Bowel cancer is the fourth most common cancer in the UK and the second biggest cancer killer. Our geospatial team was engaged by Sussex Integrated Care System (ICS) to identify hotspots of low bowel screening uptake and high cancer positivity rates within their area. We designed a bespoke web application that allowed easy and quick access to comprehensively identify and evaluate areas of concern.
Nearly 43,000 people are diagnosed with bowel cancer every year in the UK. Bowel cancer is treatable and curable especially if diagnosed early. Nearly everyone survives bowel cancer if diagnosed at the earliest stage. Acquiring detailed bowel screening data at a localised level has always been a challenge in primary care. Sussex ICS approached our geospatial team to help them to access accurate data to enable early identification.
In general, bowel screening data is only available at a generalised level. Sussex ICS wanted to be able to identify issues at a localised level. The link between lower take-up of bowel screening and deprivation and ethnicity had already been identified. Less, however, was known about the detail of links with gender and age. There was a real concern that screening uptake was going in the wrong direction within certain demographics.
Later detection of bowel cancer at stage 3, resulted in a greater burden on the family, employer, insurance companies, state benefits, community services, patient transport, etc. Where it can be diagnosed earlier at stage 1, there is a greater possibility of a normal life, including a return to work, relatively quickly if not painlessly. The impacts of ensuring earlier detection are wider than just the cost associated with the patient treatment code.
Overall, there was a need to identify high-risk areas that routinely would have been missed with current generalised or top-level data. A modelling tool which supports earlier identification/diagnosis was needed.
Our geospatial analysts identified that a user-friendly tool with an immediate visual impact was required. Following engagement sessions with Sussex ICS to discuss exact requirements, we developed and delivered a comprehensive bespoke tool that helps to build a local picture and easily identify hotspots, using data at both generalised and localised levels.
Bowel screening uptake data had always been available at the individual GP practice level, but this did not deliver the aggregate data needed to identify by area or by specific type of patient in terms of age group and gender.
To provide this information, we used patient postcode level screening data including age group and gender from the NHS Bowel Cancer Screening Southern Programme Hub and converted this to Lower Super Output Area (LSOA) level data based on the ONS Postcode Directory (ONSPD) to LSOA lookup dataset. LSOAs are a geographic hierarchy designed to improve the reporting of small area statistics in England and Wales. Also, we used a variety of existing datasets from ONSPD, Department for Communities and Local Government and NHS Digital to build our model.
Sussex ICS’ close working relationship with the NHS Bowel Cancer Screening Southern Programme Hub enabled us to gain access to bowel screening uptake data to enable visualisation at a more granular level i.e. eligible GP registered patient postcode level data. Our web application was built using the ESRI platform and can show both geographical areas at a small scale and GP practice levels. It includes the key factors, age and gender, to help identify the target group, i.e. those in the population who had lower uptake or screening. Furthermore, it can overlay most of the relevant population demographic information such as the Index of Multiple Deprivation (IMD) and Census ethnicity information to give a more detailed picture of the population in the area. This helps to better understand if any patterns of lower uptake cases exist in more deprived and diverse areas.
The bespoke mapping tool:
- Instantly gives a visual impact to enhance the story
- Enables PCNs, bowel screening hubs, cancer alliances and ICSs to use the same web tool which helps them to start engaging with one another
- Identifies specific hotspots for target enhancement activities
- Provides evidence for relevant healthcare professionals, as well as local authorities, to help in targeting and promoting effective engagement to improve cancer screening uptake
Customers are able to use this tool to identify which population segments to focus on.
It also identifies small-scale problem areas very quickly e.g. as an unintended consequence of our investigations, we found that in late working-age men in affluent locations, the pattern of uptake goes against the overall trend.
The statistics show that 1 in 15 men and 1 in 18 women will be diagnosed with bowel cancer during their lifetime. Our tool helps to highlight the substantial differences that exist between male and female screening in different age groups. With long-term plans aiming to reduce screening ages, the data from our tool reinforces the concerns being raised about current screening rates and can support conversations with the necessary parties as to how best to target high-risk cohorts.
Our geospatial team have built a close relationship with Sussex ICS, developing several interactive mapping tools in various key areas to support not only bowel cancer but also breast screening site reconfiguration and cancer referral activities. This has capitalised on the knowledge and expertise in primary care and cancer screening they have gained over more than ten years working across the south of England.
Having accurate data and mapping enables the targeting of small-scale areas and the identification of areas with unexpected high risk. This can enable earlier intervention which helps to reduce the cost of treatment, and also provides evidence to underpin health economic modelling.
Working with South, Central and West to map our cancer data has revealed so many opportunities to improve our patient care. The granular data mapping linked to known inequalities data in the same areas has shown us some significant gaps in provision where previously the higher level PCN views appeared to show no concerns. We have mapped bowel screening and referral data with the support of the CSU so far and aim to expand on this to include mortality and cancer staging in the near future. To be able to see more opportunities to engage and target patient groups within local communities and groups from prevention to palliative care will be invaluable as an ICS - Mark Hannigan, Sussex ICS Cancer Interface Manager