eHCPs in the Netherlands say smoking cessation is more critical than lung cancer screening
Lung cancer is one of the most prevalent cancers in the Netherlands, and studying the online conversation among eHCPs reveals specific areas highlighted as key issues in the country.
We analysed 595 social media posts from 197 eHCPs in the Netherlands, discussing lung cancer, using CREATION Pinpoint®. These posts, largely X (Twitter) (74%) and LinkedIn (25%), revealed various key insights, particularly about lung cancer screening, detection and prevention through smoking cessation
Over the past year, the topic that created the highest peak in the lung cancer conversation among eHCPs in the Netherlands was screening, following the introduction of a lung cancer screening trial for past smokers. Unusually, the eHCP response to this screening trial was bigger than their online activity during lung cancer awareness month, a time during which in markets such as the US and UK would see a wealth of posts from eHCPs, patients and advocacy groups alike.
CREATION.co has observed trends that in smaller markets, such as the Netherlands, while there is engagement with international markets around global issues, there are still local issues with a local audience that are discussed. The analysis of online conversation gives a unique look at these Netherlands-specific concerns.
Lung cancer screening: Worth it?
In August 2022, it was announced that 400,000 Dutch people would be receiving an invitation to take part in a population trial to investigate early detection of lung cancer to answer some questions about screening. While the logic has anecdotally been observed in wider eHCP conversation, that increased screening leads to early detection of lung cancer which leads to early treatment initiation and therefore better prognosis, eHCPs in the Netherlands are not so sure. CREATION.co found that eHCPs in the UK have recently celebrated the introduction of a national lung cancer screening program saying it would “save thousands of lives”, only showing concern at the pressure it would add to an already stretched NHS. However, following the Dutch trial announcement, eHCPs in the Netherlands were quick to share concerns. Many referenced the NELSON trial, whose screening results were announced in 2020: one general practitioner pointed out that the mortality rates across the screening group and control group were the same.
De feiten zijn dat de overall sterfte door longkankerscreening niet daalt. In beide groepen van de oorspronkelijke Nelsonstudie gingen even veel mensen dood in 10 jaar.
— joost zaat (@joostzaat) August 17, 2022
Another general practitioner called the new screening trial “a waste of money”, explaining in a later post that from 2,000 CT scans, “only one life is ‘saved’”. The same physician brought the argument that longer survival alongside early detection doesn’t mean much, when there are other factors at play, such as age and disease severity.
Dat bij vroegdiagnostiek de overleving langer is, zegt niets. De vraag is… Zijn ze ouder als ze sterven (en zijn ze minder lang/minder ernstig ziek).https://t.co/aurMJYLmPG
— huisarts alida (@HuisartsAlida) August 17, 2022
As is common, among concerns for the trial came questions around the trial design itself; Arjen Noordzij, a urologist, said the trial is not randomised so it would be impossible for it to claim a decrease in overall mortality.
Prof de Koning @ErasmusMC beweert/hoopt met deze nieuwe studie wel afname van de overall sterfte te vinden.
Hoe kan dat nou? Het is geen gerandomiseerde studie; er is geen controlegroep. https://t.co/tdJ2H4LZNN
— Arjen Noordzij (@dokter_no) August 17, 2022
Smoking cessation comes first
eHCPs did not criticise the screening trial without offering other suggestions; the case for smoking cessation as a key way to prevent lung cancer was discussed in 20% of the overall lung cancer conversation and 30% of the screening conversation.
An infectious disease epidemiologist stated that early detection of lung cancer (through screening) is secondary prevention, whereas primary prevention, stopping the cause (smoking), reduces the need for later detection.
vroegopsporing (in risicogroepen) = secundaire #preventie
— Alma Tostmann 💛💙 (@AlmaTostmann) August 17, 2022
Another eHCP, an oncologist, stated that prevention should be preferred to screening to detect cancer earlier, that efforts could be made to stop young people from smoking in the first place.
Ja: door preventie. Dus inzetten op hulp bij stoppen met roken en voorkomen dat nieuwe (jonge) mensen starten met roken ipv longkankerscreening…
— Ingrid Desar (@OncoDoc_Ingrid) August 23, 2022
In reference to the cost of widespread screening, a general practitioner asked whether the money could be spent treating the cause of lung cancer by investing it into stopping (or preventing people from starting) smoking. This viewpoint has been common in the online HCP conversation over the past year, with the WHO in the last few weeks declaring that the Netherlands is at the forefront of tobacco control, having adopted 6 cost-effective and high impact policy measures to reduce the country’s demand for tobacco. HCPs play a critical role in public health issues and their opinions (as seen in their digital discourse) have proven to lead to important policy changes numerous times.
Inequality is an issue
eHCPs were able to highlight some local disparities in health, particularly relating to smoking. This was notably initiated by the publishing of the Kankeratlas, showing the location of cancer cases across the Netherlands.
On LinkedIn, the president of the Dutch Society of Respiratory Physicians, Leon van der Toon, said people in poorer neighbourhoods aren’t helped by cheap cigarettes and that efforts in reducing health differences need to be strengthened.
Not only this, but Joost Zaat, a general practitioner, said international evidence showed that lung cancer screening mainly reaches more educated people. This was after a professor shared his invitation to screening, pointing out the extensive instructions and forms that could be difficult to fill out for the poorly educated, which he said many smokers are.
Er is wel onderzoek in de VS dat longkankerscreening vooral hogeropgeleiden bereikt en dat de stadiumverschuiving naar gr 1 bij de laagopgeleiden veel lager is.
— joost zaat (@joostzaat) August 22, 2022
These areas of disparities show where HCPs feel that extra effort could be focused to make thorough improvements across the nation.
It is clear from the HCP online conversation in the Netherlands that one cause they are very passionate about is smoking cessation as a primary prevention for lung cancer, above vast screening programs. Interestingly, CREATION.co analysis previously found a near opposite sentiment from many eHCPs in the UK who were very pleased to see the introduction of a national screening program due to its potential to save lives through early detection of lung cancer.
While the Netherlands as a small market returned a lower volume of conversation than other markets, the quality of conversation and nuance observed shows the opportunity for actionable insight that may not be uncovered in primary market research. Our webinar Digital Opinion Leaders in Lung Cancer, Opportunities to Identify, Engage and Activate Your DOLs compares these insights from the Netherlands with HCPs’ conversations in EU5 and Asian markets.
Find out more about how CREATION.co’s HCP social listening can be used alongside, or instead of, primary market research, by reaching out to us email@example.com.