Head and neck cancer risk calculator (HaNC‐RC)—V.2. Adjustments and addition of symptoms and social history factors

Abstract

Objectives: Head and neck cancer (HNC) diagnosis through the 2-week wait, urgent suspicion of cancer (USOC) pathway has failed to increase early cancer detection rates in the UK. A head and neck cancer risk calculator (HaNC-RC) has previously been designed to aid referral of high-risk patients to USOC clinics (predictive power: 77%). Our aim was to refine the HaNC-RC to increase its prediction potential. Design: Following sample size calculation, prospective data collection and statistical analysis of referral criteria and outcomes. Setting: Large tertiary care cancer centre in Scotland. Participants: 3531 new patients seen in routine, urgent and USOC head and neck (HaN) clinics. Main outcome measures: Data collected were as follows: demographics, social history, presenting symptoms and signs and HNC diagnosis. Univariate and multivariate regression analysis were performed to identify significant predictors of HNC. Internal validation was performed using 1000 sample bootstrapping to estimate model diagnostics included the area under the receiver operator curve (AUC), sensitivity and specificity. Results:The updated version of the risk calculator (HaNC-RC v.2) includes age, gender, unintentional weight loss, smoking, alcohol, positive and negative symptoms and signs of HNC. It has achieved an AUC of 88.6% with two recommended triage referral cut-offs to USOC (cut-off: 7.1%; sensitivity: 85%, specificity: 78.3%) or urgent clinics (cut-off: 2.2%; sensitivity: 97.1%; specificity of 52.9%). This could redistribute cancer detection through USOC clinics from the current 60.9%-85.2%, without affecting total numbers seen in each clinical setting. Conclusions:The use of the HaNC-RC v.2 has a significant potential in both identifying patients at high risk of HNC early thought USOC clinics but also improving health service delivery practices by reducing the number of inappropriately urgent referrals. | 381TIKKA eT Al.

The impact of coronavirus disease 2019 on head and neck cancer services: a UK tertiary centre study

“…This practice is likely to have been partly supported by the ENT UK Head and Neck Cancer Telephone Triage service tool, which risk stratifies patients into high and low risk groups. 6 The increase in benign diagnosis at first review is particularly marked for the diagnosis of laryngopharyngeal reflux, with 42 per cent of patients being diagnosed with laryngopharyngeal reflux in April 2020 compared to 27.5 per cent in January 2020. Possible causes for this include: anxiety and stress caused by the pandemic, exacerbating reflux symptoms; or patients being assessed remotely prior to referral and consequently being more likely to be referred than if they had attended a face-to-face consultation.…”

North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients

“…It utilises a nationally recognised statistical model of predicting the risk of head and neck cancer. 3 The number of clinical encounters and aerosol generating procedures are reduced, decreasing the risk of spread of Covid-19. The specialist workforce is therefore kept healthy, allowing them to continue treating patients.…”

“…Symptoms and risk factors are elicited via telephone consultation, and used to complete the head and neck cancer risk calculator, version 2. 3 If the patient is categorised as low risk (less than 2 per cent risk of cancer), they are discharged to primary care with safety-net advice. The patient should be empowered to seek review by their general practitioner in three months and re-refer if they remain symptomatic.…”

“…2 A risk calculator (the head and neck cancer risk calculator, version 2; 'HaNC-RC v.2') has been generated in order to establish the probability of head and neck cancer in individual patients. 3 We have reviewed the head and neck cancer risk calculator, version 2, and feel that this is a valuable way of triaging patients.…”

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

“…11 After further refinements using additional information to the symptom inventory in a new cohort (n = 3531), we published the Head and Neck Cancer Risk Calculator (HaNC-RC)-V.2, which demonstrated increased diagnostic efficacy with an AUC of 0.89, and a sensitivity of 85%. 12 The model performed optimally at a probability cut off of 7.1%, where the negative predictive value was 98.6%. Thus, when the symptom inventory is applied to a patient who has been referred for suspected cancer and the calculator indicates a <7.1% risk probability for cancer diagnosis, the chance of missing cancer if the patient is not seen by a face-toface conventional consultation is 1.4%.…”