An audit of clinical resources available for the care of head and neck cancer patients in England

Bradley, Patrick J.; Zutshi, B.; Nutting, Christopher M.

doi:10.1258/0022215054516214

Cited by 18 publications

(12 citation statements)

References 5 publications

(6 reference statements)

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“…They conclude that major changes in service configuration were likely to be required if the current national targets of time to diagnosis and treatment were to be met. 52 The MDT has become more and more an integral part of the clinical pathway for a patient with HN cancer in many European countries. 53 An audit and re-audit of a rapid-access HN lump clinic with the provision of immediate FNAC assessment and reporting (Ôone-stopÕ clinic) found that over two-thirds of 245 patients referred to the clinic were managed during only one visit each.…”

Section: Quality Control and Auditmentioning

confidence: 99%

Head and neck cancer in the UK: what is expected of cytopathology?

Kocjan¹,

Ramsay²,

Beale³

et al. 2009

Cytopathology

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Head and neck cancer in the UK: what is expected of cytopathology?Objective: This review highlights the role of cytopathology in cancer management within UK Head and Neck Cancer Networks and informs on the issues raised by recent UK Department of Health documents and other UK professional guidance. UK guidance requires the formal involvement of cytopathologists within multidisciplinary cancer teams, with medical and non-medical cytopathology staff setting up and running rapid access lump clinics, and support for image-guided fine needle aspiration cytology (FNAC) services. UK guidance also makes recommendations for training, resources and quality control. This review also highlights the resource gap between best practice evidence-based guidance for head and neck (HN) cancer services and existing UK provision for cytopathology, as evidenced by lack of availability of experienced staff and adequacy of training and quality control (QC). Finally, it stresses the importance in the UK of the Royal College of PathologistsÕ guidance, which defines the need for training, the experience needed for new consultants, the requirements for audit and QC. The implications for the additional resources required for HN cancer cytopathology services are discussed. Recent professional guidance specifying the provision of HN cancer services in the UK includes a cytopathology service for cancer networks, such as rapid access FNAC clinics. Although these clinics already operate in some institutions, there are many institutions where they do not and where the provision of cytopathology services would have to be restructured. This would need the support of local cancer networks and their acceptance of the detailed requirements for cytopathology, including resources, training and QC. The standards are not defined locally, as Strategic Health Authorities and Primary Care Trusts have been instructed by the Department of Health to support, invest and implement them.Keywords: Department of Health guidelines, Cancer Networks, head and neck cancer, thyroid cancer, salivary gland tumours, fine needle aspiration, ultrasound-guided biopsy The incidence of head and neck (HN) cancer in the UK has wide regional variations, from 8.6 per 100 000 in Northern Ireland to 17.0 per 100 000 in Scotland, related to smoking, lifestyle and dietary factors. Registration rates for two of the three most common forms of HN cancer, cancers of the mouth and pharynx, have risen by more than 20% over the last three decades, particularly among people less than 65 years old.2 Survival rates differ markedly according to the site and stage of the cancer. Data from the EUROCARE 3 study show that survival for all cancers in England and Wales is slightly below the European average. 3The introduction of cancer networks in England and Wales and Managed Clinical Networks in Scotland has provided the opportunity to improve the outcomes in this area. The cancer networks in England form the ÔglueÕ for coordinating the many services required by cancer patients. Their roles include st...

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Section: Quality Control and Auditmentioning

confidence: 99%

Head and neck cancer in the UK: what is expected of cytopathology?

Kocjan¹,

Ramsay²,

Beale³

et al. 2009

Cytopathology

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“…oncologists and pathologist having several site-specific meetings to attend. 24 Constraints of job plans.…”

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confidence: 99%

The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making

Palmer

Wales

Ellis

et al. 2010

BJOG

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Methods Retrospective review of the colposcopy database (Sept 2003-Sept 2009, cross-referenced with multidisciplinary team (MDT) letters, patient notes and the hospital results reporting system. Baseline statistics were used for data analysis.Main outcome measures Indications for MDT referral; concordance rates from cytopathology and histopathology review; concordance rates between MDT treatment decisions and final patient management.Results A total of 535 cases were discussed at 62 MDT meetings during the allocated study period. Discrepancy between referral cytology and cervix punch biopsy was the most common referral (49%). Cytology and histology review concurred with the initial reports in 75.8 and 97.8% of cases, respectively; the MDT decision was concordant with the final patient management in 97% of cases. The main reason for discordance (67%) resulted from patient factors.Conclusions When significant discrepancies exist between colposcopy, cytology and histopathology, then MDT discussion seems pertinent as MDT discussion can lead to the avoidance of over-treatment. To improve timeliness of treatment, MDT meetings should occur at least monthly. The results of each case discussion should be recorded in the patient case notes, the minutes of each meeting should be circulated to all MDT members and a letter describing MDT recommendations must be sent to the colposcopist responsible for patient care.Keywords Colposcopy, cytology, gynaecology, multidisciplinary team, multiprofessional.Please cite this paper as: Palmer J, Wales K, Ellis K, Dudding N, Smith J, Tidy J. The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making.

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“…1,9 In the modern era of medicine, cost-effectiveness is an increasing issue with clinicians often having to justify interventions on this basis. [10][11][12] It certainly seems within the UK that a more selective approach to EUAP is gradually developing; although this may, in part, be due to financial restrictions, there is certainly a medical evidence-base to support this move. It is likely that, as this body of evidence increases, the move away from the routine use of EUAP in all patients with oral cavity and oropharyngeal SCC will continue leaving it as a selective screening tool for high-risk individuals or those who present in a symptomatic manner.…”

Section: -5mentioning

confidence: 99%

The Use of Examination Under Anaesthesia and Panendoscopy in Patients Presenting with Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

Kerawala

Bisase

Lee

2009

annals

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INTRODUCTION Although examination under anaesthesia and panendoscopy (EUAP) has traditionally been used in the assessment of patients presenting with oral cavity and oropharyngeal squamous cell carcinoma (SCC), the era of modern medicine with its advanced imaging techniques has meant that the indications for this technique have potentially reduced. SUBJECTS AND METHODS In an attempt to quantify the current use of EUAP in the UK, a structured telephone questionnaire was undertaken of 50 maxillofacial units. Information was gathered regarding whether the technique was adopted on a routine or selective basis. Likewise perceived disadvantages were sought. RESULTS Twenty-two units (44%) carried out EUAP on all patients presenting with oral cavity and oropharyngeal SCC. Of the remaining 28 units, all employed EUAP on a selective basis, the most commonly for the assessment of the primary tumour. The most common perceived disadvantage of carrying out EUAP routinely was its potential to increase the waiting time to definitive treatment. CONCLUSIONS These results suggest a gradual move towards the selective use of EUAP in patients presenting with oral cavity and oropharyngeal SCC. KERAWALA BISASE LEE EUAP IN ORAL CAVITY AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMA PATIENTSAnn R Coll Surg Engl 2009; 91: 609-612 610 on a selective basis. For the purposes of the study 'panendoscopy' was defined as the endoscopy of the nasal cavity, nasopharynx, oropharynx, larynx and upper oesophagus, with or without bronchoscopy. The indications for EUAP were obtained in terms of index tumour assessment, detection of simultaneous disease in the asymptomatic individual and its use as a 'test anaesthetic'. In units with a selective approach, further information regarding that process was elicited, e.g. did a patient's exposure to risk factors influence its use? Finally, the perceived advantages of EUAP were obtained where relevant. ResultsRepresentatives from 50 maxillofacial units were questioned. Of these, 22 (44%) employed EUAP on all patients. Of the remaining 28 units, the most common indication for EUAP was the assessment of the index tumour (Fig. 1). Around one in four units still felt that the use of EUAP as a 'test anaesthetic' was justified.For those units adopting a selective approach, the most commonly perceived disadvantage of routine EUAP was a potential increase in waiting time to definitive treatment (Fig. 2). One-third of units also expressed concern regarding the cost implications of a second anaesthetic. DiscussionEUAP was introduced in the management of head and neck malignancy in the late 1970s and is still used in many units throughout the world on a routine basis. It requires little in the way of equipment and remains less expensive than some of the alternative modes of staging patients such as computed tomography (CT), magnetic resonance imaging (MRI) and positron imaging tomography. The morbidity and mortality is low.1 In this day and age, it may still be the most sensitive way of detecting superficial mucosal ...

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An audit of clinical resources available for the care of head and neck cancer patients in England

Abstract: Major changes in service configuration are likely to be required if the current national targets of time to diagnosis and treatment are to be met.

Cited by 18 publications

References 5 publications

Head and neck cancer in the UK: what is expected of cytopathology?

Head and neck cancer in the UK: what is expected of cytopathology?

The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making

The Use of Examination Under Anaesthesia and Panendoscopy in Patients Presenting with Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

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