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Byrne E, Jeannon JP, Oakley R, Arora A, Rovira A. Setting up a nurse-led 2-week-wait head and neck cancer diagnostic service. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:656-662. [PMID: 39023020 DOI: 10.12968/bjon.2023.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
The number of urgent '2-week-wait' referrals to hospital for people with suspected head and neck cancer being sent by primary care is constantly growing and it is becoming increasingly difficult for head and neck cancer services to meet this demand. In order for trusts to meet their Faster Diagnosis Standards, there needs to be an effective and efficient way to ensure there is capacity for patients to receive the appropriate assessments and diagnostic investigations without compromising the quality of care delivered. This article presents the proposal of introducing a nurse-led 2-week-wait clinic to meet the ever-growing demands on the service. There is discussion of the consultant-led training programme used to upskill an advanced nurse practitioner in a single-centre study, as well as explanation of the processes followed to maintain patient safety throughout the pilot project. There will also be consideration of clinical governance and discussion of how patient satisfaction with the novel service will be measured.
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Affiliation(s)
- Edie Byrne
- Diagnostic Head and Neck Advanced Nurse Practitioner, Guy's and St Thomas' NHS Foundation Trust, London
| | - Jean-Pierre Jeannon
- Consultant Head and Neck Surgeon, Guy's and St Thomas' NHS Foundation Trust, London
| | - Richard Oakley
- Consultant Head and Neck Surgeon, Guy's and St Thomas' NHS Foundation Trust, London
| | - Asit Arora
- Consultant Head and Neck Surgeon, Guy's and St Thomas' NHS Foundation Trust, London
| | - Aleix Rovira
- Consultant Head and Neck Surgeon, Guy's and St Thomas' NHS Foundation Trust, London
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Bradley PT, Lee YK, Albutt A, Hardman J, Kellar I, Odo C, Randell R, Rousseau N, Tikka T, Patterson JM, Paleri V. Nomenclature of the symptoms of head and neck cancer: a systematic scoping review. Front Oncol 2024; 14:1404860. [PMID: 38952557 PMCID: PMC11216301 DOI: 10.3389/fonc.2024.1404860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients' clinical problems more effectively and risk stratify the patient. Method The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms. Results There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings. Discussion Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician's decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign.
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Affiliation(s)
- Paula T. Bradley
- Population Health, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ying Ki Lee
- Department of Otolaryngology, Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Abigail Albutt
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - John Hardman
- Department of Otolaryngology, Barts Health NHS Trust, London, United Kingdom
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, United Kingdom
| | - Chinasa Odo
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Nikki Rousseau
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Theofano Tikka
- Department of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joanne M. Patterson
- School of Allied Health Professions & Nursing, Institute of Population Health / Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
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Metcalfe C, Oh S, Glazzard N, Ross E, George A. A novel remote assessment pathway to streamline the management of two-week-wait suspected head and neck cancer referrals: a prospective analysis of 660 patients. J Laryngol Otol 2024; 138:667-671. [PMID: 38369910 PMCID: PMC11096830 DOI: 10.1017/s002221512400015x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVE This study analyses outcomes for 660 patients managed via a novel telescopic pathway for suspected head and neck cancer referrals. METHOD Data were collected prospectively between January 2021 and December 2022, capturing all two-week-wait referrals triaged as low risk and managed via a nurse-led clinic for nasendoscopic examination and consultant-led remote assessment. RESULTS In total, 660 patients were included. There were six head and neck cancers diagnosed, giving a conversion rate of 0.9 per cent. Mean (standard deviation) time to informing the patient whether they did or did not have cancer (28-day faster diagnosis standard) was 28.6 days (20.2), with no significant difference observed in patients imaged prior to review (p = 0.63). No missed cancers were detected in the follow-up period. CONCLUSION Low-risk head and neck cancer referrals can be safely managed in a nurse-led clinic for recorded examination with asynchronous consultant-led management. Further work is required to ensure adherence to the new faster diagnosis standard.
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Affiliation(s)
- Christopher Metcalfe
- Department of Otolaryngology, Royal Stoke University Hospital, University Hospitals North Midlands, Keele University, Stoke-on-Trent, UK
| | - Soo Oh
- Department of Otolaryngology, Royal Stoke University Hospital, University Hospitals North Midlands, Keele University, Stoke-on-Trent, UK
| | - Nina Glazzard
- Department of Otolaryngology, Royal Stoke University Hospital, University Hospitals North Midlands, Keele University, Stoke-on-Trent, UK
| | - Elizabeth Ross
- Department of Otolaryngology, Royal Stoke University Hospital, University Hospitals North Midlands, Keele University, Stoke-on-Trent, UK
| | - Ajith George
- Department of Otolaryngology, Royal Stoke University Hospital, University Hospitals North Midlands, Keele University, Stoke-on-Trent, UK
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Albutt A, Hardman J, McVey L, Odo C, Paleri V, Patterson J, Webb S, Rousseau N, Kellar I, Randell R. Qualitative study exploring the design of a patient-reported symptom-based risk stratification system for suspected head and neck cancer referrals: protocol for work packages 1 and 2 within the EVEREST-HN programme. BMJ Open 2024; 14:e081151. [PMID: 38582535 PMCID: PMC11002383 DOI: 10.1136/bmjopen-2023-081151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/19/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Between 2009/2010 and 2019/2020, England witnessed an increase in suspected head and neck cancer (sHNC) referrals from 140 to 404 patients per 100 000 population. 1 in 10 patients are not seen within the 2-week target, contributing to patient anxiety. We will develop a pathway for sHNC referrals, based on the Head and Neck Cancer Risk Calculator. The evolution of a patient-reported symptom-based risk stratification system to redesign the sHNC referral pathway (EVEREST-HN) Programme comprises six work packages (WPs). This protocol describes WP1 and WP2. WP1 will obtain an understanding of language to optimise the SYmptom iNput Clinical (SYNC) system patient-reported symptom questionnaire for sHNC referrals and outline requirements for the SYNC system. WP2 will codesign key elements of the SYNC system, including the SYNC Questionnaire, and accompanying behaviour change materials. METHODS AND ANALYSIS WP1 will be conducted at three acute National Health Service (NHS) trusts with variation in service delivery models and ensuring a broad mixture of social, economic and cultural backgrounds of participants. Up to 150 patients with sHNC (n=50 per site) and 15 clinicians (n=5 per site) will be recruited. WP1 will use qualitative methods including interviews, observation and recordings of consultations. Rapid qualitative analysis and inductive thematic analysis will be used to analyse the data. WP2 will recruit lay patient representatives to participate in online focus groups (n=8 per focus group), think-aloud technique and experience-based codesign and will be analysed using qualitative and quantitative approaches. ETHICS AND DISSEMINATION The committee for clinical research at The Royal Marsden, a research ethics committee and the Health Research Authority approved this protocol. All participants will give informed consent. Ethical issues of working with patients on an urgent cancer diagnostic pathway have been considered. Findings will be disseminated via journal publications, conference presentations and public engagement activities.
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Affiliation(s)
- Abigail Albutt
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Lynn McVey
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Chinasa Odo
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | | | | | - Sarah Webb
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Rebecca Randell
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
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Lau KL, Wilson M, Oozeer N, Cocks H. Coronavirus disease 2019 pandemic telephone two-week-wait referrals in head and neck cancer - how safe were they? J Laryngol Otol 2024; 138:321-324. [PMID: 37403606 DOI: 10.1017/s0022215123001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
OBJECTIVE During the coronavirus disease 2019 pandemic, ENT-UK recommended a move from face-to-face clinics to telephone appointments. This study reviewed the safety of telephone clinics for urgent two-week-wait cancer referrals. METHODS Patients consulted in telephone clinics between April and November 2020 were identified from an electronic database. Study patients included those diagnosed with malignant disease at six months. The Head and Neck Cancer Risk Calculator version 2 score, outcome of the initial clinic and final diagnoses were reviewed. RESULTS A total of 1062 patients were triaged in clinic; 9.2 per cent (n = 98) were diagnosed with cancer at 6 months. Of these 98 patients, 69 received an urgent face-to-face appointment, 26 underwent urgent scans and 3 had a delayed telephone review. Twenty patients (20.4 per cent) diagnosed with cancer had a low-risk Head and Neck Cancer Risk Calculator score. CONCLUSION The late diagnosis rate of 0.28 per cent suggests a small proportion of cancer could have been missed. Telephone clinics, whilst a pragmatic means to maintain patient flow during the pandemic, could result in late diagnoses.
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Affiliation(s)
- Kin Lun Lau
- Department of Otolaryngology - Head and Neck Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Margarita Wilson
- Department of Otolaryngology - Head and Neck Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Nashreen Oozeer
- Department of Otolaryngology - Head and Neck Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Helen Cocks
- Department of Otolaryngology - Head and Neck Surgery, Sunderland Royal Hospital, Sunderland, UK
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Tan JY, Callaghan CJ, Lewthwaite AW, Chan CCH, Wee CT, To EYH, Summers I, Nelson JW, Smith MB, Li LQ, Morton C, Porteous L, Evans AS, Nixon IJ. Impact of primary care triage using the Head and Neck Cancer Risk Calculator version 2 on tertiary head and neck services in the post-coronavirus disease 2019 period. J Laryngol Otol 2024:1-6. [PMID: 38250823 DOI: 10.1017/s0022215124000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE This study investigates the impact of primary care utilisation of a symptom-based head and neck cancer risk calculator (Head and Neck Cancer Risk Calculator version 2) in the post-coronavirus disease 2019 period on the number of primary care referrals and cancer diagnoses. METHODS The number of referrals from April 2019 to August 2019 and from April 2020 to July 2020 (pre-calculator) was compared with the number from the period January 2021 to August 2022 (post-calculator) using the chi-square test. The patients' characteristics, referral urgency, triage outcome, Head and Neck Cancer Risk Calculator version 2 score and cancer diagnosis were recorded. RESULTS In total, 1110 referrals from the pre-calculator period were compared with 1559 from the post-calculator period. Patient characteristics were comparable for both cohorts. More patients were referred on the cancer pathway in the post-calculator cohort (pre-calculator patients 51.1 per cent vs post-calculator 64.0 per cent). The cancer diagnosis rate increased from 2.7 per cent in the pre-calculator cohort to 3.3 per cent in the post-calculator cohort. A lower rate of cancer diagnosis in the non-cancer pathway occurred in the cohort managed using the Head and Neck Cancer Risk Calculator version 2 (10 per cent vs 23 per cent, p = 0.10). CONCLUSION Head and Neck Cancer Risk Calculator version 2 demonstrated high sensitivity in cancer diagnosis. Further studies are required to improve the predictive strength of the calculator.
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Affiliation(s)
- Jiak-Ying Tan
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, Scotland, UK
| | | | | | - Claudia Ching Hei Chan
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Colette Teng Wee
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Emily Yeg Hei To
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Isabel Summers
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - James William Nelson
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Mathew Benjamin Smith
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lucy Qian Li
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, Scotland, UK
| | | | | | - Andrew Stewart Evans
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, Scotland, UK
| | - Iain James Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, Scotland, UK
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Simpson CD, Hennigan M, Morrison J. Accuracy of the Head and Neck Cancer Risk Calculator in identifying maxillofacial malignancies. Br J Oral Maxillofac Surg 2023; 61:356-361. [PMID: 37169617 DOI: 10.1016/j.bjoms.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
The OMFS urgent suspicion of cancer (USOC) referral pathway for head and neck cancer is costly in terms of time and resources, and despite NICE referral guidance, it has a low conversion rate with many inappropriate referrals. The Head and Neck Cancer Risk Calculator version 2 (HaNC-RC-v2) gives recommendations to primary care referrers on appropriate referral priority. To our knowledge, this is the first study to investigate the accuracy of the HaNC-RC-v2 in a cohort of maxillofacial referrals. Electronic patient records were reviewed for all malignancies diagnosed by OMFS in 2019 (n = 54), and a sample of USOC referrals to OMFS (n = 204). The HaNC-RC-v2 was applied to each patient, using information from the referral letter and the clinical notes from the new patient consultation. The mean and median HaNC-RC-v2 scores for patients with malignancy were 42.22% and 32.23%, respectively. For patients without malignancy, mean and median scores were 9.27% and 5.68%, respectively. There was a statistically significant relation between the presence/absence of malignancy and the recommendation made by the risk calculator (p = 0.0012). The calculator recommended USOC referral for 76% (41/54) of patients with malignancy, and only 41% (83/204) of patients without malignancy. The negative predictive value of the HaNC-RC-v2 was 99.2%. The calculator has the potential to reduce the number of inappropriate referrals to OMFS via the USOC pathway.
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Affiliation(s)
| | | | - James Morrison
- St John's Hospital, Howden Road West, Livingston EH54 6PP, UK
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Butler J, Sellstrom D, Eastwood N, Hamilton D, O'Hara J. Outcomes of an Advanced Speech and Language Therapist-Led Low-Risk 2-Week Wait Clinic for Suspected Head and Neck Cancer: A UK-Based Pilot Study. J Voice 2023:S0892-1997(23)00042-5. [PMID: 37024351 DOI: 10.1016/j.jvoice.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES To describe outcomes of a pilot Speech and Language Therapist led (SLT-led) 2-week wait (2WW) assessment clinic for head and neck cancer (HNC). STUDY DESIGN A prospective 3-month pilot clinic was conducted. All referrals were triaged by an otolaryngologist. Referrals for unilateral symptoms, palpable neck lumps and/or ear pain were excluded. SLTs performed initial assessment. All patients received oral and neck examinations, and a videolaryngoscopy, including therapy trials. All images and management plans were discussed with an otolaryngologist within one week of the clinic. Images of suspicious lesions were reviewed within 24 hours. Data were collected consecutively for all patients attending the clinic between December 2021 and March 2022. Data included demographics, smoking history, perceptual voice ratings (GRBAS), validated patient-reported outcome measures (PROMs), diagnoses, and clinical plans. Descriptive statistics were conducted within Excel and inferential statistics within SPSS. RESULTS Over 3 months, 218 patients were seen, 62% were female and the mean age was 63 years. Most patients (54%) opted for "patient initiated follow-up" and 16% received further investigations. No patients required Ear, Nose and Throat (ENT) outpatient review for second opinion. Most (65%) received a functional diagnosis. The diagnostic yield of cancer was 5% (n = 11) and high-grade dysplasia was 3% (n = 6). At the time of writing, no patients had been re-referred to the service. There was a positive relationship between risk of diagnosis and mean GRBAS score (P < 0.01), and VHI-10 score (p=0.013). Patients with higher-risk diagnoses tended to be male, older, and had a history of smoking. PROMs suggested that laryngeal symptoms, regardless of underlying pathology, affect quality of life. CONCLUSION Experienced SLTs working alongside otolaryngologists safely led assessment and directed treatment planning for patients referred to ENT on the 2WW pathway. The rate of high-risk diagnoses was low. Higher GRBAS and VHI-10 scores may be useful indicators for higher risk diagnoses.
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Affiliation(s)
- Jen Butler
- Northumbria Healthcare NHS Foundation Trust, With Academic Funding From Health Education England/National Institute for Health Research.
| | - Diane Sellstrom
- Newcastle upon Tyne Hospitals - Newcastle Upon Tyne, United Kingdom
| | - Natalie Eastwood
- Newcastle upon Tyne Hospitals - Newcastle Upon Tyne, United Kingdom
| | - David Hamilton
- Newcastle upon Tyne Hospitals - Newcastle Upon Tyne, United Kingdom
| | - James O'Hara
- Newcastle University - Newcastle Upon Tyne, United Kingdom
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Garrard A, Bashyam A, Pitkin L. Telephone triage for 2-week-wait cancer clinics: a viable alternative to face-to-face clinics? Ann R Coll Surg Engl 2023; 105:348-351. [PMID: 36259330 PMCID: PMC10066652 DOI: 10.1308/rcsann.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Head and neck cancer services have had to adapt to reduce the risk of exposure to patients and staff during the pandemic. Telephone consultations as a first point contact have been adopted in some centres. It is important that this does not lead to delays in diagnosis. Our hospital adopted a telephone triage service and we aim to describe the implications of this structure. METHODS Data were collected from all new patients referred to the head and neck 2-week-wait (2ww) pathway from June to September of 2019 and 2020. Days between first clinic appointment and cancer or noncancer diagnosis were calculated. Statistical tests were performed between years. RESULTS A total of 215 patients in 2019, and 165 in 2020 were included; 23 (6.8%) cancer diagnoses were identified across 2019 and 2020 groups. The cancer group had a mean time from first consultation to date of diagnosis of 16.33 days in 2019 and 12.81 days in 2020. There was no significant difference in days until diagnosis between 2019 and 2020 (p=0.05). In the noncancer group there was no significant difference in days until noncancer diagnosis (p=0.05). In 2020 26.1% (n=43) patients did not need to be seen face-to-face (f2f) under the 2ww pathway after telephone triage. CONCLUSIONS No difference in diagnosis timing was observed between cancer and noncancer patents in 2019 and 2020. Telephone clinics reduce the total number of f2f appointments required. Reduction in the number of f2f appointments may have other benefits in saving time and environmental costs.
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Affiliation(s)
- A Garrard
- King's College London Faculty of Life Sciences and Medicine, UK
| | | | - L Pitkin
- Royal Surrey County Hospital, UK
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Metcalfe C, Gaskell P, McLelland T, Patel S, Muzaffar J, Dalton L, Coulson C. A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals. Eur Arch Otorhinolaryngol 2023; 280:1677-1682. [PMID: 36109380 PMCID: PMC9483526 DOI: 10.1007/s00405-022-07653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. METHODS Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. 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 (χ2 < 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). CONCLUSIONS 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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Affiliation(s)
- Christopher Metcalfe
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - Peter Gaskell
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Thomas McLelland
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Sanjay Patel
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Jameel Muzaffar
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Lucy Dalton
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Chris Coulson
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK
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Farzandipour M, Nabovati E, Sharif R. The effectiveness of tele-triage during the COVID-19 pandemic: A systematic review and narrative synthesis. J Telemed Telecare 2023:1357633X221150278. [PMID: 36683438 PMCID: PMC9892819 DOI: 10.1177/1357633x221150278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/21/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Telehealth services were used by healthcare centers during the COVID-19 pandemic in order to identify and manage patients at the forefront of the healthcare system. As one of these technologies, tele-triage refers to the assessment of a patient's health status through telephone or another means of communication and recommending treatment or providing appropriate referrals in emergency rooms and primary care offices. This study aimed to perform a systematic review of the evidence on the effectiveness of tele-triage, as one of these technologies, during the COVID-19 pandemic. METHODS Medline (via PubMed), Scopus, and Web of Science databases were searched for relevant English articles published since the pandemic's onset until December 30, 2021. Studies investigating the tele-triage's effect on patient safety, clinical outcomes, and patient satisfaction were included. Data on study characteristics, intervention characteristics, and their effects on study outcomes were extracted separately by two authors. A narrative synthesis of the included studies was ultimately performed. RESULTS Out of the 6312 retrieved studies, 14 met the inclusion criteria. The tele-triage intervention was offered by an algorithm-based system in eight studies (57.14%) and by healthcare providers in six other studies (42.86%) to determine the patient's level of care. According to the results, tele-triage interventions during COVID-19 can reduce unnecessary emergency room visits (by 1.2-22.2%), improve clinical outcomes after intervention (such as would closure in diabetic feet), reduce mortality and injuries, and ensure patient satisfaction with tele-triage (53-98%). CONCLUSIONS This study found that tele-triage interventions reduced unnecessary visits, improved clinical outcomes, reduced mortality, and injuries, increased patient satisfaction, reduced healthcare provider workload, improved access to primary care consultation, and increased patient safety and satisfaction. Therefore, tele-triage systems are not only suitable for providing acute and emergency care remotely but they are also recommended as an alternative tool to monitor and diagnose COVID-19.
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Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Richard Sullivan
- Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Patient perceptions of a remote assessment pathway in otology: a qualitative descriptive analysis. Eur Arch Otorhinolaryngol 2022; 280:2173-2180. [PMID: 36201006 PMCID: PMC9540146 DOI: 10.1007/s00405-022-07684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022]
Abstract
Purpose This study aims to gain in-depth feedback on patient perceptions of remote assessment in otology, to better inform the development of a telemedicine pathway for new otology referrals. Methods A qualitative descriptive approach was employed to analyse semi-structured interviews from 14 patients seen in a routine otology clinic. Results Patients were generally accepting of the proposed telemedicine pathway. Key themes included maintaining quality of care, adequate training for facilitators, reducing waiting times, appropriate actioning of clinic outcomes and anxiety surrounding the use of technology. Conclusions Our proposed telemedicine pathway for new otology referrals is acceptable to patients, provided there is no compromise in the standard of their care versus a traditional pathway. These results further our understanding of remote assessment in otology from the patient perspective and may help to inform the development of such pathways outside of our centre.
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14
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Hardman JC, Harrington K, Roques T, Sood S, Jose J, Lester S, Pracy P, Simo R, Repanos C, Stafford F, Jennings C, Winter SC, Wheatly H, Homer J, Kumar BN, Paleri V. Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative. BMC Med Res Methodol 2022; 22:189. [PMID: 35818027 PMCID: PMC9275134 DOI: 10.1186/s12874-022-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- John C Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Tom Roques
- Department of Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sanjai Sood
- Department of Otolaryngology, Head and Neck Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jemy Jose
- Department of Otolaryngology, Head and Neck Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Shane Lester
- Department of Otolaryngology, Head and Neck Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Paul Pracy
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ricard Simo
- Department of Otolaryngology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Costa Repanos
- Department of Otolaryngology, Head and Neck Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Frank Stafford
- Department of Otolaryngology, Head and Neck Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Chris Jennings
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stuart C Winter
- Department of Otolaryngology, Head and Neck Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hugh Wheatly
- Department of Otolaryngology, Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jarrod Homer
- Department of Otolaryngology, Head and Neck Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - B Nirmal Kumar
- Department of Otolaryngology, Head and Neck Surgery, Wrightington Wigan & Leigh NHS Foundation Trust, Wigan, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
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15
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Zhang H, Hardman JC, Tikka T, Nankivell P, Mehanna H, Paleri V. Symptom-based remote assessment in post-treatment head and neck cancer surveillance: A prospective national study. Clin Otolaryngol 2022; 47:561-567. [PMID: 35634790 DOI: 10.1111/coa.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/18/2022] [Accepted: 05/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report the incidence of locoregional recurrence in head and neck cancer (HNC) patients under surveillance following treatment undergoing symptom-based remote assessment. DESIGN A 16-week multicentre prospective cohort study. SETTING UK ENT departments. PARTICIPANTS HNC patients under surveillance following treatment undergoing symptom-based telephone assessment. MAIN OUTCOME MEASURES Incidence of locoregional recurrent HNC after minimum 6-month follow-up. RESULTS Data for 1078 cases were submitted by 16 centres, with follow-up data completed in 98.9% (n = 1066). Following telephone consultation, 83.7% of referrals had their face-to-face appointments deferred (n = 897/1072). New symptoms were reported by 11.6% (n = 124/1072) at telephone assessment; 72.6% (n = 90/124) of this group were called for urgent assessments, of whom 48.9% (n = 44/90) came directly for imaging without preceding clinical review. The sensitivity and specificity for new symptoms as an indicator of cancer recurrence were 35.3% and 89.4%, respectively, with a negative predictive value of 99.7% (p = .002). Locoregional cancer identification rates after a minimum of 6 months of further monitoring, when correlated with time since treatment, were 6.0% (n = 14/233) <1 year; 2.1% (n = 16/747) between 1 and 5 years; and 4.3% (n = 4/92) for those >5 years since treatment. CONCLUSIONS Telephone assessment, using patient-reported symptoms, to identify recurrent locoregional HNC was widely adopted during the initial peak of the COVID-19 pandemic in the United Kingdom. The majority of patients had no face-to-face reviews or investigations. New symptoms were significantly associated with the identification of locoregional recurrent cancers with a high specificity, but a low sensitivity may limit symptom assessment being used as the sole surveillance method.
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Affiliation(s)
- Henry Zhang
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | | | | | - Paul Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
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16
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Durbin BL, Faulkner JD, Jernigan R, Hope D, Jacob B, Hope WW. Patient Referrals for Hernia Consultations through the International Hernia Collaboration (IHC) Online Social Media Platform. Am Surg 2022; 88:1026-1027. [PMID: 35282710 DOI: 10.1177/00031348211058633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social media platforms are becoming more ubiquitous in surgery with a mission to bring surgeons closer together through education and learning. The purpose of this project is to evaluate the social media posts relating to referral of patients through one of the online social media platforms. The International Hernia Collaboration closed Facebook site was queried with terms relating to referrals and descriptive statistics generated. There were a total of 36 posts relating to surgical referrals between October 2014 and January 2021. Posts were from 32 different surgeons and included 30 different locations throughout the United States. An online social media platform is a viable way to refer patients throughout the United States and abroad. Further study is needed to evaluate the role of social media for surgical referrals and its impact on patient care.
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Affiliation(s)
- Breanna L Durbin
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Justin D Faulkner
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Richard Jernigan
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Davis Hope
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Brian Jacob
- Department of Surgery, 5944Mount Sinai Health System, New York, NY, USA
| | - William W Hope
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
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17
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Metcalfe C, Dogan M, Glazzard N, Ross E, George A. Introduction of a novel telescopic pathway to streamline 2-week-wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation. Laryngoscope Investig Otolaryngol 2022; 7:117-124. [PMID: 35155789 PMCID: PMC8823166 DOI: 10.1002/lio2.721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022] Open
Abstract
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. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Christopher Metcalfe
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Mehmet Dogan
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Nina Glazzard
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Elizabeth Ross
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Ajith George
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
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Kaddour H, Jama GM, Stagnell S, Kaddour S, Guner K, Kumar G. Remote triaging of urgent suspected head and neck cancer referrals: our experience during the first wave of the COVID-19 pandemic. Eur Arch Otorhinolaryngol 2022; 279:1111-1115. [PMID: 34661717 PMCID: PMC8522533 DOI: 10.1007/s00405-021-07135-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In response to the coronavirus disease 2019 (COVID-19) pandemic, otolaryngology departments across the United Kingdom have adopted non-face-to-face clinics with consultations being carried out remotely, via telephone or video calls. By reducing footfall on hospital sites, the aim of this strategy was to limit direct contact and curb the spread of infection. This report outlines our experience of conducting a telephone triage clinic in the assessment of urgent suspected head and neck cancer referrals during the first wave of the COVID-19 pandemic. METHODS New patients who were referred on the urgent suspected head and neck cancer pathway were prospectively identified between 1 May 2020 and 31 August 2020. Patients were triaged remotely using telephone consultations. Risk stratification was performed using the 'Head and Neck Cancer Risk Calculator' (HaNC-RC v.2). RESULTS Four-hundred and twelve patients were triaged remotely during the 4-month study period. Of these, 248 patients were deemed 'low risk' (60.2%), 78 were classed as 'moderate risk' (18.9%) and 86 were considered 'high risk' (20.9%) according to the HaNC-RC v.2 risk score. Twenty-four patients who were assessed during the study period were diagnosed with head and neck cancer (5.82%). CONCLUSION The use of teleconsultation, supported by a validated, symptom-based risk calculator, has the potential to provide a viable and effective adjunct in the assessment and management of new suspected head and neck cancer patients and should be considered as part of the inherent re-shaping of clinical service delivery following the ongoing pandemic.
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Affiliation(s)
- Hesham Kaddour
- Department of Otolaryngology, Queen's Hospital, Romford, UK
| | - Guled M Jama
- Department of Otolaryngology, Queen's Hospital, Romford, UK.
| | - Sami Stagnell
- Department of Oral Surgery, East Surrey Hospital, Redhill, UK
| | | | - Karen Guner
- Department of Otolaryngology, Queen's Hospital, Romford, UK
| | - Gaurav Kumar
- Department of Otolaryngology, Queen's Hospital, Romford, UK
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