Outcomes of an Advanced Speech and Language Therapist-Led Low-Risk 2-Week Wait Clinic for Suspected Head and Neck Cancer: A UK-Based Pilot Study

Butler, Jen; Sellstrom, Diane; Eastwood, Natalie; Hamilton, David W.; O’Hara, James

doi:10.1016/j.jvoice.2023.02.007

Cited by 3 publications

(1 citation statement)

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“…Butler et al . 11 have published data from a speech and language therapist-led two-week-wait clinic that has the advantage of employing speech and language therapist expertise to provide a therapeutic service to patients with voice symptoms in addition to the primary aim of cancer detection. Whilst the speech and language therapist team operate with some autonomy, the care of all patients in this study was overseen by a consultant head and neck surgeon, as is the case with our model.…”

Section: Discussionmentioning

confidence: 99%

A novel remote assessment pathway to streamline the management of two-week-wait suspected head and neck cancer referrals: a prospective analysis of 660 patients

Metcalfe,

Oh,

Glazzard

et al. 2024

J. Laryngol. Otol.

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Objective This study analyses outcomes for 660 patients managed via a novel telescopic pathway for suspected head and neck cancer referrals. Method Data were collected prospectively between January 2021 and December 2022, capturing all two-week-wait referrals triaged as low risk and managed via a nurse-led clinic for nasendoscopic examination and consultant-led remote assessment. Results In total, 660 patients were included. There were six head and neck cancers diagnosed, giving a conversion rate of 0.9 per cent. Mean (standard deviation) time to informing the patient whether they did or did not have cancer (28-day faster diagnosis standard) was 28.6 days (20.2), with no significant difference observed in patients imaged prior to review (p = 0.63). No missed cancers were detected in the follow-up period. Conclusion Low-risk head and neck cancer referrals can be safely managed in a nurse-led clinic for recorded examination with asynchronous consultant-led management. Further work is required to ensure adherence to the new faster diagnosis standard.

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Section: Discussionmentioning

confidence: 99%

A novel remote assessment pathway to streamline the management of two-week-wait suspected head and neck cancer referrals: a prospective analysis of 660 patients

Metcalfe,

Oh,

Glazzard

et al. 2024

J. Laryngol. Otol.

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Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross‐sectional multidisciplinary global web survey

Payten,

Weir,

Madill

2024

Intl J Lang & Comm Disor

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BackgroundPublished best‐practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines.AimsTo provide an up‐to‐date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech–language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs).Methods & ProceduresENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis.Outcomes & ResultsPatterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years’ experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory–perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory–perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs).Conclusions & ImplicationsPractice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis.WHAT THIS PAPER ADDSWhat is already known on the subject Best‐practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni‐disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians’ use in a diagnostic voice assessment.What this paper adds to the existing knowledge This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians’ preferences when selecting clinical tools to inform a differential diagnosis.What are the potential or actual clinical implications of this work? This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced‐based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best‐practice guidelines.

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Speech and language therapist‐led clinics for low‐risk suspected head and neck cancer referrals: A qualitative study of ear, nose and throat surgeons’ views

Occomore‐Kent,

Hardman,

Roe

et al. 2024

Intl J Lang & Comm Disor

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BackgroundOver 200,000 patients are referred onto the suspected head and neck cancer (HNC) pathway annually in the UK, with around 3% receiving a cancer diagnosis. With new HNC advancements in identifying patients at low risk of a cancer diagnosis, one proposal is a speech and language therapy (SLT)‐led first point of contact clinic for low‐risk patients presenting with voice or swallowing symptoms.AimsTo explore ear, nose and throat (ENT) surgeons’ views regarding this model.Materials & MethodsThe study used a qualitative study design using semi‐structured interviews. Transcribed responses were analysed using thematic analysis.Outcomes & ResultsA total of 11 UK ENT surgeons participated. Themes included the positives and challenges of the proposed model; existing facilitators that increase the likelihood of success; and the requirements for successful implementation. Service variation impacted level of interest. Waiting times were problematic at some sites more than others; SLT workforce issues were of differing prevalence; SLT competence and interest differed; and support from organizational leaders varied. Participants’ personal views also varied, for example, acceptability of the model to patients, or what governance structure is required. There was no single SLT‐led clinic model suitable for all centres; however, some general principles were identified to inform further evaluation and implementation of this model.Conclusions & ImplicationsPrinciples included the deployment of SLTs experienced in laryngeal examination and flexible nasendoscopy; dedicated job plans and workforce; professional and regulatory body recognition and support; and clear training, supervision structure and job description for the role. Service outcomes, training protocol and competencies require robust evaluation.WHAT THIS PAPER ADDSWhat is already known on this subject During the SARS‐CoV‐2 pandemic, a risk calculator tool was developed to identify patients at highest risk of cancer who were referred to the 2‐week‐wait (2ww) ENT pathway. These patients require urgent face to face ENT assessment. Lower risk patients with voice and swallowing difficulties still require management of their symptoms and an SLT‐led clinic model is one potential solution for this population. While SLTs’ views of this model have been explored with a UK‐wide survey and focus groups, ENT surgeons’ perspectives are yet to be investigated.What this study adds to the existing knowledge This study explores ENT surgeons’ views regarding SLT‐led clinics for patients who are referred through the 2ww ENT pathway, stratified as being at low risk of cancer, and with voice and/or swallowing symptoms of likely benign aetiology. Participants shared many positive perceptions of the clinic along with factors that they felt would enhance its success (facilitators). Key requirements for the success of this clinic model were also highlighted, along with challenges that need to be addressed.What are the practical and clinical implications of this work? The need for this clinic model varied by centre. However, general principles included the importance of a dedicated workforce with pre‐existing relevant expertise; and a clear role profile, training process and competencies framework. Professional, statutory and regulatory bodies’ recognition of the role is required, and robust evaluation of the model is necessary.

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Outcomes of an Advanced Speech and Language Therapist-Led Low-Risk 2-Week Wait Clinic for Suspected Head and Neck Cancer: A UK-Based Pilot Study

Cited by 3 publications

References 13 publications

A novel remote assessment pathway to streamline the management of two-week-wait suspected head and neck cancer referrals: a prospective analysis of 660 patients

A novel remote assessment pathway to streamline the management of two-week-wait suspected head and neck cancer referrals: a prospective analysis of 660 patients

Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross‐sectional multidisciplinary global web survey

Speech and language therapist‐led clinics for low‐risk suspected head and neck cancer referrals: A qualitative study of ear, nose and throat surgeons’ views

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