Adolescents with cancer often experience a longer diagnostic delay than children, mainly because they take longer to go to a doctor. The Italian Society for Adolescents with Oncohematological Diseases (SIAMO) has launched an information campaign focusing on raising adolescents’ awareness of the importance of diagnosing cancer early.
The concepts of the campaign were developed by a scientific committee of clinicians, cancer patients and their parents, and marketing experts. The title of the campaign is “There’s no reason why”. A video has been launched on TV channels and the Internet, and the final frame refers viewers to the SIAMO website, which provides advice to help adolescents interpret any symptoms they experience.
The video has had 12,181 views. In the 6 months following the launch of the campaign, the SIAMO website page dedicated to the campaign was opened by 9,767 viewers for a total of 13,632 views.
Though it remains very difficult to judge the efficacy of this initiative, the value of a campaign focusing on improving the adolescent population’s cancer awareness is supported by the large number of studies published on the diagnostic delay in this age group. Our campaign goes to show the importance of ensuring cooperation between the different stakeholders involved in the global care of adolescents with cancer.
Tumori 2016; 102(3): 270 - 275
Article Type: ORIGINAL RESEARCH ARTICLE
AuthorsChiara Magni, Francesca Maggioni, Angelo Ricci, Elena Barisone, Momcilo Jankovic, Emma Sarlo Postiglione, Enrica Cargnel, Barbara Rita Barricelli, Stefano Valtolina, Laura Veneroni, Stefano Chiaravalli, Pietro Lapidari, Mirko Capelletti, Carlo A. Clerici, Andrea Biondi, Andrea Ferrari
- • Accepted on 05/02/2016
- • Available online on 26/03/2016
- • Published in print on 02/06/2016
This article is available as full text PDF.
It has been variously reported that adolescent cancer patients often experience a longer diagnostic delay than children (1, 2). This may happen for numerous reasons. Some are patient related (the so-called “patient delay”), i.e., how patients interpret their signs and symptoms, and how promptly they report them to a doctor. Others depend on general practitioners’ ability to interpret cancer symptoms and consequently refer patients promptly to a specialist center for diagnosis and appropriate treatment (“doctor delay”). A previous study conducted at the Istituto Nazionale Tumori (INT) in Milan showed, however, that the main contributor to the diagnostic delay in this age group concerns the time it takes for adolescents to decide to see a doctor (2). The time to diagnosis can have a considerable impact on patients’ chances of cure (for some tumor types at least), even though the relationship between symptom interval and patient outcome remains a debated issue (3). An early diagnosis can also have some other, complementary advantages, reducing the apprehension and anxiety related to a cancer diagnosis (4). An information campaign was launched in Italy by the Italian Society for Adolescents with Oncohematological Diseases (Società Italiana Adolescenti con Malattie Onco-ematologiche; SIAMO) (5, 6) in an effort to address the problem of diagnostic delay in adolescents with cancer. SIAMO is a project organized by the Italian Pediatric Oncology Network (Associazione Italiana Ematologia Oncologia Pediatrica; AIEOP) and it was conceived in cooperation with the adult hematological and oncological scientific societies, with a view to ameliorating adolescents’ oncological care by focusing on the specific needs of this age group (7, 8). SIAMO is supported by the Federation of Associations of Parents of Children with Cancer (Federazione Italiana Associazioni Genitori Oncoematologia Pediatrica; FIAGOP).
The concepts of the information campaign were developed by a dedicated scientific committee consisting of clinicians, young cancer patients, and their parents; the campaign material was prepared by Ogilvy & Mather, one of the world’s largest marketing companies, in cooperation with the Dynamo Camp non-profit association (part of SeriousFun Children’s Network). Other societies involved in the project were PostAtomic and BlowUp Film. The fundamental aim was to generate a video that could draw attention to the importance of early cancer diagnosis. The campaign was entitled “There’s no reason why”. The campaign was addressed primarily to young people from 15 to 20 years old, and only secondarily to the community as a whole, families, clinicians and institutions. A famous Italian rapper, Jake la Furia, was asked to act as testimonial to attract the target population’s attention. His was the speaking voice of the campaign, talking directly to adolescents as if he were an older brother. A smiling patient cured of cancer also appeared at the end of the video.
The campaign used images and language likely to be familiar to young people, trying to match actual moments of their lives, but also their worries and anxiety. The aim of the campaign was to deliver an inclusive message: “We understand your fears, but we are here with you.” The final message on the video referred viewers to the SIAMO website (
The Ogilvy & Mather company provided its services free of charge (pro bono), while insurance, filming and out-of-pocket costs amounting to €15,000 were covered by FIAGOP.
The video was launched on several TV channels and on YouTube and was also the object of numerous online and printed press articles.
A frame from the video “There’s no reason why”. The text says, “There’s no reason why some people get cancer in high school… but there is a reason why some of them get better. Early diagnosis is up to you. Go to progettosiamo.it.”
A frame from the video “There’s no reason why”.
A frame from the video “There’s no reason why”.
A frame from the video “There’s no reason why”.
The last frame of the video refers viewers to the SIAMO website, which opens on a page dedicated to the campaign, showing the following text: “Early diagnosis is important and it’s up to you. If you feel a pain that has no known cause and that keeps coming back; if you have a swelling/lump and don’t know where it comes from, and it doesn’t heal for several weeks; if you’ve been feeling tired for a long time, for no apparent reason; if you often bleed; if you have been losing a lot of weight in recent weeks; if you have a mole that has changed in shape or size, or color; if you are experiencing any persistent symptoms that you don’t understand; don’t panic. There may be lots of explanations for these signs and symptoms, but – just to be on the safe side – we suggest you see your doctor.”
The video was launched on September 1, 2014 in 2 different versions, one for television lasting 30 seconds and the other lasting 45 seconds, uploaded to the Web (
The campaign circulated on the Web and social media with the hashtag #nonceunperche using various communication channels, particularly Facebook and Twitter. The campaign was launched not only on the FIAGOP pages (and those of numerous parents’ associations forming part of the federation), but also on Jake la Furia’s pages and those of the companies that contributed to the preparation of this awareness campaign.
On the Internet the video received 12,181 views. In the 6 months following the launch of the campaign (September 1, 2014 to March 1, 2015) the SIAMO website page dedicated to the campaign was viewed by 9,767 single visitors for a total of 13,632 views. In addition, the diffusion of the video was supported by a press release and it was the object of several articles in national mass media and websites focusing on young people. It was also broadcast by numerous radio channels.
Finally, the campaign was launched on the website of the Italian Health Ministry at the time of the 13th International Childhood Cancer Day (February 15, 2015). This international day was also celebrated with a conference entitled “Io, adolescente, l’ospedale che vorrei” (“The hospital that I, as an adolescent, would like”) held in Milan and organized by FIAGOP, AIEOP and SIAMO, with the support of the Italian Health Ministry, where several of the mass media relaunched the campaign as a “breaking news” item.
This paper describes the development and dissemination of an information campaign to raise cancer awareness among adolescents. The campaign focuses particularly on the importance of diagnosing cancer early in this age group, and on making young people realize which signs and symptoms should be considered a potential cause for concern and prompt them to seek a doctor’s advice.
It is obviously impossible to assess the campaign’s efficacy in terms of reducing the diagnostic delay in adolescent cancer patients. The figures mentioned in this paper, such as the number of times the online video was viewed, can only give an idea of how successful the campaign has been in attracting attention to the issue. It is only with time, and only if this campaign is followed up by other such schemes, that it will be possible to say whether Italian teenagers have become more aware of the fact that cancer can involve their age group too, and what symptoms might lead to an early diagnosis.
The value of our campaign stems from many previously published reports of adolescent cancer patients often experiencing considerable diagnostic delay.
A selection of published studies on time to diagnosis in adolescents with cancer
|Authors||Characteristics of the study||Major findings|
|TtD = time to diagnosis; CNS = central nervous system; STS = soft tissue sarcomas; RMS = rhabdomyosarcoma; PFS = progression-free survival; OS = overall survival; EFS = event-free survival.|
|Fajardo-Gutiérrez et al 2002 (9)||Retrospective analysis of 4,940 patients aged 0-14 years with malignant tumors||TtD positively correlates with age and tumor type. No correlation found between TtD and tumor stage. Tumor biology influences TtD|
|Haimi et al 2004 (10)||Retrospective analysis of 315 patients aged 0-20 years with solid tumors||TtD positively correlates with age and tumor type. TtD is predictive of survival. The relationship between TtD and prognosis is very complex and related to tumor biology|
|Goyal et al 2004 (11)||Retrospective analysis of 103 patients aged 4-22 years with bone tumors||TtD positively correlates with age (<12 years 2.7 months vs. 4.2 months in patients >12 years). Older patients also experience longer patient delay (1.7 months vs. 0.5 months)|
|Dang-Tan et al 2008 (12)||Retrospective analysis of 2,896 patients aged 0-19 years with malignant tumors||TtD positively correlates with age. Median patient delay positively correlates with age (p = 0.0001). TtD is also associated with tumor type|
|Kukal et al 2009 (13)||Retrospective analysis of 315 patients aged 0-16 years with CNS tumors||TtD positively correlates with age: parental delay is smaller in younger patients (<4 years, 31 days; 4-8 years, 63 days; 8-12 years, 79 days; >12 years, 106 days). TtD is also associated with tumor type and site. TtD inversely correlates with PFS and OS probability. The effect of tumor biology on survival overwhelms any effect on survival of a delay in diagnosis|
|Ferrari et al 2010 (1)||Retrospective analysis of 575 patients aged 0-21 years with STS||TtD positively correlates with age. Significant association between TtD and tumor size and histology. Positive correlation found between TtD and outcome|
|Cecen et al 2011 (14)||Retrospective analysis of 329 patients aged 0-19 years with malignant tumors||TtD positively correlates with age. In older patients, referral delay is longer. TtD is also associated with tumor type. TtD inversely relates to metastatic stage at presentation|
|Bisogno et al 2012 (15)||Prospective analysis of 643 patients aged 0-19 years with RMS||TtD positively correlates with age (4.6 weeks in children vs. 8 weeks in adolescents). RMS presents with more aggressive features in adolescents and this may have an impact on their survival, though no correlation was found between TtD and prognosis|
|Loh et al 2012 (16)||Retrospective analysis of 390 patients aged 0-18 years with malignant tumors||TtD positively correlates with age. No association with disease stage at presentation. Symptom interval is inversely related to disease stage and survival. TtD is not significantly predictive of EFS|
|Brasme et al 2012 (17)||Review of 98 studies||The belief that a long delay before diagnosis of pediatric cancers leads to worse prognosis is often untrue. For most pediatric cancers TtD probably depends most on the tumor’s biology|
|Lethaby et al 2013 (18)||Review of 32 studies on TtD||Cancer TtD varies between diagnostic groups and with age at diagnosis in the majority of studies. Specific criteria identifying circumstances in which delay has occurred should accompany a defined timeline to diagnosis or treatment in every study|
|Veneroni et al 2013 (2)||Prospective analysis of 425 patients aged 0-25 years with malignant solid tumors||TtD positively correlates with age (47 days in patients aged 0-14 years vs. 137 days in those aged ≥15 years; p<0.001). Patient delay in adolescent patients accounts for 63.3% of the total symptom interval|
|Launay et al 2014 (19)||Review of 50 studies on TtD||Weaknesses in the quality of reporting of studies of TtD. Need for development of new (or refinement of existing) guidelines for reporting this type of study|
|Barr 2014 (20)||Review||The assumption that the longer the TtD the poorer the prospect of survival Is not supported by evidence. The biology of the tumor is the most important determinant of outcome. Shortening TtD in order to minimize anxiety|
|Brasme et al 2014 (4)||Prospective analysis of 436 patients aged 0-21 years with Ewing sarcoma||TtD positively correlates with age. TtD is also associated with tumor site. The study did not show a significant relationship between longer TtD and unfavorable outcome in Ewing sarcoma|
|Ferrari et al 2015 (3)||Prospective analysis of 351 patients aged 0-25 years with solid malignancies||At least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays|
Adolescent patients involved in the Youth Project at the Istituto Nazionale Tumori in Milan talk about how they came to be diagnosed with cancer (
|Elisa, 16 years old: “After 4 weeks the pain got more intense. My arm was bruised and I thought, once again, that I must have been sleeping on it. I really didn’t want to see a doctor, as I didn’t like going to the doctor’s, so I went to a drugstore and was given an ointment to put on my arm. We thought it was just an infection.”|
|Camilla, 14 years old: “I had trouble sleeping. I would wake up at night because of the pain I felt. My mother was worried and started consulting doctors and taking me to be examined, and this went on for 6 months. Then one day at the hospital lots of doctors came into my room.”|
|Angelo, 20 years old: “I started taking antibiotics for a bad sore throat. At first we thought it was a cyst or an inflamed salivary gland. The oncologist said that he had never treated cancer in a 20-year-old, and that is why he referred me to the INT.”|
|Davide, 16 years old: “It was a small mass and I was told not to worry, that I could relax and wait and see. Then the mass got bigger, but still the doctors didn’t understand what it was. They finally realized it was a brain tumor and that it had to be removed. … Why me? … There’s a problem, but there’s a solution too.”|
|Elisabetta, 20 years old: “My diagnosis took rather a long time. It was agreed with my general practitioner that I could wait and see. The swelling was there for 6 months. Because of the rarity of the condition, the doctors were caught unprepared too. They thought I’d have to go abroad to obtain a diagnosis and a cure.”|
The campaign is one of many schemes implemented by SIAMO as part of a comprehensive Italian program dedicated to adolescents with cancer. SIAMO aims to be a cultural movement as well as a project of the scientific societies dedicated to pediatric and adult medical oncology, and correlated with cooperative groups running clinical trials (8). In Italian, the word “siamo” means “we are”, but the acronym can also be read as “sì amo”, meaning “yes, I love”. We believe that its name perfectly represents what lies behind the “There’s no reason why” campaign, i.e., the will to focus with passion on providing genuine support for young people with cancer.
The authors thank the Associazione Bianca Garavaglia for supporting the Youth Project at the Pediatric Oncology Unit at the Istituto Nazionale Tumori, Milan, Italy.
- Magni, Chiara [PubMed] [Google Scholar] 1
- Maggioni, Francesca [PubMed] [Google Scholar] 2, 3
- Ricci, Angelo [PubMed] [Google Scholar] 3
- Barisone, Elena [PubMed] [Google Scholar] 4
- Jankovic, Momcilo [PubMed] [Google Scholar] 5
- Postiglione, Emma Sarlo [PubMed] [Google Scholar] 3
- Cargnel, Enrica [PubMed] [Google Scholar] 6
- Barricelli, Barbara Rita [PubMed] [Google Scholar] 7
- Valtolina, Stefano [PubMed] [Google Scholar] 7
- Veneroni, Laura [PubMed] [Google Scholar] 1
- Chiaravalli, Stefano [PubMed] [Google Scholar] 1
- Lapidari, Pietro [PubMed] [Google Scholar] 1
- Capelletti, Mirko [PubMed] [Google Scholar] 1
- Clerici, Carlo A. [PubMed] [Google Scholar] 1, 8
- Biondi, Andrea [PubMed] [Google Scholar] 5
- Ferrari, Andrea [PubMed] [Google Scholar] 1, * Corresponding Author (firstname.lastname@example.org)
Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy
Associazione Dynamo Camp Onlus, Limestre (Pistoia) - Italy
Federazione Italiana Associazioni Genitori Oncoematologia Pediatrica FIAGOP, Modena - Italy
Pediatric Onco-Hematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children’s Hospital, Turin - Italy
Pediatric Hematology-Oncology Department and Tettamanti Research Center, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, Monza - Italy
Ogilvy and Mather Italia, Milan - Italy
Department of Computer Science, University of Milan, Milan - Italy
Clinical Psychology, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy