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

Tikka, Theofano; Pracy, Paul; Paleri, Vinidh

doi:10.1111/coa.12597

Cited by 33 publications

(34 citation statements)

References 14 publications

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“…Assuming dentists do not refer all these patients on to the two-week wait pathway this could reduce the burden placed on the service. Also in support of this approach, Tikka et al 4 concluded that red and white patches are a poor predictor of cancer with a predictive value of 4% (although this exceeds the >3% target set by NICE guidance), but that oral swelling is an important indicator of potential cancer. However, NG12 guidance may expose patients to increased risk of delayed referral because there is no clear referral pathway between doctors and dentists for suspected cancer.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

New NICE referral guidance for oral cancer: does it risk delay in diagnosis?

Grimes

Patel

Avery

2017

British Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 97%

“…4 A referral from a dentist with a lump on the lip, or in the oral cavity, consistent with cancer, or a patch that is either red, or red and white, that is consistent with oral cancer 6 1.8. 5 An unexplained thyroid lump 0 by pain, or bleeding or swelling, or both, for a referral for suspected cancer).…”

Section: 83mentioning

confidence: 99%

New NICE referral guidance for oral cancer: does it risk delay in diagnosis?

Grimes

Patel

Avery

2017

British Journal of Oral and Maxillofacial Surgery

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“…Compared to other international centers, the rate of malignant cases among individuals referred to our institution is high (63.9% overall, considering cases highly suspect, and 78.7%, considering cases only in group B). British studies with patients with complaints related to UADT diseases showed variable rate between 8 and 15% of malignancy [19][20][21][22] . It is important to note that in Brazil and in the United Kingdom the referral criteria of the patient with suspicion of upper airway digestive tract cancer to the specialist are very similar and should be sent to the oncology centers of SUS those patients with suspected or confirmed malignant neoplasia.…”

Section: /11mentioning

confidence: 99%

Audit about first consultations on head and neck oncological surgery in Brazil

Girardi¹

2018

Arch. Head Neck Surg.

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Introduction:The establishment of high complexity centers in Oncology aims to guarantee faster access to a specialist. Objective: to evaluate the profile of the cases referenced to a head and neck oncology center. Methods: Retrospective cohort study, selecting first consultations for head and neck surgical oncology in a public service of a philanthropic institution, for 12 consecutive months. Clinical and demographical data were obtained, besides information about diagnosis, staging of malignant cases, treatment and outcomes. Results: From the308 cases included, 197 (63.9%) cases confirmed malignancy (62.0%) or had high suspicion for cancer (1.9%). The remaining 111 (36.0%) cases were confirmed benign diseases (53 -17.2%) or cases with high suspicion of benignity (58 -18.8%). Non-melanocytic skin cancer comprised most of the malignant cases (63.3%); non-cancerous thyroid pathologies were the majority of benign cases (45.9%). Most cases of skin and lip cancer presented with disease at early stages (86.8%), while most cases of cancer of the upper airway and digestive tract (UADT) and thyroid/ salivary glands were in advanced stages (75.6 and 71.4%, respectively). There were not deaths related to the disease in the first year of follow-up, apart from the UADT cancer group. Among these, the 12-month survival was 45.9%. Advanced staging, history of alcoholism and irresectability/inoperability were associated with poorer prognosis. Conclusion:Compared to other global centers, the observed rate of first oncological consultations was high. Among the cases of UADT cancer, history of alcoholism and more advanced clinical and pathological presentation were associated with lower survival.

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“…In 2016, our group used information from a cohort of 4715 patients referred in for suspected HNC to generate a 13-symptom inventory which, when combined with age, could generate a personalized risk of cancer with a high diagnostic efficacy (area under the curve [AUC] 0.77). 10 Sensitivity analysis identified the 8% risk probability cutoff to offer optimal performance for the calculator. This risk calculator was subsequently validated in an external cohort of 1998 patients, where it performed well compared to the inception cohort, with an AUC of 0.81.…”

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

Abstract: This study 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.

Cited by 33 publications

References 14 publications

New NICE referral guidance for oral cancer: does it risk delay in diagnosis?

New NICE referral guidance for oral cancer: does it risk delay in diagnosis?

Audit about first consultations on head and neck oncological surgery in Brazil

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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