‘Urgent suspicion of cancer’ referrals to a head and neck clinic – what do patients expect?

Montgomery, Jenny; Douglas, Catriona; Begbie, F; Hitchings, Andrew W.; MacKenzie, Kenneth

doi:10.1017/s0022215119001543

Cited by 5 publications

(10 citation statements)

References 23 publications

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“…Even prior to the pandemic, head and neck cancer care suffered from poor public awareness of potential red flag symptoms. 3 Following over a year of overshadowing or absence of cancer public health warnings during the pandemic, it is likely this awareness is worse now. Combined with ongoing coronavirus transmission and potential associated public reluctance or difficulty in accessing primary care, it is prudent to assume ongoing delay in presentation of patients with head and neck cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The public generally underestimates incidence, are unaware that smoking and alcohol are significant risk factors, and do not appreciate the significance of red flag symptoms. 3 The onset of the coronavirus disease 2019 (Covid-19) pandemic and lockdown in March 2020 in the UK caused significant disruption to out-patient services. This was associated with a sudden reduction in urgent cancer referrals that remained below pre-pandemic levels until August 2020.…”

Section: Introductionmentioning

confidence: 99%

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Advancing head and neck cancer following the coronavirus disease 2019 pandemic

et al. 2022

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Objective Delay in the diagnosis of head and neck cancer can result in significant excess morbidity and mortality. How the pandemic has affected patient presentation in Scotland is unknown. Method This retrospective cohort study compared all presentations of head and neck cancer between June and October of 2019 with the same period following the peak of the pandemic in 2020 in West Scotland, a region populated by 2.5 million people. Results A total of 528 patients met our inclusion criteria. Compared with 2019, patients in 2020 were more likely to present with a higher American Joint Committee on Cancer stage (odds ratio, 1.67 (95 per cent confidence interval = 1.20 to 2.31); p = 0.002), a longer preceding symptom duration (odds ratio, 2.03 (95 per cent confidence interval = 1.44 to 2.87; p < 0.001) and to have an emergency presentation (odds ratio, 2.53, (95 per cent confidence interval = 1.15 to 5.55; p = 0.017). Conclusion Patients are presenting later with more advanced head and neck cancer following the coronavirus disease 2019 pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Advancing head and neck cancer following the coronavirus disease 2019 pandemic

et al. 2022

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“…Most of the publications present European data ( 5 , 11 – 13 , 19 , 22 – 28 , 35 , 42 , 43 , 45 – 48 , 50 – 52 , 55 – 58 , 61 ) of which the majority were from the UK ( 11 – 13 , 19 , 22 – 24 , 26 – 28 , 43 , 45 – 47 , 49 – 51 , 55 , 56 , 58 , 61 ). Eight of the selected papers were from lower or middle income countries ( 18 , 20 , 21 , 30 , 31 , 33 , 34 , 36 ), seven from the USA ( 32 , 37 – 39 , 41 , 54 , 60 ), three from Canada ( 40 , 44 , 53 ) and one from Australia ( 59 ).…”

Section: Summarising the Resultsmentioning

confidence: 99%

Nomenclature of the symptoms of head and neck cancer: a systematic scoping review

Bradley,

Lee,

Albutt

et al. 2024

Front. Oncol.

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IntroductionEvolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients’ clinical problems more effectively and risk stratify the patient.MethodThe review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms.ResultsThere were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings.DiscussionSymptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician’s decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign.

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“…Many patients delay before seeking medical attention, and the percentage of head and neck cancer that presents with the urgent suspicion of cancer pathway is high, resulting in patients with late-stage disease and limited treatment options. 12 Implementation of The Journal of Laryngology & Otology the risk calculator could reduce this inappropriate referral rate, accurately up-triaging 25 per cent of patients with a head and neck cancer from non-urgent suspicion of cancer pathways. This has the potential to significantly reduce waiting times for this high-risk patient group.…”

Section: Discussionmentioning

confidence: 99%

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

Tikka

Morton

et al. 2022

J. Laryngol. Otol.

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Objective This study aimed to investigate the use of the head and neck cancer risk calculator version 2 in a primary care setting and to evaluate the impact of the risk calculator on the number of referrals stratified by urgency and cancer yield. Method Referrals between April 2019 and August 2019, April 2020 and July 2020 (pre-risk calculator) and August 2020 and July 2021 (post-risk calculator) were analysed. Referral urgency, head and neck cancer risk calculator version 2 score, cancer diagnosis, cancer type and further investigations were recorded. Results The 2023 patient encounters were analysed; there were 1110 (55 per cent) referrals before head and neck cancer risk calculator version 2 use and 913 (45 per cent) after head and neck cancer risk calculator version 2 use. A higher proportion of older (p < 0.001) and male (p < 0.013) patients were seen post-head and neck cancer risk calculator version 2 use. All cancer cases were seen on the urgent suspicion of cancer pathway post-head and neck cancer risk calculator version 2 use; however, a higher proportion of patients were seen as urgent suspicion of cancer (51.1 vs 83.5 per cent; p < 0.001). Overall, the cancer diagnosis rate increased from 2.7 to 4.1 per cent. Conclusion The head and neck cancer risk calculator version 2 had high sensitivity in cancer diagnosis. More studies are required to optimise the predicted versus actual cancer probability gap.

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‘Urgent suspicion of cancer’ referrals to a head and neck clinic – what do patients expect?

Cited by 5 publications

References 23 publications

Advancing head and neck cancer following the coronavirus disease 2019 pandemic

Advancing head and neck cancer following the coronavirus disease 2019 pandemic

Nomenclature of the symptoms of head and neck cancer: a systematic scoping review

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

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