Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-22T15:23:40.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Two week wait referral criteria – heading in the right direction?

Published online by Cambridge University Press:  02 August 2019

C Gao ,
C Qin ,
S Freeman ,
N Oskooee  and
J Hughes
C Gao
Affiliation:
UCL Medical School, London, UK Department of General Surgery, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, UK
C Qin
Affiliation:
UCL Medical School, London, UK Department of Care of the Elderly, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
S Freeman*
Affiliation:
UCL Medical School, London, UK Department of ENT, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
N Oskooee
Affiliation:
UCL Medical School, London, UK
J Hughes
Affiliation:
Head and Neck Centre, University College London Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Dr Samuel Freeman, Wexham Park Hospital, Slough SL2 4HL, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses.

Methods

The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer.

Results

Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent.

Conclusion

The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10–15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.

Keywords

Head And Neck CancerReferralGuidelineRisk FactorsMouthPharynxLarynxThyroidEarNoseSmokingAlcohol ConsumptionHuman Papilloma VirusRadiation
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 8 , August 2019 , pp. 704 - 712
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr S Freeman takes responsibility for the integrity of the content of the paper

References

1Cancer Research UK. Head and neck cancers incidence statistics. In: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/oral-cancer/incidence#heading-Two [13 December 2018]Google Scholar
2Department of Health and Social Care. The New NHS. In: https://www.gov.uk/government/publications/the-new-nhs [13 December 2018]Google Scholar
3Langton, S, Siau, D, Bankhead, C. Two-week rule in head and neck cancer 2000-14: a systematic review. Br J Oral Maxillofac Surg 2016;54:120–31Google Scholar
4McKie, C, Ahmad, UA, Fellows, S, Meikle, D, Stafford, FW, Thomson, PJ et al. The 2-week rule for suspected head and neck cancer in the United Kingdom: referral patterns, diagnostic efficacy of the guidelines and compliance. Oral Oncol 2008;44:851–6Google Scholar
5Lyons, M, Philpott, J, Hore, I, Watters, G. Audit of referrals for head and neck cancer – the effect of the 2-week, fast track referral system. Clin Otolaryngol Allied Sci 2004;29:143–5Google Scholar
6Hobson, JC, Malla, JV, Sinha, J, Kay, NJ, Ramamurthy, L. Outcomes for patients referred urgently with suspected head and neck cancer. J Laryngol Otol 2008;122:1241–4Google Scholar
7National Institute for Health and Care Excellence Guideline. National Collaborating Centre for Cancer. Suspected cancer: recognition and referral. In: https://www.nice.org.uk/guidance/ng12/evidence/full-guideline-pdf-2676000277 [13 December 2018]Google Scholar
8Tikka, T, Pracy, P, Paleri, V. Refining the head and neck cancer referral guidelines: a two-centre analysis of 4715 referrals. Clin Otolaryngol 2016;41:66–75Google Scholar
9Smith, E, Rottscholl, R, Brosch, S, Reiter, R. Malignant lymphoma in the larynx [in German]. Laryngorhinootologie 2013;92:381–8Google Scholar
10Rimmer, J, Watson, J, O'Flynn, P, Vaz, F. A head and neck “two-week wait” clinic: cancer referrals or the worried well? Ann R Coll Surg Engl (Suppl) 2012;94:1–4Google Scholar
11Shaw, R, Beasley, N. Aetiology and risk factors for head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130:S9–12Google Scholar
12Hamdan, A, Mitchell, P. The two-week wait guideline for suspected CNS tumours: a decade analysis. Br J Neurosurg 2013;27:642–5Google Scholar
13Hawary, AM, Warburton, HE, Brough, RJ, Collins, GN, Brown, SC, O'Reilly, PH et al. The ‘2-week wait’ rule for referrals for suspected urological cancers--urgent need for refinement of criteria. Ann R Coll Surg Engl 2008;90:517–22Google Scholar
14Heck, JE, Berthiller, J, Vaccarella, S, Winn, DM, Smith, EM, Shan'gina, O et al. Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Int J Epidemiol 2010;39:166–81Google Scholar
15Pracy, P, Prichard, LS, Whitehead, IJ, Moorthy, R. The 2-week wait head & neck cancer referrals: is this system working? The Otorhinolaryngologist 2013;6:182–6Google Scholar
16Gardner, S, Wijesekara, J. ENT 2-week wait audit. Br J Gen Pract 2009;59:779–80Google Scholar
17Dolan, RW, Vaughan, CW, Fuleihan, N. Symptoms in early head and neck cancer: an inadequate indicator. Otolaryngol Head Neck Surg 1998;119:463–7Google Scholar
18Hong, B, Shaikh, Z, Adcock, S, Aldallal, SN. Two-week wait false alarms? A prospective investigation of 2WW head and neck cancer referrals. Br Dent J 2016;220:521–6Google Scholar
19National Institute for Health and Care Excellence Clinical Knowledge Summaries. Lung and pleural cancers - recognition and referral. In: https://cks.nice.org.uk/lung-and-pleural-cancers-recognition-and-referral#!scenario [28 November 2018]Google Scholar
20Parasher, AK, Abramowitz, M, Weed, D, Franzmann, E, Goodwin, J, Hu, J et al. Ethnicity and clinical outcomes in head and neck cancer: an analysis of the SEER database. J Racial Ethn Health Disparities 2014;1:267–74Google Scholar
21Sethi, RV, Sethi, RK, Herr, MW, Deschler, DG. Malignant head and neck paragangliomas: treatment efficacy and prognostic indicators. Am J Otolaryngol 2013;34:431–8Google Scholar
22Lau, K, Wilkinson, J, Moorthy, R. A web-based prediction score for head and neck cancer referrals. Clin Otolaryngol 2018;43:1043–9Google Scholar
23Wong, BYW, Fischer, S, Cruickshank, HE. Clinical outcome of head and neck cancer patients: a comparison between ENT patients referred via the 2 weeks wait pathway and alternative routes in the UK health system. Eur Arch Otorhinolaryngol 2017;274:415–20Google Scholar
Supplementary material: File

Gao et al. supplementary material

Tables S1-S3

Download Gao et al. supplementary material(File)
File 210.4 KB