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Outcome of two-week head and neck cancer pathway for the otolaryngology department in a tertiary centre

Published online by Cambridge University Press:  05 August 2021

B Mettias ,
A Charlton  and
S Ashokkumar
B Mettias*
Affiliation:
Department of Otorhinolaryngology, University Hospitals of Leicester NHS Trust, Leicester, UK
A Charlton
Affiliation:
Department of Otorhinolaryngology, University Hospitals of Leicester NHS Trust, Leicester, UK
S Ashokkumar
Affiliation:
Department of Otorhinolaryngology, University Hospitals of Leicester NHS Trust, Leicester, UK
*
Author for correspondence: Mr Bassem Mettias, ENT Department, Leicester University Hospitals, LeicesterLE1 5WW, UK E-mail: [email protected]
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Abstract

Background

The two-week-wait head and neck cancer referral pathway was introduced by the Department of Health, and refined through National Institute for Health and Care Excellence guidelines which were updated in 2015.

Methods

A retrospective study was conducted of two-week-wait referrals to out-patient ENT from January to June 2018. The analysis included demographics, referral symptoms according to National Institute for Health and Care Excellence 2015 guidelines, cancer pick-up rates and positive predictive values.

Results

A total of 1107 patients were referred for suspected head and neck cancer over six months, with 6 per cent diagnosed with cancer. Neck lump, persistent hoarseness and throat pain were the most common presenting symptoms. Neck lump had the highest positive predictive value, followed by oral swelling. Oral bleeding and persistent unilateral sore throat showed significant positive predictive values. Investigation for metastatic head and neck cancer of an unknown primary or the involvement of other multidisciplinary teams could hinder the achievement of a 62-day treatment target.

Conclusion

The cancer pick-up rate from two-week-wait referrals is only 1.5 times higher than routine referrals. The ‘red flag’ symptoms given in the 2015 National Institute for Health and Care Excellence update would benefit from further review.

Keywords

Head And Neck CancerWaiting ListEarly Detection Of CancerGuideline Adherence
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 10 , October 2021 , pp. 869 - 873
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr B Mettias takes responsibility for the integrity of the content of the paper

This paper was presented at the Midlands Institute of Otorhinolaryngology Winter Meeting, 17 January 2020, Cosford, UK.

References

Cancer Research UK. In: https://www.cancerresearchuk.org/ [4 September 2019]Google Scholar
NICE. Head and neck cancers - recognition and referral. In: https://cks.nice.org.uk/head-and-neck-cancers-recognition-and-referral/ [4 September 2019]Google Scholar
McKie, C, Ahmad, UA, Fellows, S, Meikle, D, Stafford, FW, Thomson, PJ et al. The 2-week rule for suspected head and neck cancer in the United Kingdom: referral patterns, diagnostic efficacy of the guidelines and compliance. Oral Oncol 2008;44:851–6CrossRefGoogle ScholarPubMed
Hobson, JC, Malla, JV, Sinha, J, Kay, NJ, Ramamurthy, L. Outcomes for patients referred urgently with suspected head and neck cancer. J Laryngol Otol 2008;122:1241–4CrossRefGoogle ScholarPubMed
Tikka, T, Pracy, P, Paleri, V. Refining the head and neck cancer referral guidelines: a two-centre analysis of 4715 referrals. Clin Otolaryngol 2016;41:66–75CrossRefGoogle ScholarPubMed
Douglas, CM, Carswell, V, Montgomery, J. Outcomes of urgent suspicion of head and neck cancer referrals in Glasgow. Ann R Coll Surg Engl 2019;101:103–6CrossRefGoogle ScholarPubMed
Gao, C, Qin, C, Freeman, S, Oskooee, N, Hughes, J. Two week wait referral criteria - heading in the right direction? J Laryngol Otol 2019;133:704–12CrossRefGoogle ScholarPubMed
Tikka, T, Kavanagh, K, Lowit, A, Jiafeng, P, Burns, H, Nixon, IJ et al. Head and neck cancer risk calculator (HaNC-RC)—V.2. Adjustments and addition of symptoms and social history factors. Clin Otolaryngol 2020;45:380–8CrossRefGoogle ScholarPubMed
Duvvi, SK, Thomas, L, Vijayanand, S, Reddy, KT. Two-week rule for suspected head and neck cancer. A study of compliance and effectiveness. J Eval Clin Pract 2006;12:591–4CrossRefGoogle ScholarPubMed
Pracy, P. The 2-week wait head & neck cancer referrals: is this system working? The Otorhinolaryngologist 2013;6:182–6Google Scholar
Allam, A, Nijim, H. Persistent unilateral sore throat: should it be included in the 2-week wait referral criteria by NICE. Int J Otolaryngol 2019;5:4920514Google Scholar