Outcomes of urgent suspicion of head and neck cancer referrals in Glasgow

Abstract

Introduction Primary care patients with a suspected head and neck cancer are referred through the urgent suspicion of cancer referral pathway. Rates of cancer detection through this pathway are low. Evidence surrounding the pathway of these patients is lacking. This study aimed to determine the outcome of urgent suspicion of cancer referrals for head and neck cancer. Methods and methods All head and neck cancer urgent suspicion of cancer referrals in NHS Greater Glasgow and Clyde between June 2015 and May 2016 were analysed in regard to their clinical pathway. Results There were 2116 urgent suspicion of cancer referrals in the one-year period. The overall cancer rate was 235 (11.8%), compared with 152 (7.6%) that resulted in a primary head and neck cancer diagnosis. Of the total, 851 (42.6%) were reassured and discharged after one clinic appointment; 536 (26.8%) were followed up for suspected benign pathology and 436 (21.8%) were actively investigated for cancer. Conclusion A significant proportion of patients attending urgent suspicion of cancer clinic appointments can be seen and discharged in one clinic appointment, provided there is same day imaging available. Cancer identification rates through urgent suspicion of cancer pathways remain low.

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study

“…Considering clinical outcomes, the cancer diagnosis rate of 12% in the RDC was comparable with conversion rates in many site-specific cancer pathways. Urgent suspected cancer pathway conversion rates were reported to be between a median of 8.0% and 17.0%, 20 and to have a mean of 11.8%, 21 depending on the use of urgent pathways, referral rates, and cancer type. Also, a recent systematic review and metaanalysis of fast-track diagnosis of colorectal cancer found a cancer detection rate of 7.7% (confidence interval = 6.9% to 8.5%).…”

Remote Triage Incorporating Symptom-Based Risk Stratification for Suspected Head and Neck Cancer Referrals: A Prospective Population-Based Study

“…The overall cancer incidence of 5.6% identified in this study is consistent with rates reported in the literature and by national data sets, which vary between 3.6% and 11.8%, and it also corresponds with a national trend toward lower incidence rates in this population over time as the number of suspected cancer referrals to secondary care increases. 9,17,[22][23][24] As the number of referrals increases, risk stratification may become even more important for Cancer Month 0, 2021 appropriate hospital resource allocation and the identification of cancers, which represent a diminishing proportion of the referrals coming in. However, burdening primary care physicians with collecting and recording symptom data for risk stratification is unlikely to be appropriate.…”

An audit to analyse the two-week wait pathway at an oral cancer specialist district general hospital

“…This is in keeping with the audits and reviews from other sites, further questioning the 2ww pathway symptom guidelines. 7,8,9 There is no dispute in the necessity of patients being seen promptly for suspected HNCs. However, this does highlight the high sensitivity and low specificity of the 2ww as a screening tool.…”

“…A recent audit from a head and neck cancer unit in Glasgow showed that, in one year, 7.6% of patients referred under the 2ww pathway were positive for a primary HNC. 7 Pindolia et al showed that 96% of the 2ww referrals in a major London head and neck centre were nonmalignant, instead resulting in diagnoses such as oral lichen planus and recurrent aphthous ulceration (47% and 14%, respectively). 8 This questions whether the 2ww pathway is being overused by referring practitioners.…”