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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.

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