Speech and language therapy assessment of patients on the 2-week wait head and neck cancer referral pathway: evidence and opinion following a pilot study

Abstract

Purpose of review Spiralling numbers of patients are being referred on the two-week wait (2WW) head and neck cancer referral pathway. Only a small proportion are found to have cancer. There is a call for change in the management of these referrals, particularly following coronavirus. Allied health professionals (AHPs) are being encouraged by the NHS to extend their clinical practice to address increased demand. Speech and Language Therapists (SLTs) may offer a solution to some of the 2WW pathway's challenges. Recent findings Recent evidence highlights problems with the pathway and reasons for change. Hoarse voice is consistently found to be the most common presenting symptom. Emerging evidence suggests SLTs can extend their scope of practice to manage new hoarse voice referrals. A pilot project is described. Outcomes from this and other ongoing studies explore efficacy and investment required to make this proposal an achievable prospect for the future Summary The management of 2WW referrals on the head and neck cancer pathway needs to change. Preliminary findings suggest SLTs working within the context of the multidisciplinary team can safely extended their role to improve management of these patients. Professional role outline, recognition, guidance, and training framework are needed.

Rethinking the ‘one-stop’ neck lump clinic: a novel pathway beyond coronavirus disease 2019

“…This included the use of risk-stratification tools, early radiological or cytological diagnostics, 13,14 telephone consultations, 15 and allied healthcare professionals. 16 Although early ultrasound and diagnostics were used, to our knowledge no formalised pathway has been proposed to allow efficient delivery of such a service.…”

The impact of 2 weeks wait referral on survival of head and neck cancer patients

“…Larger numbers of non-cancer patients presenting at HNC centres affects waiting times, taxes department resources and ultimately impacts patient care. To tackle this increase in referrals, several options have showed to be effective such as telephone triaging [ 26 ] or consultations [ 27 ], the implementation of risk stratification systems to assess the risk of cancer [ 28 ] or allied health care professionals such as speech and language therapists assessing new patients [ 29 ]. This last option is particularly relevant considering that patients referred under the 2WW HNC have a higher risk of cancer in the future [ 30 ] and as seen in our series, a higher prevalence of smoking becoming this referral a great opportunity for smoking cessation referral and prevention of cancer, proven to be more effective within the 2WW than elsewhere [ 31 ].…”

“…This approach dramatically shortens the pathway but this is at expense of a filter function carried by the private specialist that is possible due to the system idiosyncrasy entailing a large use of resources that makes it difficult to reproduce elsewhere. This would justify the implementation of “filters” from GP referral to tertiary centre specialist appointment as already proposed with speech and language therapists [ 29 ] or advanced nurse practitioners.…”