Remote triaging of urgent suspected head and neck cancer referrals: our experience during the first wave of the COVID-19 pandemic

Abstract

Purpose In response to the coronavirus disease 2019 (COVID-19) pandemic, otolaryngology departments across the United Kingdom have adopted non-face-to-face clinics with consultations being carried out remotely, via telephone or video calls. By reducing footfall on hospital sites, the aim of this strategy was to limit direct contact and curb the spread of infection. This report outlines our experience of conducting a telephone triage clinic in the assessment of urgent suspected head and neck cancer referrals during the first wave of the COVID-19 pandemic. Methods New patients who were referred on the urgent suspected head and neck cancer pathway were prospectively identified between 1 May 2020 and 31 August 2020. Patients were triaged remotely using telephone consultations. Risk stratification was performed using the ‘Head and Neck Cancer Risk Calculator’ (HaNC-RC v.2). Results Four-hundred and twelve patients were triaged remotely during the 4-month study period. Of these, 248 patients were deemed ‘low risk’ (60.2%), 78 were classed as ‘moderate risk’ (18.9%) and 86 were considered ‘high risk’ (20.9%) according to the HaNC-RC v.2 risk score. Twenty-four patients who were assessed during the study period were diagnosed with head and neck cancer (5.82%). Conclusion The use of teleconsultation, supported by a validated, symptom-based risk calculator, has the potential to provide a viable and effective adjunct in the assessment and management of new suspected head and neck cancer patients and should be considered as part of the inherent re-shaping of clinical service delivery following the ongoing pandemic.

Otolaryngologic Presentations to Emergency Departments During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

“…Implementation of telehealth services, pre-appointment screening, more stringent triaging of patients, and outright cessation of elective visits and procedures were all utilized following initial outbreak and lockdown during the COVID-19 pandemic to help mitigate transmission of the virus and overburdening of healthcare systems. [32][33][34][35] Such measures were particularly important in otolaryngology, given the prevalence of aerosol-generating procedures in the specialty. 36 Despite these measures leading to dramatic reductions in patient censuses, presentations of various otolaryngologic manifestations were still seen in ED settings.…”

Primary care triaging of head and neck cancer referrals using the head and neck cancer risk calculator version 2: impact on a tertiary head and neck service

“…Several papers have recently been published that demonstrate the utility of the head and neck cancer risk calculator version 2 with remote secondary care triage, resulting in a significant reduction in the percentage of patients referred as an urgent suspicion of cancer without compromising sensitivity. [13][14][15][16][17] The head and neck cancer risk calculator version 2 in this setting has the potential to have a meaningful effect on the assessment and management of patients presenting with head and neck symptoms, particularly in the redistribution of resources post-Covid-19. However, our findings suggest that translation from secondary to primary care use of this predictive tool may not be straightforward, and additional work is required to refine the model and adapt it to use in this setting.…”

Mobile Health System for Meeting Health Information Needs in Patients With Head and Neck Cancer Undergoing Radiotherapy

“…18 The ideal mHealth will meet patients' needs and enhance convenience and efficiency in clinical settings. 19,20 However, to our knowledge, current applications of mHealth in HNC are mainly focused on remote triage, 21,22 disease detection, 23,24 and symptom management, 25,26 leaving patients' diverse needs unaddressed, including psychology, nutrition, and physical activity. Moreover, most studies have focused on continuity of care at home.…”