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 novel remote assessment pathway to streamline the management of two-week-wait suspected head and neck cancer referrals: a prospective analysis of 660 patients

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.

Implementation of the Symptom Based Risk Calculator for Head and Neck Cancer HaNC-RC v.2 Post COVID-19 Pandemic. A Single Centre Audit

Background

As the incidence of head and neck cancer continues to rise, the volume of referrals to our urgent suspected cancer clinics continues to rise with it. Cancer referral and review time targets are not being met within the UK, and our centre has experienced an increase in volume of referrals which cannot be met by available clinic slots. We proposed a pathway to the North East London Cancer Alliance to safely triage these patients using the Head and Neck Cancer Risk Calculator version 2 (HaNC-RCv2).

Methods

All 2-week-wait referrals to our unit in June 2023 were initially triaged in a telephone consultation by a specialty registrar working in the department. A brief history would be taken, and a risk score calculated. Those scoring < 5% were moved to routine or less urgent follow up.

Results

120 patients were referred to our department. We were able to safely triage 48.7% patients off the urgent suspected cancer pathway and to routine follow up. A total of 3 patients were found to have a head and neck malignancy and all were treated within the 62 day window.

Conclusion

As trusts work to cut the waiting times following the COVID-19 pandemic, there is an evident need for more efficient practices. The use of validated, safe triaging methods such as this can play a central role.

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

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.