Image: Professor Nick James from the ICR, who leads the Man Van project. Credits: The Royal Marsden
Data from a pilot study suggest the ‘Man Van’, an innovative targeted outreach programme, could improve healthcare access for men and potentially speed up the detection of prostate cancer.
As a result, the service has been awarded more than £500k in funding from NHS England to offer more health checks to men in North and South-West London over the next 12 months, with The Royal Marsden Cancer Charity also continuing its financial support.
The mobile health clinic, developed by The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, and RM Partners West London Cancer Alliance, was launched earlier this year to improve healthcare access for men over 45 from groups who are less likely to receive regular health checks, and are at risk of having cancer diagnosed late, when it is more difficult to treat.
The Man Van – which has also been supported by Tackle Prostate Cancer – has so far visited seven different locations in South London associated with poor healthcare outcomes, including GP surgeries and construction sites. More than 600 men visited the mobile clinic during the pilot phase.
Of these, 14 were diagnosed with prostate cancer, with the majority first indicated via high prostate-specific antigen (PSA) levels identified through a blood test given in the van. Nine of these cancers were classed as significant, which meant treatment was likely to be needed to prevent the disease from progressing.
Black men, who have double the risk of developing prostate cancer and an increased risk of death once diagnosed, were particularly targeted for checks. This group made up nearly a third (29 per cent) of those seen and ten (71 per cent) of those diagnosed with the disease.
Next phase of the project will see 4,000 more men receiving health checks
In the general population, research has shown a single PSA screening test will be elevated in about 10 per cent of men over 55 years and, of these, around three out of 10 men will have prostate cancer. However, previous studies have also shown that only around one third to half of prostate cancers detected through screening require treatment – the rest are classed as low-risk and unlikely to need interventions.
The pilot data from the Man Van suggests that the rate of cancer detected through the service, which targets people at the highest risk, and the proportion of cancers needing treatment could be higher than screening the general population. This may mean this approach is an effective way to increase diagnosis rates and will be robustly tested through the next phase of the project, in which 4000 more men will receive health checks.
Researchers also found that uptake for health checks was high, as was satisfaction with the service. This indicates that mobile services could be a convenient way for men to access healthcare, which may lead to conditions being diagnosed earlier, improving long-term health outcomes. Effective tactics for boosting uptake included issuing appointments via text in partnership with GP practices and community engagement initiatives, such as working with churches.
The Man Van also tests for other common health conditions. For example, during the pilot, 18 (5 per cent of those tested) men were diagnosed with diabetes, over a quarter (28 per cent) with possible hypertension and nearly three-quarters (74 per cent) with an elevated body mass index (BMI), which can all cause serious health problems.
After each clinic in the van, a Royal Marsden nurse discusses the findings with those assessed and, with their consent, shares this information with their GP. If necessary, men are referred to a specialist service for further investigations or treatment. If an increased risk of cancer is potentially detected, The Royal Marsden, a world-class cancer centre, will be offered as a referral option along with their local hospital.
"If it hadn’t been for the van, I wouldn’t have known I have cancer"
Council worker Olukayode Dada, 60 from New Addington, was diagnosed with prostate cancer after visiting the Man Van in May and has been treated at The Royal Marsden. Olukayode said:
“I first heard about the Man Van when I got a text from my GP surgery inviting me for an appointment. The health check itself was quick, and the clinicians were very cordial. For example, after noticing my first language is Yoruba, the doctor in the van went the extra mile to make me feel comfortable, acknowledging how you greet elders in my culture. A few days later, the same doctor called me to say my PSA levels were higher than normal, which can indicate prostate cancer. It was very scary and shocking, as I had no symptoms whatsoever.
“As I wanted to be seen in a specialist centre, I then chose to be referred to The Royal Marsden where I had more tests in the hospital’s Rapid Diagnostic and Assessment Centre. By June, my diagnosis was confirmed but, fortunately, the cancer had been caught early. My treatment has involved hormone therapy and radiotherapy, and my final radiotherapy appointment was in November. I think the Man Van is a very good idea. As it was local, it was easy for me to get checked and, if it hadn’t been for the van, I wouldn’t have known I have cancer.”
'Early detection to can transform survival rates'
Professor Nick James, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, said:
“The Man Van is an innovative community-centred initiative that offers health checks with a focus on prostate cancer to men known to be at high risk of late diagnosis close to home and in the workplace. These pilot results, while based on small numbers, indicate the van could be an effective way of improving healthcare access for a range of issues faced by men as well as targeting those at highest risk of prostate cancer, potentially speeding up detection of the disease.
“Early detection of cancer can transform survival rates and boost people’s chances of being cured. Thanks to generous funding from NHS England and The Royal Marsden Cancer Charity, we will continue offering health checks in the Man Van in London and evaluating the service, which I hope to see rolled out more widely in the future.”