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Outcomes for patients referred urgently with suspected head and neck cancer

Published online by Cambridge University Press:  27 March 2008

J C Hobson ,
J V Malla ,
J Sinha ,
N J Kay  and
L Ramamurthy
J C Hobson*
Affiliation:
Department of Otolaryngology, Stepping Hill Hospital, Stockport, UK
J V Malla
Affiliation:
Department of Otolaryngology, Stepping Hill Hospital, Stockport, UK
J Sinha
Affiliation:
Department of Otolaryngology, Stepping Hill Hospital, Stockport, UK
N J Kay
Affiliation:
Department of Otolaryngology, Stepping Hill Hospital, Stockport, UK
L Ramamurthy
Affiliation:
Department of Otolaryngology, Stepping Hill Hospital, Stockport, UK
*
Address for correspondence: Mr Jonathan Hobson, 20 Claremont Grove, Manchester M20 2GL, UK. Fax: 07092 039313 E-mail: jonathanhobson@gmail.com
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Abstract

Introduction:

The 1998 National Health Service White Paper stated that anyone suspected of having a cancer would be seen by a specialist within two weeks. The ‘trigger symptoms’ prompting such referral have been nationally agreed by the National Institute for Health and Clinical Excellence. This study aimed to quantify the diagnostic yield of urgent referrals for suspected head and neck malignancy, and to identify reasons why patients ultimately diagnosed with malignancy may not have been referred via this pathway.

Materials and methods:

All patients referred to the trust with suspected head and neck malignancy in 2005 were included in the study. Data were obtained on date of referral, date of appointment, reason for referral and which National Institute for Health and Clinical Excellence guideline heading the referral fell under, clinical findings, and final diagnosis. Concurrently, all patients in the trust with a histological diagnosis of head and neck malignancy were identified using the computer records of the pathology department.

Results:

One hundred and seventy-seven patients were referred with suspected head and neck malignancy over the one-year study period. Of these, 169 were seen within two weeks. The commonest causes of referral were hoarseness and neck lumps. Of these patients, 22 (12 per cent) were ultimately diagnosed with malignancy. During the one-year study period, 39 patients were diagnosed hospital-wide with head and neck malignancy, 17 of whom had not been referred via the urgent referral pathway. No unifying theme was identified to explain why these patients had not been referred via this pathway.

Conclusion:

In a group of patients with symptoms suggestive of head and neck malignancy, only 12 per cent were ultimately diagnosed with cancer. Of all the patients within the trust diagnosed with head and neck cancer, 44 per cent had come from outside the urgent referral pathway.

Keywords

Head and Neck NeoplasmsReferral and ConsultationGuidelinesOutpatients
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 11 , November 2008 , pp. 1241 - 1244
Copyright
Copyright © JLO (1984) Limited 2008

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Footnotes

Presented as a poster at the joint ENT-UK and Royal Society of Medicine Summer Meeting, 6–7 September 2007, London, UK.

References

1 Department of Health. The New NHS: Modern, Dependable. London: Department of Health, 1998Google Scholar
2 Department of Health. Referral Guidelines For Suspected Cancer. London: Department of Health, 2000Google Scholar
3 National Institute for Clinical Excellence. Referral Guidelines For Suspected Cancer. London: National Institute for Clinical Excellence, 2005Google Scholar
4 Shah, HV, Williams, RW, Irvine, GH. Fast-track referrals for oral lesions: a prospective study. Br J Oral Maxillofac Surg 2006;44:207–8Google Scholar
5 Williams, RW, Hughes, W, Felmingham, S, Irvine, GH. An audit of two week wait referrals for head and neck cancer. Ann R Coll Surg Engl 2002;84(suppl):304–6CrossRefGoogle Scholar
6 National Cancer Alliance. Patient Centred Cancer Services? What Patients Say. London: National Cancer Alliance, 1996Google Scholar
7 Spurgeon, P, Barwell, F, Kerr, D. Waiting times for cancer patients in England after general practitioners' referrals: retrospective national survey. BMJ 2000;320:838–9Google Scholar
8 Department of Health. National Survey Of NHS Patients: Cancer. London: Department of Health, 2002Google Scholar
9 Department of Health. Waiting Times For Cancer: Progress, Lessons Learned And Next Steps. London: Department of Health, 2006Google Scholar
10 Department of Health. Cancer waiting times achieving the two week target. Health Service Circular 1999;205Google Scholar
11 Sikora, K. New guidelines for urgent referral of patients with cancer are waste of energy. BMJ 2000;320:59Google ScholarPubMed
12 Debnath, D, Dielehner, N, Gunning, KA. Guidelines, compliance, and effectiveness: a 12 months' audit in an acute district general healthcare trust on the two week rule for suspected colorectal cancer. Postgrad Med J 2002;78:748–51CrossRefGoogle Scholar
13 Eccersley, AJ, Wilson, EM, Makris, A, Novell, JR. Referral guidelines for colorectal cancer – do they work? Ann R Coll Surg Engl 2003;85:107–10CrossRefGoogle ScholarPubMed
14 Fenton, JE, Hone, S, Gormley, P, O'Dwyer, TP, McShane, DP, Timon, CI. Hypopharyngeal tumours may be missed on flexible oesophagogastroscopy. BMJ 1995;311:623–4Google Scholar
15 Koyi, H, Hillerdal, G, Brandén, E. A prospective study of a total material of lung cancer from a county in Sweden 1997–1999: gender, symptoms, type, stage, and smoking habits. Lung Cancer 2002;36:9–14Google Scholar
16 Hamilton, W, Peters, TJ, Round, A, Sharp, D. What are the clinical features of lung cancer before the diagnosis is made? A population based case-control study. Thorax 2005;60:1059–65CrossRefGoogle ScholarPubMed
17 Cant, PJ, Yu, DS. Impact of the ‘2 week wait’ directive for suspected cancer on service provision in a symptomatic breast clinic. Br J Surg 2000;87:1082–6Google Scholar
18 Tromp, DM, Brouha, XD, Hordijk, GJ, Winnubst, JA, de Leeuw, RJ. Patient and tumour factors associated with advanced carcinomas of the head and neck. Oral Oncol 2005;41:313–19CrossRefGoogle ScholarPubMed
19 Brouha, XD, Tromp, DM, de Leeuw, JR, Hordijk, GJ, Winnubst, JA. Laryngeal cancer patients: analysis of patient delay at different tumor stages. Head Neck 2005;27:289–95CrossRefGoogle ScholarPubMed
20 Carvalho, AL, Pintos, J, Schlecht, NF, Oliveira, BV, Fava, AS, Curado, MP et al. Predictive factors for diagnosis of advanced-stage squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 2002;128:313–18Google Scholar