An evaluation of the Be Clear on Cancer: Blood in Pee campaigns

The Be Clear on Cancer team within Public Health England (PHE) recently published their Blood in Pee (BiP) evaluation report which investigates the effects of public awareness campaigns, educating the public about blood in pee as a cancer symptoms and the importance of visiting the GP early, To promote this work, we have released a blog that explains the findings and conclusions.  

What are the Be Clear on Cancer campaigns?

Be Clear on Cancer  (BCoC) is a PHE programme which began in 2011 to raise awareness of cancer symptoms and encourage people to visit their GP in order to improve early diagnosis. This work takes place locally, regionally and nationally across England. A variety of media channels are used to reach the target audiences such as billboards, television and radio broadcasts and more recently, social media platforms. The length of the campaigns vary, with the Blood in Pee campaigns lasting for approximately 6 weeks. They are targeted at specific groups who may be more at risk of the cancer type in question: for the Blood in Pee (BiP) campaign, this included people aged 50 years and over. The findings are presented as individual metric summaries and subsequently as final evaluation reports, published on the Be Clear on Cancer website.  

Is ‘Blood in Pee’ a symptom of cancer?

Blood in pee can be a symptom of kidney cancer which is increasingly common, with 9,438 people diagnosed in 2018 in England. It can also be a symptom of bladder cancer with 8,671 people being diagnosed in 2018 in England. The risk of bladder and kidney cancer is higher in those aged 50 years and over, so this was the target age group of the campaigns.

The ‘Blood in Pee’ Campaign

Figure 1: Timeline of Blood in Pee campaigns

Figure 2: Campaign materials

The Be Clear on Cancer Blood in Pee (BiP) campaign was introduced to encourage people to visit their doctor with symptoms that may suggest bladder or kidney cancer so that these can be diagnosed early. Blood in pee is considered an appropriate symptom for people to look out for, given that a large majority of patients with bladder cancer reported visible blood in their pee. The worldwide numbers of cases of kidney cancer is rising. 27.5% of patients who had to undergo the surgical removal of a kidney experienced blood in their pee. The Blood in Pee campaign provided a good opportunity to encourage members of the public aged 50 and over to pay attention to symptoms and visit their doctor.

The BiP campaigns ran between 2012 and 2016, at local, regional and national levels (Figure 2).  A fourth national BiP campaign ran from 19 July to 16 September 2018 and the final evaluation being due in Spring 2021. A combination of materials were used including television and radio adverts, leaflets and billboard advertising to promote the key message (Figure 1).

The primary message was: ‘if you notice blood in your pee, even if it’s just the once, tell your doctor straight away’.

Following the campaign, patient data can be used to evaluate whether or not it encouraged people to visit their doctor if they noticed blood in their pee, and how many of these turned out to have bladder or kidney cancer.

What did the campaigns measure?

The National Cancer Registration and Analysis Service (NCRAS) evaluated the impact of the campaigns on a number of measurements including the numbers of GP attendances, urgent GP referrals, cancers diagnosed, diagnostics in secondary care (imaging tests), and the proportion of cancers which were diagnosed at an early stage . NCRAS used a range of available datasets containing patient data to analyse the impact of the campaign. Further details on the specific data sources and analysis can be found within the Be Clear on Cancer Methodology document.

Did the findings suggest whether or not the campaign had an impact?

The recently published final evaluation report provides detailed results of each metric from the BiP campaigns. A selection of some interesting findings are as follows:

Number of GP attendances for ‘blood in pee

  • An increase during and after the first campaign
  • An increase during the second campaign
  • No evidence of impact in the third campaign

Number of bladder and kidney Cancers diagnosed

  • An increase in the number of bladder and kidney cancers diagnosed during and shortly after the first and second campaigns
  • An increase in the number of bladder cancers diagnosed during and shortly after the third campaign

Proportion of cancers diagnosed at an Early stage

  • An increased proportion of early stage kidney cancers during and shortly after the first campaign
  • An increased proportion of early stage bladder cancer diagnoses during and shortly after the second and third campaigns

The results outlined above suggest that the BiP awareness campaigns increased symptom awareness and encouraged people with blood in their pee to visit their doctor. This may have resulted in more people being diagnosed with bladder or kidney cancer earlier, resulting in more early stage diagnoses. The results within the final evaluation demonstrate the importance of patient data and how the impact of Be Clear on Cancer campaigns can be evaluated. Without obtaining and keeping records of patient data, it would not be possible to identify the impact demonstrated by the Blood in Pee campaigns as well as other cancer awareness programmes.

Who collaborated on this work?

The Be Clear on Cancer programme is delivered in partnership with NHS England, Department of Health and Social Care and Cancer Research UK, with input from clinical and academic partners. The results obtained from patient data are analysed by NCRAS analysts and the Be Clear on Cancer evaluation team. An overall final evaluation of campaign impact was conducted by a clinician with a speciality in urological cancer.

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England (PHE).

Where can I go for more information?

Patient data was used to measure the effects of Be Clear on Cancer Blood in Pee campaigns

Be Clear on Cancer: local, regional and first, second and third national Blood in Pee campaigns: Final Evaluation

Be Clear on Cancer Evaluation page – NCIN website