The 2-Week Wait Head & Neck Cancer Referrals: Is this System Working?

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Abstract

Introduction: The UK uses primary care physicians as “gatekeepers” to specialist services. In 2000 a referral pathway was implemented for patients with suspected Head & Neck cancer ensuring assessment by a specialist within 2-weeks of referral. Our aim was to assess the cancer detection rate for 2-week wait referrals and determine whether a one-stop clinic would be an appropriate use of resources in a 2-week wait referral clinic. Materials and Methods: A retrospective audit of all 2-week referrals from July 2009 to July 2010.

 

Results: Total 2-week-wait referrals = 622. Confirmed malignancy = 35. 181 patients underwent imaging, of which 76 had an ultrasound, 40 of these were ultrasound guided Fine Needle Aspiration Cytology.

Conclusion: The limited need for FNAC and ultrasound scans suggests that there is unlikely to be any significant benefit in implementing a one-stop clinic. A specific suspected cancer referral pathway in our unit has not resulted in a dramatic improvement in cancer diagnosis rates.

Additional Info

  • Authors: LS Prichard, IJ Whitehead & R Moorthy, P Pracy
  • Keywords: Head and Neck cancer, Referral and consultation, Outpatient clinic.
Read 13430 times Last modified on Friday, 20 December 2013 14:28

2 comments

  • Comment Link Wednesday, 08 January 2014 13:39 posted by Costa Repanos

    A useful study that highlights how non-specific the original 2 week wait criteria are. 18 patients seen for every cancer found (i.e 5.6%) is lower than most of the other 2 week wait target specialities and interestingly has fallen from around 10% when the 2 week wait system was first introduced. Is this abuse of the system or GPs responding appropriately to increased demand and reasonable patient concern and expectation? It's not possible to say definitively, but we know it hasn't had a demonstrable effect on survival in head and neck cancer since 2000. As a UK profession we need to look at this and seriously think about how these 2 week wait forms are worded and how we can improve the system.

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  • Comment Link Tuesday, 07 January 2014 18:44 posted by Kim Ah-See

    Excellent review of how poorly the current H&N Cancer Guidelines function, overloading the expensive H&N MDT service.
    The data will be very helpful for future guideline development and I would really like to see data on the positive predictive values of all the H&N symptoms so we could triage patients accordingly. While I agree that GP education may help I fear that a defensive climate within which we work will trump any efforts to improve awareness

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