What was the Public Health issue?

Oral health context and rationale

Head & neck cancer:

The term head and neck cancer encompasses over thirty different subsites ranging from the lip and oral cavity to the back of the throat and larynx.

The following key findings are from Cancer Research UK 2014 and cited in the Head and Neck Cancer strategy information pack C&M 2014 www.nwcscnsenate.nhs.uk

Nationally: 

  • Since the early 1990’s, head and neck cancer incidence rates have increased by a third (30%) in the UK. The increase is larger in females (40%) than in males (20%).
  • Incidence rates of oral cancer are projected to rise by 33% in the UK between 2014 and 2035.
  • Head and neck cancer in England is more common in people living in the most deprived areas.
  • During 1998-2000 the majority of cases of head and neck cancer were in people aged 65 and over – 49% of cases were in people under the age of 65. During 2008-10 the proportion of cases in the under 65’s had increased to 53% meaning that the majority of cases were now in people under the age of 65.
  • Aetiological factors for oral cancer are related to tobacco, alcohol consumption and diets low in fruit and vegetables.
  • Recent finding indicate a sharp rise in the incidence rates of oral pharynx cancer linked to human papillomavirus, particulalry effecting the younger adult population.

Locally:

  • Head and neck cancer incidence and mortality rates for Cheshire & Merseyside are significantly higher and increasing at a faster rate than England.
  • Incidence rates of oral cancer are highest locally in Birkenhead, Bootle, Halton and Knowsley.

What was done to address the issue?

Background:

This programme is commissioned by National Health Service England-North and is a collaboration between; Public, Health England, Local Dental Network C&M, Primary Dental Care Managed Clinical Network C&M, Health Education England, Oral Maxillofacial Unit Aintree Hospital and Cancer Research UK (CRUK), the project is expanding to include the C&M Cancer Alliance Group.

Primary aims:

  • Decrease incidence of oral cancer
  • Improve oral cancer survival rates
  • Reduce morbidity of treatment

Key objectives

  • Raise awareness of the signs, symptoms and risk factors associated with oral cancer.
  • Ensure good practice when making and appropriate urgent two-week referral to a secondary care cancer service.
  • Promoting good practice guidance on how to engage with patients when talking about oral cancer.
  • Raise awareness of the concept and application of MECC in relation to oral cancer risk factors and the principles and practice of brief intervention, including signposting to local smoking cessation, alcohol and substance misuse support service.

Target group:

Currently there are approximately 360 NHS general dental practices and 4 salaried community dental services in C&M.

At present approximately 90 out of the 360 NHS general dental practices across C&M have subscribed to an NHSE-North commissioned education/peer review programme with enhanced audit programme.

Brief overview of activity to date:

  1. Developed a multi-disciplinary steering group.
  2. Conducted a pre-campaign questionnaire with the 90 peer review general dental practices, to establish a base-line knowledge and insight into current practice.
  3. Developed a local oral cancer care guide, aligned to CRUK/BDA national guide and NICE guidance. Key components include; prevention, early detection and referral. The guide can be accessed via: https://www.dental-referrals.org/
  4. Distributed 364 hard copies of the local oral cancer care guide to all general dental practices and community dental services in C&M and signposted all to an electronic version of the guide.
  5.  Delivered two oral cancer conferences, one in Liverpool and one in Chester, offered to all general dental practices and community dental services in C&M.
  6. Delivered five ‘Making Every Contact Count’ study events across C&M in partnership with local lifestyle/smoking cessation services – offered to all general dental practices and community dental services in C&M.
  7. Provided peer review practice-based education to all 90 participating general dental practices, in relation to the theory and application of MECC within a dental practice setting.
  8. Post-campaign questionnaire & analysis.
  9. Fostered and strengthened links with the cancer alliance network and the MECC workstream.
  10. Development and implementation of a new e-referral process for the two-week pathway in C&M.
  11. To complement this programme the C&M cancer alliance provided the ‘Live Well, Stay Well Patient Guide’, the resource is currently being piloted with key members of the primary dental care managed clinical network group for C&M.
  12. Currently conducting a twelve month follow up evaluation in two local authority areas, to explore; the numbers and patterns of referral to local smoking cessation services, how the concept of MECC is adopted and applied within in a dental practice setting, including challenges and learning.

What was the outcome of the intervention?

Brief overview of outcomes:

  1. The pre and post campaign highlighted an increase in knowledge and awareness in relation to the key programme objectives.
  2. The programme gave an opportunity for dental staff to meet their local smoking cessation/lifestyle services.
  3. The programme model has been adopted for the North West footprint.
  4. The programme enabled the opportunity to develop and strengthen working relationships with organisation outside of traditional NHS boundaries.
  5. The programme highlighted the need to explore the development of an integrated model(s) with wider professional for example: general medical practitioners and pharmacists.
  6. Successful funding proposal for a pilot programme to implement a head and neck cancer specialist community nurse.
  7. The twelve-month follow-up evaluation is currently on-going.

Next steps…

  • Complete the twelve-month evaluation.
  • To continue to support dental practices with the implementation of MECC.
  • Explore and design approaches of delivery for MECC within NHS general dental practices.
  • Provide dental practices with evidence-based educational resources that can be distributed to high risk patient, as part of a MECC brief intervention at identified opportunities within pathways.
  • To generate an increased sense of significance with all clinicians involved, of the importance of delivering and embedding preventative health messages, realising that prevention is everyone’s responsibility.

Key dental documents:

Description of the above documents:

Local oral cancer care guide https://www.dental-referrals.org/

National BDA.CRUK oral cancer recognition toolkit https://www.doctors.net.uk/eClientopen/CRUK/oral_cancer_toolkit 

Delivering better oral health: an evidence-based toolkit https://assets.publishing.service.gov.uk/government/uploads/system/

For further information:

Dr Yvonne Dailey, Consultant in Dental Public Health, Public Health England, e-mail: yvonne.dailey@phe.gov.uk

Helen Parsley, Dental Public Health Support Manager, Public Health England, e-mail: helen.parsley@phe.gov.uk