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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: samuel.freeman@nhs.net
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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 

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Footnotes

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

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