Efficacy of the Two-Week Wait Referral System for Head and Neck Cancer: A Systematic Review

Kumar, Rajneesh; Drinnan, Michael; Mehanna, Hisham M.; Paleri,

doi:10.1308/147363512x13189526439917

Cited by 10 publications

(13 citation statements)

References 16 publications

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“…Our study has confirmed that detection rate of cancer via the 2WW pathway remains low which is in keeping with previous studies . We show that current referral criteria can be refined significantly to improve diagnostic efficacy, without the risk of excluding symptoms that may still have PPV of over 3%.…”

Section: Discussionsupporting

confidence: 90%

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Refining the head and neck cancer referral guidelines: a two‐centre analysis of 4715 referrals

Tikka

Pracy

Paleri

2016

Clinical Otolaryngology

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Section: Discussionsupporting

confidence: 90%

“…Following the 2005 update, new audits and research papers failed to show any significant improvement in cancer detection rate, highlighting poor compliance to guidelines . These papers also identified the need for further education of primary care physicians in the appropriate use of the urgent 2‐week referral proforma .…”

mentioning

confidence: 99%

Refining the head and neck cancer referral guidelines: a two‐centre analysis of 4715 referrals

Tikka

Pracy

Paleri

2016

Clinical Otolaryngology

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“…Our study has confirmed that detection rate of cancer via the 2WW pathway remains low which is in keeping with previous studies. [5][6][7][8][9][10][11][13][14][15][16][17][18] We show that current referral criteria can be refined significantly to improve diagnostic efficacy, without the risk of excluding symptoms that may still have PPV of over 3%. We have identified the significant positive and negative symptom predictors of HNC in this large cohort and generated a well-fitted model that estimates the risk of HNC based on referral symptoms and demographics.…”

Section: Synopsis Of the New Findingsmentioning

confidence: 99%

“…12 Following the 2005 update, new audits and research papers failed to show any significant improvement in cancer detection rate, highlighting poor compliance to guidelines. 13,14 These papers also identified the need for further education of primary care physicians in the appropriate use of the urgent 2-week referral proforma. 15,16 Additionally, it was recommended that a standardised national proforma be developed based on specific signs and symptoms which have a proven correlation with HNC.…”

mentioning

confidence: 99%

Refining the head and neck cancer referral guidelines: a two centre analysis of 4715 referrals

Tikka

Pracy

Paleri

2016

British Journal of Oral and Maxillofacial Surgery

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Our aim was to identify the set of referral criteria that will offer optimal diagnostic efficacy in patients suspected to have head and neck cancer (HNC) in the primary care setting. We analysed the referral criteria and outcomes from two tertiary care cancer centres in the United Kingdom. Between 2007 and 2010, 4715 patients were referred via the fast track system with a suspected HNC. The main outcome measures were the parameters of diagnostic efficacy, a multivariate regression model to calculate estimated probability of HNC and the area under the receiver operating characteristic curve (AUROC). We found that the majority of referring symptoms had a positive predictive value higher than the 3% cut-off point stated to be significant for HNC detection in the 2015 NICE recommendations. Nevertheless, our multivariate analysis identified 9 symptoms to be linked with HNC. Of these, only 4 are included in the latest NICE guidelines. The best fit predictive model for this dataset included the following symptoms: hoarseness>3 weeks, dysphagia>3 weeks, odynophagia, unexplained neck mass, oral swelling >3 weeks, oral ulcer >3weeks, prolonged otalgia with normal otoscopy, presence of blood in mouth with concurrent sensation of lump in throat, and presence of otalgia with concurrent lump in throat sensation. Intermittent hoarseness and sensation of lump in throat were negatively associated with HNC. The AUROC demonstrated that our model had a higher predictive value (0.77) compared to those generated using the NICE 2005 (0.69) and 2015 (0.68) referral criteria (p<0.0001). An online risk calculator based on this study is available at http://www.orlhealth.com/risk-calculator.html. This paper presents a significantly refined version of referral guidelines which demonstrate greater diagnostic efficacy than the current NICE guidelines. We recommend that further iterative refinements of referral criteria be considered when referring patients with suspected HNC.

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“…Systematic reviews have shown that the pooled detection rate of cancer in this population is between 8.8% 8 and 11.1%. 9 Thus, the vast majority of referrals may be safely triaged to a deferred assessment.…”

Section: New Referralsmentioning

confidence: 99%

Rapid implementation of an evidence‐based remote triaging system for assessment of suspected referrals and patients with head and neck cancer on follow‐up after treatment during the COVID‐19 pandemic: Model for international collaboration

et al. 2020

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Background: Outpatient telemedicine consultations are being adopted to triage patients for head and neck cancer. However, there is currently no established structure to frame this consultation.Methods: For suspected referrals with cancer, we adapted the Head and Neck Cancer Risk Calculator (HaNC-RC)-V.2, generated from 10 244 referrals with the following diagnostic efficacy metrics: 85% sensitivity, 98.6% negative predictive value, and area under the curve of 0.89. For follow-up patients, a symptom inventory generated from 5123 follow-up consultations was used. A customized Excel Data Tool was created, trialed across professional groups and made freely available for download at www. entintegrate.co.uk/entuk2wwtt, alongside a user guide, protocol, and registration link for the project. Stakeholder support was obtained from national bodies. Results:No remote consultations were refused by patients. Preliminary data from 511 triaging episodes at 13 centers show that 77.1% of patients were discharged directly or have had their appointments deferred.Discussion: Significant reduction in footfall can be achieved using a structured triaging system. Further refinement of HaNC-RC-V.2 is feasible and the authors welcome international collaboration.

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Efficacy of the Two-Week Wait Referral System for Head and Neck Cancer: A Systematic Review

Cited by 10 publications

References 16 publications

Refining the head and neck cancer referral guidelines: a two‐centre analysis of 4715 referrals

Refining the head and neck cancer referral guidelines: a two‐centre analysis of 4715 referrals

Refining the head and neck cancer referral guidelines: a two centre analysis of 4715 referrals

Rapid implementation of an evidence‐based remote triaging system for assessment of suspected referrals and patients with head and neck cancer on follow‐up after treatment during the COVID‐19 pandemic: Model for international collaboration

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