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TICTOC study: Raising awareness of vague cancer symptoms in Cwm Taf Morgannwg

Spotting the signs of cancer isn’t always easy. Vague symptoms like unexplained tiredness and weight loss are often not thought of as a cause for concern.

However, they can be a serious sign of cancer. That’s why researchers in Cardiff are collaborating with the NHS and Public Health Wales on a study called TICTOC, which is testing the acceptability and feasibility of running and evaluating a vague cancer symptom awareness campaign in an area of high socioeconomic deprivation.

Funded by Cancer Research Wales, the study launched in 2020 with the study’s multifaceted campaign running in Cwm Taf Morgannwg between July 2021-March 2022. The campaign included posters, pharmacy bags, radio adverts and targeted Facebook posts alongside the introduction of TIC-TOC cancer champions; members of the local community who are trained to offer support and share campaign resources.

“TIC-TOC was designed to let people know that these lesser-known vague symptoms could be serious, and to encourage people experiencing these symptoms to go to their GP. We also wanted to send a positive message that finding cancer early can improve outcomes” said WCRC-funded researcher Dr Grace McCutchan.

“The Rapid Diagnostic Clinic is a new cancer referral pathway that has been set up in Cwm Taf Morgannwg to accelerate diagnosis of cancer among people presenting with vague cancer symptoms. The TIC-TOC campaign aimed to get people into these Rapid Diagnostic Clinics sooner, to diagnose in the cancer earlier, more treatable stages. We designed the TIC-TOC campaign to address what we know from our research about why people living in deprived areas might put off going to see their GP with cancer symptoms.”

Cwm Taf Morgannwg was chosen as the study site because rates of cancer are often higher in areas of deprivation. People living in these areas also tend to take longer between noticing a symptom and visiting their doctor, increasing their likelihood of being diagnosed with advanced stage cancer.

The area is home to one of Wales’ first Rapid Diagnosis Clinics, making it an ideal location for the study. Researchers are comparing data from Cwm Taf Morgannwg against data from a comparator site – Swansea Bay, which also has a Rapid Diagnostic Clinic but will not be targeted by the campaign.

“With the TIC-TOC study, we’re testing whether we can deliver and evaluate the campaign. We are collecting data to look at things like whether the campaign acceptable to the public, if the role of the cancer champion is acceptable/feasible, and if it’s possible to collect data to assess whether the campaign works,” said Dr McCutchan.

The TIC-TOC campaign came to an end in April 2022. The team are now analysing the study data and considering their next steps.

“We launched this study during the COVID-19 pandemic, which brought many challenges,” said Dr McCutchan. “The success of this study was partly due to excellent collaboration between NHS Wales, Public Health Wales, Health Boards and Universities, and it has already supported people to enter into these new diagnostic pathways.”