Rethinking the ‘one-stop’ neck lump clinic during COVID-19 and beyond: A
novel pathway and pilot study
Abstract
AIM Current guidelines advocate ‘one-stop’ neck lump assessment for
cancer referrals. We pilot a novel pre-clinic ultrasound pathway,
present the outcomes and discuss strengths and limitations especially in
view of the current COVID-19 pandemic. METHODS Patients referred by the
GP on a two-week-wait cancer pathway with a ‘neck lump’ were allocated
pre-clinic ultrasound scans followed by an ENT clinic appointment.
Demographics, patient journey details and outcomes were collected and
analysed. RESULTS 99 patients underwent pre-clinic ultrasound assessment
by a specialist consultant radiologist an average of 8.02 days after
referral with 30 (30.3%) also undergoing biopsy. Patients were
followed-up 14.1 days (range 2 – 26 days) after initial referral. In
92.9% of patients, a positive impact was achieved; at the first clinic
appointment 45 patients were discharged (45.5%), ten were listed for
surgery (10.1%), a cancer diagnosis was made in a further 12 patients
(12.1%), 6 patients (6.1%) were referred onwards to another speciality
and 19 patients (19.2%) were taken off the cancer pathway and followed
up routinely. In four patients, it was retrospectively felt that
ultrasound was not indicated as the referral did not accurately reflect
the patient’s presenting complaint or examination findings. Repeat
ultrasound was inadvertently requested for one patient. Two patients
were reviewed prior to biopsy results being available leading to an
additional appointment being required. CONCLUSION Pre-clinic ultrasound
scanning is an alternative to the current ‘one-stop’ neck lump pathway.
Our results demonstrate a reduction in clinic visits, quicker diagnosis
and low proportion of unnecessary scans. Our proposed pathway requires
minimal service restructuring and has added potential cost savings. We
have found it to be effective during the COVID-19 pandemic in minimising
the face-to-face consultations and the number of aerosol generating
procedures (AGPs). Further refinement is needed to streamline and make
the process more robust. A larger study with direct comparison to the
‘one-stop’ clinic is required to assess further strengths and
limitations.