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

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.

Coronavirus disease 2019 pandemic telephone two-week-wait referrals in head and neck cancer – how safe were they?

“…7 Historically, the most common types of malignancy diagnosed from the head and neck cancer urgent pathway have been oral cavity cancer, lymphoma, laryngeal cancer and thyroid cancer. 8 The same pattern was observed in this study. This may suggest that the Covid-19 pandemic has not caused any major deviations from the pre-pandemic head and neck cancer referral patterns.…”

“…Under the current 2-week-wait pathway, patients with cancer should receive their initial diagnosis within 28 days of the initial referral. 8 Three cases in the study cohort were diagnosed outside of this window and therefore are considered to be late diagnoses. There are limited data on the late or missed diagnosis rate of the head and neck cancer two-week-wait pathway.…”

Virtual issue: ENT care of older adults

“…The diagnosis of head and neck cancer aims to be rapid in order to facilitate early treatment, but administrative systems such as the ‘two-week-wait’ clinics have had limited success, and delays in diagnosis are all too common. 39,40 These clinics have a disappointing detection rate, and as many cancer patients are diagnosed in the ‘routine’ system – so getting routine waiting times down to acceptable levels is just as important if timely cancer treatment is the real aim. The Covid-19 pandemic has introduced further barriers to early cancer diagnosis.…”

Transoral robotic tongue base mucosectomy for head and neck cancer of unknown primary: six-year outcome experience

“…6,7 This is particularly pertinent since the oropharynx remains the most common site of carcinoma of unknown primary, especially in patients with HPV-positive disease. 2,8,9 Thus, alternative diagnostic techniques have been sought to overcome these limitations of PET-CT to reduce the number of patients classified as having cancer of unknown primary.…”

“…Thus, this may affect compliance with the National Health Service England national cancer waiting pathway (e.g., cancer patients should be treated within 31 days after the decision to treat) that recommended 94 per cent target. 9 Thus, this study aims to demonstrate our local detection rates of primary tumours in patients with metastatic cervical adenopathy from an unknown primary using robotic tongue base mucosectomy. In addition, we also aim to assess the effect of this diagnostic tool on the national cancer waiting time target.…”