%
of respondents from Sunderland said they are not confident they would notice a symptom of
lung cancer, whilst 70% said they are not confident they would notice a symptom of bowel
cancer.
Whilst it is positive that many respondents say they would contact a doctor within a week to
discuss a symptom of bowel or lung cancer, targeted material is required to raise awareness
of specific symptoms of both types of cancer, but particularly bowel cancer, for which
levels of awareness are extremely poor.
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8. Appendices
8.1. Final Questionnaire
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8.2. Required and Achieved Quotas
Required and achieved quotas according to age, gender and ethnicity
Demographic
Gender
Age
Ethnicity
Sunderland
South Tyneside
Gateshead
Required
Achieved
Required
Achieved
Required
Achieved
Male
50%
49%
50%
44%
50%
50%
Female
50%
51%
50%
56%
50%
50%
18-24 years
13%
16%
12%
13%
11%
13%
25-34 years
16%
15%
15%
15%
16%
14%
35-44 years
16%
12%
17%
16%
18%
13%
45-54 years
18%
17%
18%
17%
18%
12%
55-64 years
15%
17%
15%
19%
15%
15%
65 years +
21%
23%
22%
21%
22%
33%
White
BME
95%
5%
98%
2%
93%
7%
96%
4%
94%
6%
95%
5%
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