A safe management pathway for low-risk head and neck cancer suspected referrals
Reviewed by Madhup K Chaurasia

Head and neck cancer is the eighth most common malignancy and numbers are increasing. This has led to increasing number of suspected cancer referrals which, with imposition of the 28-day Faster Diagnosis Standard implemented in 2020, has further burdened the capacity of the NHS. Interestingly, 95% of patients referred do not have cancer. In order to cope with voluminous referrals for suspected head and neck cancer and very low uptake of actual malignancy, the authors have devised a nurse-led telescopic clinic. Based on the head and neck cancer risk calculator (2020) those patients triaged as ‘low risk’ go to this clinic. The attending patients undergo repeat face-to-face risk stratification along with oral examination and flexible endoscopy. Videos are stored and reviewed asynchronously by a consultant. These clinics also see patients with negative prior imaging. However, patients considered to be ‘high risk’ and those with potentially sinister features noted in prior imaging are seen directly by a consultant. There were 660 patients in the low-risk group, 543 of which were seen directly and 117 after prior scanning. The images taken in the nurse-led clinics and then sent to consultants were deemed adequate for 98.9% of cases. The remaining required further examination but none of these had cancer. There was no significant statistical difference in the Faster Diagnosis Standard between patients undergoing prior imaging or seen in community or hospital clinics. Twenty-one patients (3.2%) were re-referred from the nurse-led clinic but none of these had any malignancy. Only one patient remained undiagnosed but this turned out to be oesophageal and not head and neck cancer. The authors therefore consider this telescopic pathway safe for patients referred with suspected cancer. Mention has been made of EVEREST-HN programme already underway and use of AI. These may considerably enhance the triage system which is very much required in the present scenario.

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.
Metcalfe C, Oh S, Glazzard N, et al.
J LARYNGOL OTOL
2024;138(6);667–71.