The 2-week rule for suspected head and neck cancer in the United Kingdom: Referral patterns, diagnostic efficacy of the guidelines and compliance

McKie, Christopher; Ahmad, Umear A.; Fellows, S; Meikle, David; Stafford, F. W.; Thomson, Peter; Welch, A. R.; Paleri, Vinidh

doi:10.1016/j.oraloncology.2007.10.010

Cited by 67 publications

(76 citation statements)

References 11 publications

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“…One of the proposed advantages of a fast-track system is its potential to identify the tumours at an earlier stage, but in this study 73% of tumours were stages III and IV at presentation, which is similar to the figure of 67% for advanced stage disease in the Newcastle study [11].…”

Section: Discussionsupporting

confidence: 72%

“…However, similar to our study, of the 12% of cancer diagnoses made by Hobson et al, only 5% were primary head and neck cancer, the remainder being lymphoma and a variety of other malignancies. The largest audit of 1,079 suspected head and neck cancer referrals from the Newcastle group also demonstrated a consistently low cancer detection rate of only 11% [11], although again the diagnoses of lymphoma and thyroid malignancy were included in their overall cancer detection rate.…”

Section: Discussionmentioning

confidence: 99%

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Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer

Kennedy

Aziz

Khalid

et al. 2011

Eur Arch Otorhinolaryngol

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We adapted the 2002 Scottish Referral Guidelines for suspected squamous cell carcinoma of the head and neck (SCCHN) as a set of "alarm symptoms." These were then incorporated into a new Suspected Cancer Urgent Referral Electronically (SeCURE) system enabling immediate electronic referral from primary care to the appropriate hospital-based multi-disciplinary cancer team. All referrals made via the SeCURE system during the first year of its implementation were reviewed retrospectively. One hundred and ninety patients were urgently referred, of whom 15 (8%) were ultimately diagnosed with SCCHN. This audit demonstrated overall poor compliance with the referral guidelines. Although the electronic referral system helped for speedy clinic appointments, there was a low pick up rate of positive head and neck cancer cases. Continuing education for GPs is important and following discussion with colleagues in primary care, steps have been taken to reinforce awareness and more appropriate use of the SeCURE system.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer

Kennedy

Aziz

Khalid

et al. 2011

Eur Arch Otorhinolaryngol

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“…4 The studies scored between 8 and 15 out of a maximum of 16.The reasons for performing the studies were unclear in two of the audits 5,8 and the design of the data collection method was only outlined in one paper. 10 A total of 1,809 2ww referrals were analysed, yielding 199 findings of cancer. The proportion of 2ww referrals that were positive for cancer ranged from 6.3% to 14.6%.…”

Section: Resultsmentioning

confidence: 99%

“…7,9,10 Three studies 5,6,8 did not report the data regarding the compliance of the referrals to the NICE guidelines and were therefore not included in the analysis.The positive predictive values of each of the referral criteria were only outlined in the paper by McKie et al 10 and so collective data were not available for meta-analysis.…”

Section: -10mentioning

confidence: 99%

Efficacy of the Two-Week Wait Referral System for Head and Neck Cancer: A Systematic Review

et al. 2012

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The publication of the NHS Cancer Plan by the Department of Health in September 2000 led to an increase in the number of urgent referral clinics as the guidelines stipulated that cancer patients should not wait more than two months from referral to initiation of treatment. 1 following the implementation of these guidelines for head and neck cancer (HNC) referrals in December 2000, the National Institute for Health and Clinical Excellence (NICE) released an update as part of Clinical Guidance 27 in 2005 2 outlining eight key symptoms that should prompt urgent referral to secondary care.

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“…Several audits of this intervention have shown it to be successful in reducing professional delay, but a high proportion of non-malignant lesions have been referred, with no significant improvement in stage of disease at diagnosis. [162][163][164][165] This highlights a low sensitivity among GMPs and GDPs and stresses the need for further education and training in assessing malignant lesions and OPMLs. [162][163][164][165] Whilst newer techniques, such as toluidine blue staining, chemiluminescence, and autofluorescence, are becoming more established clinical tools for differentiating dysplastic from nondysplastic lesions and malignant from non-malignant tissue, the most suitable, accessible, and practical screening tool for a GMP or GDP remains a methodical extra-oral and intraoral examination in adequate white light.…”

Section: General Medical and Dental Practitionersmentioning

confidence: 99%

Opportunities for achieving early diagnosis of oral cancer within the medical profession in Australia

Webster¹

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Most oral cancers lack early symptoms that would prompt a patient to seek diagnosis; hence at presentation more than 60% of patients are diagnosed with stage III or IV advanced disease. Survival rates and morbidity are dramatically improved if the disease is treated at an early stage, preferably asymptomatic in stage one. Therefore, early detection of oral cancer and oral potentially malignant lesions in the asymptomatic phase via an oral cancer screening examination is important.The core objective of this thesis is to determine whether asymptomatic diagnosis of oral cancer at an early stage of disease is achievable in Australia. We achieve this by evaluating the awareness of, and attitudes toward, oral cancer and opportunistic screening held by recently-diagnosed oral cancer patients, experienced general medical practitioners, and recentlygraduated medical students. From these studies we found that participants with oral cancer had poor awareness of oral cancer and poor knowledge of risk factors prior to diagnosis. Nearly all were over 40 years of age and most consumed tobacco or alcohol or both, suggesting a target population for opportunistic screening in the primary healthcare setting. Patient, professional, and total diagnostic ii delay were better than in many other countries. In the asymptomatic phase before diagnosis, participants with oral cancer were more likely to visit a GMP over a General Dental Practitioner (GDP), and likely to do so multiple times each year, identifying significant opportunities for GMPs to perform opportunistic oral cancer screening.We also found that Australian GMPs and GMSs have an inadequate level of knowledge of oral cancer, OPMLs, risk factors, and inadequate skill in performing opportunistic oral cancer screening examinations. At the present level of knowledge and confidence, it would be unlikely for a GMP to conduct a thorough visual and tactile oral cancer screening examination even if a highrisk individual presented to his or her clinic. Only 7% of participants with oral cancer were diagnosed in the asymptomatic phase, and all were diagnosed by health practitioners with a dental qualification.We conclude that asymptomatic diagnosis of oral cancer at an early stage of disease is achievable in the primary medical healthcare setting in Australia via opportunistic oral cancer screening. Initiating a consultation with a GMP or GDP for an oral cancer screening examination would require a patient to have an improved awareness of oral cancer and knowledge of his or her personal risk factors for developing it. To increase opportunistic oral cancer screening activity from Australian GMPs, interventions need to ensure that GMPs and GMSs reach competence in risk factors for oral cancer, identifying high-risk populations, diagnostic confidence, and skill in performing the nine-step visual and tactile opportunistic oral cancer screening examination.iii

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The 2-week rule for suspected head and neck cancer in the United Kingdom: Referral patterns, diagnostic efficacy of the guidelines and compliance

Cited by 67 publications

References 11 publications

Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer

Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer

Efficacy of the Two-Week Wait Referral System for Head and Neck Cancer: A Systematic Review

Opportunities for achieving early diagnosis of oral cancer within the medical profession in Australia

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