Results
In the seven months study period, a total 1062 patients were referred on
the HNC two-week-wait pathway. The mean age was 58.9 (range 16-98). All
1062 patients received an initial telephone consultation and were able
to be identified at six months follow up.
Ninety-eight (9.2%) patients received a new diagnosis of malignancy.
The most common types of malignancy seen in the study cohort were cancer
of the oral cavity (n=29), followed by lymphoma (n=18), larynx (n=10)
and thyroid (n=8) (Figure 1). Ninety-five patients received positive
cancer diagnosis following the first telephone appointment, of which 69
patients had a diagnosis made primarily on imaging ordered following
this appointment and 26 patients at a subsequent face-to-face
appointment.
Three patients, all of whom scored low risk on HaNC-RCv2 were offered
non-urgent follow up after their initial phone clinics, but were
subsequently diagnosed with cancer. This yields a late diagnosis rate of
0.28%. The three cases received deferred telephone appointment at
4-weeks, 6-weeks, and 3-months respectively (Figure 2).
The three cases with a late diagnosis were: a 62F diagnosed with lung
adenocarcinoma who presented with a hoarse voice, an 83F diagnosed with
laryngeal squamous cell carcinoma who also presented with a hoarse
voice, and a 60M diagnosed with non-Hodgkin’s lymphoma of the base of
tongue who presented with feeling of something stuck in throat. (Table
1)
In terms of HaNC-RCv2 of the study cohort, 80% (n=78) were classed as
high risk and 20% (n=20) were classed as low risk.1In particular, all three cases with late diagnoses were classed as low
risk in the study.