Skip to main content Accessibility help

‘Urgent suspicion of cancer’ referrals to a head and neck clinic – what do patients expect?

  • J Montgomery (a1), C M Douglas (a1), F Begbie (a1), A Hitchings (a1) and K MacKenzie (a2)...



Public awareness of ‘red flag’ symptoms for head and neck cancer is low. There is a lack of evidence regarding patient concerns and expectations in consultations for cancer assessment.


This prospective questionnaire study examined the symptoms, concerns and expectations of 250 consecutive patients attending an ‘urgent suspicion of cancer’ clinic at a tertiary referral centre.


The patients’ most frequent responses regarding their concerns were ‘no concerns’ (n = 72, 29 per cent); ‘all symptoms’ were a cause for concern (n = 65, 26 per cent) and ‘neck lump’ was a symptom causing concern (n = 37, 17 per cent). The expectations of patients attending clinic were that they would find out what was wrong with them, followed by having no expectations at all. Overall patient knowledge of red flag symptoms was lacking and their expectations were low.


Patients with non-cancer symptoms are frequently referred with suspected cancer. Patients with red flag symptoms are not aware of their significance and they have low expectations of healthcare.


Corresponding author

Author for correspondence: Ms J Montgomery, Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, Scotland, UK E-mail:


Hide All

Ms J Montgomery takes responsibility for the integrity of the content of the paper



Hide All
1National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. In: [26 June 2019]
2Scottish Referral Guidelines for Suspected Cancer. 2014. In: [26 June 2019]
3Mathew, A, Desai, KM. An audit of urology two-week wait referrals in a large teaching hospital in England. Ann R Coll Surg Engl 2009;91:310–12
4Hamilton, W, Sharp, D. Diagnosis of colorectal cancer in primary care: the evidence base for guidelines. Fam Pract 2004;21:99106
5Luryi, AL, Yarbrough, WG, Niccolai, LM, Roser, S, Reed, SG, Nathan, CA et al. Public awareness of head and neck cancers: a cross-sectional survey. JAMA Otolaryngol Head Neck Surg 2014;140:639–46
6Megwalu, UC. Health literacy in patients with head and neck cancer: an understudied issue. JAMA Otolaryngol Head Neck Surg 2017;143:645–6
7Beitler, JJ, Chen, AY, Jacobson, K, Owens, A, Edwards, M, Johnstone, PA. Health literacy and health care in an inner-city, total laryngectomy population. Am J Otolaryngol 2010;31:2931
8Fingland, P, Carswell, V, Tikka, T, Douglas, CM, Montgomery, J. The value of chest X-ray in the Scottish Referral Guidelines for suspected head and neck cancer in 2144 patients. J Laryngol Otol 2018;132:434–8
9Crosbie, R, McKendrick, M, Corson, S, Lowit, A, MacKenzie, K. Patient expectation of a voice clinic consultation: development of the ACaPELa questionnaire by assessment of four hundred and fifty-five patients. Clin Otolaryngol 2017;42:185–8
10Morris, NS, Field, TS, Wagner, JL, Cutrona, SL, Roblin, DW, Gaglio, B et al. The association between health literacy and cancer-related attitudes, behaviors, and knowledge. J Health Commun 2013;18(suppl 1):223–41
11HRA Decision Tool. In: [26 June 2019]
12Zeitler, M, Fingland, P, Tikka, T, Douglas, CM, Montgomery, J. Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow. Clin Otolaryngol 2018;43:861–7
13van Deudekom, FJ, Schimberg, AS, Kallenberg, MH, Slingerland, M, van der Velden, LA, Mooijaart, SP. Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review. Oral Oncol 2017;64:2736
14Olsen, MH, Boje, CR, Kjaer, TK, Steding-Jessen, M, Johansen, C, Overgaard, J et al. Socioeconomic position and stage at diagnosis of head and neck cancer - a nationwide study from DAHANCA. Acta Oncol 2015;54:759–66
15Conway, DI, McMahon, AD, Smith, K, Black, R, Robertson, G, Devine, J et al. Components of socioeconomic risk associated with head and neck cancer: a population-based case-control study in Scotland. Br J Oral Maxillofac Surg 2010;48:1117
16Douglas, CM, Carswell, V, Montgomery, J. Outcomes of urgent suspicion of head and neck cancer referrals in Glasgow. Ann R Coll Surg Engl 2019;101:103–6
17Moreno, CC, Jarrett, T, Vey, BL, Mittal, PK, Krupinski, EA, Roberts, DL. Patient knowledge regarding colorectal cancer risk, opinion of screening, and preferences for a screening test. Curr Probl Diagn Radiol 2019;48:50–2
18Macleod, U, Mitchell, ED, Burgess, C, Macdonald, S, Ramirez, AJ. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer 2009;101(suppl 2):S92101
19Varela-Centelles, P, Ledesma-Ludi, Y, Seoane-Romero, JM, Seoane, J. Information about oral cancer on the Internet: our patients cannot understand it. Br J Oral Maxillofac Surg 2015;53:393–5
20Protheroe, J, Whittle, R, Bartlam, B, Estacio, EV, Clark, L, Kurth, J. Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health Expect 2017;20:112–19
21Stewart, DW, Adams, CE, Cano, MA, Correa-Fernandez, V, Li, Y, Waters, AJ et al. Associations between health literacy and established predictors of smoking cessation. Am J Public Health 2013;103:e439
22Deary, IJ, Wilson, JA. Problems in treating globus pharyngis. Clin Otolaryngol Allied Sci 1994;19:5560
23Berhane, A, Enquselassie, F. Patient expectations and their satisfaction in the context of public hospitals. Patient Prefer Adherence 2016;10:1919–28
24McCaffery, KJ, Smith, SK, Wolf, M. The challenge of shared decision making among patients with lower literacy: a framework for research and development. Med Decis Making 2010;30:3544
25Kim, SP, Knight, SJ, Tomori, C, Colella, KM, Schoor, RA, Shih, L et al. Health literacy and shared decision making for prostate cancer patients with low socioeconomic status. Cancer Invest 2001;19:684–91
26Lyons, 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;29:143–5
27Langton, S, Siau, D, Bankhead, C. Two-week rule in head and neck cancer 2000–14: a systematic review. Br J Oral Maxillofac Surg 2016;54:120–31


‘Urgent suspicion of cancer’ referrals to a head and neck clinic – what do patients expect?

  • J Montgomery (a1), C M Douglas (a1), F Begbie (a1), A Hitchings (a1) and K MacKenzie (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed