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

Hardman, John; Tikka, Theofano; Paleri, Vinidh; UK, ENT; BAHNO, BAHNO; INTEGRATE,

doi:10.2139/ssrn.3810765

Cited by 11 publications

(19 citation statements)

References 22 publications

(20 reference statements)

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“…Indeed, Hardman et al demonstrated that the negative predictive value of a "low risk" outcome from the calculator was 99.1% in data from over 4500 patients triaged during the initial COVID19 surge. 14 Our results were in keeping with this finding, with cancer conversion rates of 17% and <1%, respectively, for the highand low-risk pathways. The patients at our center identified as highrisk were essentially managed as they would have been prior to the pandemic; that is they are reviewed in a face to face clinic for clinical examination including fiberoptic nasendoscopy.…”

Section: Discussionsupporting

confidence: 89%

Introduction of a novel telescopic pathway to streamline 2‐week‐wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation

Metcalfe

Doğan

Glazzard

et al. 2021

Laryngoscope Investig Oto

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Objectives: This study summarizes the introduction of a novel telescopic pathway, which streamlines 2-week-wait suspected head and neck cancer referrals to our unit, describes the logistics of the pathway, and analyzes referral numbers and outcomes.We also discuss wider issues surrounding remote assessment in head and neck cancer.Methods: Data were collected prospectively between January and May 2021, capturing all 2-week-wait referrals to our unit following the introduction of a telescopic pathway which utilized a nurse-led clinic for nasendoscopic examination of selected patients and consultant-led remote assessment using store and forward technology.Information on referral numbers, waiting times and outcomes was recorded.Results: Three hundred and forty (185 high risk, 155 low risk) patients entered the telescopic pathway with the remaining 74 patients seen on the conventional standard of care pathway. Cancer conversion rates were 17%, <1%, and 5.4% for the high-risk telescopic, low-risk telescopic and standard of care pathways respectively.No patients discharged from the telescopic pathway were re-referred within 3 months. Review capacity for endoscopic examination was higher per consultant on the telescopic pathway versus the standard of care (p = .01). Conclusion:A combination of risk stratification and asynchronous telescopic assessment shows promise for the management of suspected head and neck cancer referrals. Potential benefits include consultant-led care for all patients and enhanced documentation. Digital communication with patients may also assist with adherence to the new NHS 28-day diagnostic standard for cancer referrals. Ongoing data collection is required to assess how the pathway functions over a longer period.

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Section: Discussionsupporting

confidence: 89%

Introduction of a novel telescopic pathway to streamline 2‐week‐wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation

Metcalfe

Doğan

Glazzard

et al. 2021

Laryngoscope Investig Oto

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“…Telephone consultations have also been employed effectively when triaging two-week-wait suspected head and neck cancer referrals. Hardman et al showed that use of a validated risk calculator, utilised as part of a telephone consultation, demonstrated a low risk of harm, with potential to reduce the number of unnecessary hospital attendances 3 .…”

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals

Metcalfe

Gaskell

McLelland

et al. 2022

Preprint

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Objectives: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. Design: Retrospective cohort study. Setting: UK secondary/tertiary referral unit. Participants: New adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, reviewed in either a face-to-face or telephone clinic. Main outcome measures: Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. Results: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (2 <0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts respectively (p<0.001). Conclusion: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem, however further research is required.

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“…HNSCCUP is a condition where the patient presents with metastatic cancer in the lymph nodes of the neck but where the original site of the cancer (which is usually thought to be from the mucosa lining the upper aerodigestive tract) cannot be identified on clinical examination, imaging investigations or diagnostic biopsies. 4 It accounts for roughly 3-5% of head and neck cancers, which itself is the 8th most common form of cancer in the UK [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative

Hardman

Harrington

Roques

et al. 2022

BMC Med Res Methodol

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Background Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. Methods A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. Results Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached ‘strong agreement’ (n = 25, 2, 0 for each round, respectively), a single statement achieved ‘agreement’ only (round 3), and ‘no agreement’ could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. Conclusions The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.

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

Abstract: Remote triage incorporating symptom-based risk stratification for suspected head and neck cancer referrals: A prospective population-based study. Cancer.

Cited by 11 publications

References 22 publications

Introduction of a novel telescopic pathway to streamline 2‐week‐wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation

Introduction of a novel telescopic pathway to streamline 2‐week‐wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation

A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals

Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative

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