Audit of the two-week pathway for patients with suspected cancer of the head and neck and the influence of socioeconomic status

Rogers, Simon; Staunton, A.; Girach, R.; Langton, S.G.; Lowe, Derek

doi:10.1016/j.bjoms.2018.09.016

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…Head and neck cancer (HNC) is the eighth most common cancer worldwide [1]. Despite the increasing etiological importance of human papillomavirus (HPV) infection observed in recent years, the long-lasting history of smoking and alcohol abuse is still the prevailing cause of this cancer, and reflects the lower socioeconomic status of the patients [2]. Consequently, the time from the symptoms' appearance and the first medical consultation is often delayed in these patients [3].…”

Section: Introductionmentioning

confidence: 99%

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Psychological distress and nutritional status in head and neck cancer patients: a pilot study

Gosak

Gradišar

Kozjek

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To determine whether the psychological state of patients with head and neck cancer (HCN) is associated with their nutritional status. Methods In 40 patients with locally advanced HNC treated with definitive or adjuvant (chemo)radiotherapy, psychological and nutritional status were assessed before treatment, at its completion and 3 months' post-therapy. Psychosocial distress was measured using the Hospital Anxiety and Depression Scale questionnaire (HADS-A, HADS-D), whereas the nutritional status was evaluated using standard methods (Nutritional Risk Screening Tool 2002, anthropometric data, dynamometry and laboratory tests) and with a bioelectrical impedance analysis parameter phase angle (PA). Results Before treatment, more patients were screened positive for anxiety than at treatment completion (p = 0.037) or 3 months' post-therapy (p = 0.083). Depression prevalence was non-significantly higher at the end and after therapy. Compared to the baseline, more cachectic patients and a reduction of PA values were found at successive assessments. Anxiety was more often recorded among malnourished/cachectic patients (assessment 1, p = 0.017; assessment 2, p = 0.020) who were also found more frequently depressed (assessment 2, p = 0.045; assessment 3, p = 0.023). Significantly higher PA values were measured in patients without distress determined at 3 months' post-therapy by the HADS-A (p = 0.027). Conclusion The association between the psychological and nutritional status found in this pilot study and the options for intervention warrants further clarification in a larger prospective trial.

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Section: Introductionmentioning

confidence: 99%

“…Consequently, the time from the symptoms' appearance and the first medical consultation is often delayed in these patients [3]. At presentation, two-thirds of them have a locally advanced disease with associated anatomical abnormalities and functional disorders in the affected area [2].…”

Section: Introductionmentioning

confidence: 99%

Psychological distress and nutritional status in head and neck cancer patients: a pilot study

Gosak

Gradišar

Kozjek

et al. 2020

Eur Arch Otorhinolaryngol

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“…Only one socio-economic variable was selected among the many considered in this study (inemployed, self employed with one parent working), but it was shown that most of the selected variables were correlated with other socio-economic and health factors (Chaturvedi, 2001). Deprivation was found to be not significant, in contrast with the large amount of literature linking deprivation or socio-economic status with cancer diagnosis and survival rates (Liao et al, 2023, Bithell et al, 2013, Chambers et al, 2020, Shack et al, 2008, Edwards et al, 2006, Rogers et al, 2019, Rafiq et al, 2019, Phillips et al, 2019, Taib et al, 2018.…”

Section: Discussionmentioning

confidence: 87%

“…These factors acquired by linking primary and secondary data are: The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation for LSOAs in England. Every LSOA in England is ranked from 1 (most deprived or poor) to 5 (quintile) or 10 (decile) (least deprived or most affluent), but there is no definitive cut-off below which an area is considered 'deprived' (Rogers et al, 2019).…”

Section: Exposure and Predictor Variablesmentioning

confidence: 99%

Syndemic Geographic Patterns of Cancer Types in a Health Deprived Area of England: a new Paradigm for Public Health Cancer Interventions?

Jones,

Keegan,

Knox

et al. 2024

Preprint

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Cancer poses a significant public health challenge, and accurate tools are crucial for effective intervention, especially in high-risk areas. The North West of England, historically identified as a region with high cancer incidence, has become a focus for public health initiatives. This study aims to analyse cancer risk factors, demographic trends and spatial patterns in this region by employing a novel spatial joint modelling framework designed to account for large frequencies of left-censored data. Cancer diagnoses were collected at the postcode sector level. The dataset was left-censored due to confidentiality issues, and categorised as interval censored. Demographic and behavioural factors, alongside socio-economic variables, both at individual and geographic unit levels, were obtained from the linkage of primary and secondary health data and various open source datasets. An ecological investigation was conducted using joint spatial modelling on nine cancer types (breast, colorectal, gynaecology, haematology, head and neck, lung, skin, upper GI, urology), for which explanatory factors were selected by employing an accelerated failure model with lognormal distribution. Post-processing included principal components analysis and hierarchical clustering to delineate geographic areas with similar spatial patterns of different cancer types. The study included 15,506 cancer diagnoses from 2017 to 2022, with the highest incidence in skin, breast and urology cancers. Preliminary censoring adjustments reduced censored records from 86% to 60%. Factors such as age, ethnicity, frailty and comorbidities were associated with cancer risk. The analysis identified 22 relevant variables, with comorbidities and ethnicity being prominent. The spatial distribution of the risk and cumulative risk of the cancer types revealed regional variations, with five clusters identified. Rural areas were the least affected by cancer and Barrow-in-Furness was the area with the highest cancer risk. This study emphasizes the need for targeted interventions addressing health inequalities in different geographical regions. The findings suggest the need for tailored public health interventions, considering specific risk factors and socio-economic disparities. Policymakers can utilize the spatial patterns identified to allocate resources effectively and implement targeted cancer prevention programmes.

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“…A systematic review estimated that OPMD has a 12% mean risk of malignant progression [10]. In the UK, it was found that only 7% of OPMD patients, referred using the two-week 'fast-track' suspected cancer referral system, actually developed OSCC [18]. An audit (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) carried out in a UK district general hospital found a significant 450% increase in the annual number of 'fast-track' referral patients but cancer detection rate decreased by 50% [19] indicating an unnecessary burden on secondary care due to large number of false positives being referred.…”

Section: Introductionmentioning

confidence: 99%

Molecular Signatures of Tumour and Its Microenvironment for Precise Quantitative Diagnosis of Oral Squamous Cell Carcinoma: An International Multi-Cohort Diagnostic Validation Study

Teh

Liang

et al. 2022

Cancers

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Background: Heterogeneity in oral potentially malignant disorder (OPMD) poses a problem for accurate prognosis that impacts on treatment strategy and patient outcome. A holistic assessment based on gene expression signatures from both the tumour cells and their microenvironment is necessary to provide a more precise prognostic assessment than just tumour cell signatures alone. Methods: We reformulated our previously established multigene qPCR test, quantitative Malignancy Index Diagnostic System (qMIDS) with new genes involved in matrix/stroma and immune modulation of the tumour microenvironment. An algorithm calculates and converts a panel of 16 gene mRNA expression levels into a qMIDS index to quantify risk of malignancy for each sample. Results: The new qMIDSV2 assay was validated in a UK oral squamous cell carcinoma (OSCC) cohort (n = 282) of margin and tumour core samples demonstrating significantly better diagnostic performance (AUC = 0.945) compared to previous qMIDSV1 (AUC = 0.759). Performance of qMIDSV2 were independently validated in Chinese (n = 35; AUC = 0.928) and Indian (n = 95; AUC = 0.932) OSCC cohorts. Further, 5-year retrospective analysis on an Indian dysplastic lesion cohort (n = 30) showed that qMIDSV2 was able to significantly differentiate between lesions without transformation and those with malignant transformation. Conclusions: This study validated a novel multi-gene qPCR test on a total of 535 tissue specimens from UK, China and India, demonstrating a rapid minimally invasive method that has a potential application for dysplasia risk stratification. Further study is required to establish if qMIDSV2 could be used to improve OPMD patient management, guide treatment strategy and reduce oral cancer burden.

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Audit of the two-week pathway for patients with suspected cancer of the head and neck and the influence of socioeconomic status

Cited by 9 publications

References 10 publications

Psychological distress and nutritional status in head and neck cancer patients: a pilot study

Psychological distress and nutritional status in head and neck cancer patients: a pilot study

Syndemic Geographic Patterns of Cancer Types in a Health Deprived Area of England: a new Paradigm for Public Health Cancer Interventions?

Molecular Signatures of Tumour and Its Microenvironment for Precise Quantitative Diagnosis of Oral Squamous Cell Carcinoma: An International Multi-Cohort Diagnostic Validation Study

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