Background

Cancer outcomes are poor in the UK’s socioeconomically deprived communities, with low symptom awareness contributing to prolonged help-seeking and advanced stage disease. We tested whether a theory-grounded, facilitated cancer awareness intervention could improve cancer symptom recognition and increase motivation to seek help among adults living in deprived communities.

Method

Adults aged over 40 recruited opportunistically in community and primary healthcare settings in deprived areas of Yorkshire and South Wales were randomised to intervention or control. Cancer symptom recognition (primary outcome at 2-weeks, total score range 0-12), anticipated symptom presentation, perceived barriers, beliefs about cancer and state anxiety were measured at baseline, 2-weeks and 6-months post randomisation. Healthcare implementation costs and resource use data were evaluated. Intervention effects were tested using multilevel linear regression adjusted for baseline score.

Results

A total 234 participants were randomised, with high retention at 2-weeks (90%) and 6-months (85%). There was no significant difference in total symptom recognition at 2-weeks [adjusted mean difference (AMD) 0.57, 95% CI -0.03-1.17, p=0.06]. Intervention participants reported increased symptom recognition (AMD  0.78, 95% CI 0.18-1.37, p<0.01) and earlier intended presentation (AMD  -1.96, 95% CI -3.02--0.91, p<0.01) 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 lesser known symptoms (e.g. persistent tiredness, unexplained weight loss) was higher in the intervention (2-weeks p=0.04, 6-months p<0.01). Differences in perceived barriers, beliefs and state anxiety were not significant. Total implementation cost per participant was £91.34, with no significant between-groups differences in healthcare resource use post-intervention and potential to be cost-effective.

Conclusion

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. The health check is a viable low-cost intervention to increase cancer symptom awareness and earlier help-seeking, especially for vague, common cancer symptoms that require expedited routes to diagnosis.

Impact statement

The health check intervention has the potential to achieve significant public health benefits by improving cancer outcomes among adults living in socioeconomically deprived communities.