Persistent Unilateral Sore Throat: Should It Be Included in the 2-Week Wait Referral Criteria by NICE

Allam, Ahmed; Nijim, Hazem

doi:10.1155/2019/4920514

Cited by 8 publications

(9 citation statements)

References 7 publications

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“…One of the new additions to the HaNC‐RC v2 is the sore throat symptom. This is supported by recent studies, showing unilateral sore throat to have a 9.5% positive predictive value in identification of HNC . Indeed, in our multivariate model, patients with unilateral persistent sore throat were 9.7 times more likely to have cancer compared with individuals without sore throat.…”

Section: Discussionsupporting

confidence: 89%

“…This is supported by recent studies, showing unilateral sore throat to have a 9.5% positive predictive value in identification of HNC. 22 Indeed, in our multivariate model, patients with unilateral persistent sore throat were 9.7 times more likely to have cancer compared with individuals without sore throat. By making these changes, the predictive power of the revised calculator, following internal validation, was 88.6%.…”

Section: Comparison With Other Studiesmentioning

confidence: 76%

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

Tikka

Kavanagh

Lowit

et al. 2020

Clinical Otolaryngology

105

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Comparison With Other Studiesmentioning

confidence: 76%

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

Tikka

Kavanagh

Lowit

et al. 2020

Clinical Otolaryngology

105

View full text Add to dashboard Cite

show abstract

“…A recent study also agreed with the high positive predictive value for persistent sore throat (9.5 per cent). 11 The authors stated the need to refine the NICE criteria in the next update. 11 A recent study conducted in London showed a decrease in cancer detection rate, from 10 per cent to 3.76 per cent, with implementation of the 2015 NICE update; this could point to missing cases that are later diagnosed during routine referral.…”

Section: Discussionmentioning

confidence: 99%

“…11 The authors stated the need to refine the NICE criteria in the next update. 11 A recent study conducted in London showed a decrease in cancer detection rate, from 10 per cent to 3.76 per cent, with implementation of the 2015 NICE update; this could point to missing cases that are later diagnosed during routine referral. 7 However, the authors did not compare cancer pick-up rate with routine referrals.…”

Section: Discussionmentioning

confidence: 99%

Outcome of two-week head and neck cancer pathway for the otolaryngology department in a tertiary centre

2021

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Background The two-week-wait head and neck cancer referral pathway was introduced by the Department of Health, and refined through National Institute for Health and Care Excellence guidelines which were updated in 2015. Methods A retrospective study was conducted of two-week-wait referrals to out-patient ENT from January to June 2018. The analysis included demographics, referral symptoms according to National Institute for Health and Care Excellence 2015 guidelines, cancer pick-up rates and positive predictive values. Results A total of 1107 patients were referred for suspected head and neck cancer over six months, with 6 per cent diagnosed with cancer. Neck lump, persistent hoarseness and throat pain were the most common presenting symptoms. Neck lump had the highest positive predictive value, followed by oral swelling. Oral bleeding and persistent unilateral sore throat showed significant positive predictive values. Investigation for metastatic head and neck cancer of an unknown primary or the involvement of other multidisciplinary teams could hinder the achievement of a 62-day treatment target. Conclusion The cancer pick-up rate from two-week-wait referrals is only 1.5 times higher than routine referrals. The ‘red flag’ symptoms given in the 2015 National Institute for Health and Care Excellence update would benefit from further review.

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“…A systematic review of relevant literature yielded nine studies. [2][3][4][5][6][7][8][9][10] Three studies were excluded because the authors did not report the compliance with NICE criteria in their results. 7,9,10 Another cohort study between two centres was excluded.…”

Section: Resultsmentioning

confidence: 99%

Two-week-wait referrals in otolaryngology in a tertiary centre: cross-sectional study of benign outcomes, with a systematic review

2021

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Objective The two-week-wait referral is designed to improve early detection in cancer patients. This retrospective study analysed those ENT two-week-wait referrals to out-patient clinics in a tertiary head and neck oncology centre, from January to June 2018, which were not compliant with National Institute for Health and Care Excellence guidelines (2015 update). Methods Referral symptoms were statistically analysed against National Institute for Health and Care Excellence guidelines, with detailed analysis of reasons for non-compliance. In addition, a systematic review of similar previously published articles was conducted. Results There were 1107 patients referred through the two-week-wait pathway. Of these referrals, 52 per cent were compliant with National Institute for Health and Care Excellence 2015 guidelines. Six errors were identified for non-compliant referrals, most commonly inconsistencies in referral (e.g. globus sensation) and intermittent disease course (e.g. intermittent hoarseness). Of all patients referred, 93 per cent were diagnosed with benign conditions, with laryngopharyngeal reflux being the commonest. Twenty-two per cent of referred patients were discharged after the first visit. Conclusion Two-week-wait referral is inappropriately overused. There are many non-compliant referrals, and most of the outcomes are benign.

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Persistent Unilateral Sore Throat: Should It Be Included in the 2-Week Wait Referral Criteria by NICE

Cited by 8 publications

References 7 publications

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

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

Outcome of two-week head and neck cancer pathway for the otolaryngology department in a tertiary centre

Two-week-wait referrals in otolaryngology in a tertiary centre: cross-sectional study of benign outcomes, with a systematic review

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