1599 Review of Telephone Consultations for Suspected Head and Neck Cancer Referrals During The COVID-19 Pandemic

Abstract Introduction Pandemic COVID-19 necessitated a transformation in the delivery of healthcare. Telephone consultations were introduced to protect and progressively manage patients with minimal delay. This is a review of the effectiveness of these remote consultations for suspected 2-week wait (2ww) head and neck cancer referrals to a north London NHS teaching hospital Oral and Maxillofacial unit during the first official UK government lockdown from March - July 2020. Method Prospective electronic records of 176 consecutive 2ww referrals between March – July 2020 was assessed. Data analysed included initial telephone consultations, subsequent face-to-face (F2F) appointments, if required, the interval from telephone to F2F appointments and histopathological diagnoses. Results 157 patients (n = 176) received an initial telephone call, of which 127 (80.9%) required a F2F consultation. The number of days between the initial telephone consultation and subsequent F2F assessment ranged from 0 to 141, with a mean of 11 and a median of 1. Notably, 31 patients (24.4%) were seen in person on the same day as their telephone consultation. Biopsies were indicated for 69 patients (54.3%) of which 9 (13.0%) were diagnosed as malignancies. Conclusions Whilst protecting patients from a pandemic is utmost, continuing care for non-pandemic conditions must be considered. It is even more important to manage 2ww referrals efficiently. These results indicate the majority of suspected cancer referrals warrant F2F assessment for a confident outcome. Despite reinstated, ongoing social restrictions, 2ww referrals are now being seen exclusively F2F, subject to patient choice. This information is useful for planning and strategizing services in a head and neck OMFS unit.

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A pilot “Telephone-and-Test” (Modified Straight-to-Test) for ENT two-week wait referrals

10.22541/au.161271322.25634280/v1 ◽

2021 ◽

Author(s):

Billy Wong ◽

Maria Kiakou ◽

Leon Fletcher ◽

Madhup Chaurasia ◽

Mark Puvanendran

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Differentiated Thyroid Carcinoma ◽

Lymphoproliferative Disease ◽

Test Model ◽

Radiological Investigation ◽

Telephone Consultation ◽

Pilot Model ◽

Observational Cohort

Objective To assess the efficacy and outcome of a pilot model in triaging urgent suspected head and neck cancer referrals during the Covid-19 pandemic. Design Prospective observational cohort study Setting Regional Head and Neck Cancer hub, United Kingdom. Participants 84 patients who were referred via the 2 week wait pathway and streamed directly for imaging investigations after initial telephone consultation. Main outcome measures The malignancy detection rate using the telephone-and-test model Results 495 2-week wait referrals were received during the study period. 104 patients were discharged following their initial telephone consultation. 84 (17%) patients were streamed directly for imaging investigations following their telephone consultation. Malignancy was identified in 11.9% of patients which included squamous cell carcinoma, differentiated thyroid carcinoma and lymphoproliferative disease. 51% of patients had other benign pathologies such as benign salivary gland tumour, benign thyroid disease and physiological lymphadenopathy. Following their radiological investigation, 48.8% of patients were discharged without any need for further consultations. Conclusions The telephone-and-test approach is an effective and efficient model for triaging head and neck two-week wait referrals, which could be applicable outside the pandemic times.

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Telephone consultation for two-week-wait ENT and head and neck cancer referrals: initial evaluation including patient satisfaction

The Journal of Laryngology & Otology ◽

10.1017/s0022215121003157 ◽

2021 ◽

pp. 1-16

Author(s):

A Rovira ◽

S Brar ◽

T Munroe-Gray ◽

E Ofo ◽

C Rodriguez ◽

...

Keyword(s):

Head And Neck Cancer ◽

Patient Satisfaction ◽

Head And Neck ◽

Neck Cancer ◽

Initial Evaluation ◽

Telephone Consultation

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Informing patient choice and service planning in surgical voice restoration: valve usage over three years in a UK head and neck cancer unit

The Journal of Laryngology & Otology ◽

10.1017/s0022215121004060 ◽

2021 ◽

pp. 1-22

Author(s):

K McLachlan ◽

A Hurren ◽

S Owen ◽

N Miller

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Service Planning ◽

Patient Choice ◽

Voice Restoration

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Satisfaction with telemedicine presentation at a multidisciplinary tumour meeting among patients with head and neck cancer

Journal of Telemedicine and Telecare ◽

10.1258/135763303767149951 ◽

2003 ◽

Vol 9 (3) ◽

pp. 150-155 ◽

Cited By ~ 15

Author(s):

Joacim Stalfors ◽

Lotta Holm-Sjögren ◽

Åsa Schwieler ◽

Helene Törnqvist ◽

Thomas Westin

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

District Hospital ◽

Regional Hospital ◽

Control Group ◽

Local Hospital ◽

Face To Face ◽

District Hospitals ◽

Familiar Environment

Patients with head and neck cancer in the western part of Sweden are presented at a multidisciplinary tumour (MDT) meeting held once a week at the regional hospital in Göteborg. During a 13-month study period, 58 patients were presented via telemedicine; 45 of these patients (78%) answered a questionnaire. A face-to-face control group (the FTF group, n = 46) comprised patients from district hospitals not using telemedicine. These patients travelled to Göteborg for the MDT meeting; 39 of them (85%) answered the questionnaire. All patients were satisfied with the MDT meeting. Answers to two of the 10 questionnaire items differed significantly between the groups: the FTF group agreed that 'It felt as if everybody was talking about me, but not to me' more than did the telemedicine group, while the telemedicine group gave higher ratings for the item 'It felt good to have my doctor [the physician from the local hospital] by my side' than did the FTF group. Telemedicine was not experienced as a barrier and the patients expressed their confidence in taking part in these meetings in a familiar environment such as the local district hospital with their local otolaryngologist.

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Hypopharyngeal cancer: United Kingdom National Multidisciplinary Guidelines

The Journal of Laryngology & Otology ◽

10.1017/s0022215116000529 ◽

2016 ◽

Vol 130 (S2) ◽

pp. S104-S110 ◽

Cited By ~ 19

Author(s):

P Pracy ◽

S Loughran ◽

J Good ◽

S Parmar ◽

R Goranova

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Hypopharyngeal Cancer ◽

Patient Choice ◽

Emission Tomography ◽

Positron Emission ◽

The Uk

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With an age standardised incidence rate of 0.63 per 100 000 population, hypopharynx cancers account for a small proportion of the head and neck cancer workload in the UK, and thus suffer from the lack of high level evidence. This paper discusses the evidence base pertaining to the management of hypopharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care.Recommendations• Cross-sectional imaging with computed tomography of the head, neck and chest is necessary for all patients; magnetic resonance imaging of the primary site is useful particularly in advanced disease; and computed tomography and positron emission tomography to look for distant disease. (R)• Careful evaluation of the upper and lower extents of the disease is necessary, which may require contrast swallow or computed tomography and positron emission tomography imaging. (R)• Formal rigid endoscopic assessment under general anaesthetic should be performed. (R)• Nutritional status should be proactively managed. (R)• Full and unbiased discussion of treatment options should take place to allow informed patient choice. (G)• Early stage disease can be treated equally effectively with surgery or radiotherapy. (R)• Endoscopic resection can be considered for early well localised lesions. (R)• Bulky advanced tumours require circumferential or non-circumferential resection with wide margins to account for submucosal spread. (R)• Offer primary surgical treatment in the setting of a compromised larynx or significant dysphagia. (R)• Midline lesions require bilateral neck dissections. (R)• Consider management of silent nodal areas usually not addressed for other primary sites. (G)• Reconstruction needs to be individualised to the patients’ needs and based on the experience of the unit with different reconstructive techniques. (G)• Consider tumour bulk reduction with induction chemotherapy prior to definitive radiotherapy. (R)• Consider intensity modulated radiation therapy where possible to limit the consequences of wide field irradiation to a large volume. (R)• Use concomitant chemotherapy in patients who are fit enough and consider epidermal growth factor receptor blockers for those who are less fit. (R)

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977 The Role of Telephone Triage in Head and Neck Cancer Care in a Teaching Hospital

British Journal of Surgery ◽

10.1093/bjs/znab259.487 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

T Turner ◽

J Daniels ◽

A Belloso

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Teaching Hospital ◽

Neck Cancer ◽

Day Treatment ◽

Diagnosis And Treatment ◽

Electronic Patient Records ◽

Telephone Triage ◽

Treatment Standards ◽

Face To Face

Abstract Introduction NHS England sets standards to ensure prompt specialist review, diagnosis, and treatment of cancer. Patients with suspected cancer should receive specialist review within 14 days of referral, diagnosis by day 28 and first treatment by day 62. To reduce transmission during the SARS-CoV-2 pandemic, the NHS recommended telephone triage as the first specialist appointment. The effect of telephone triage on head and neck cancer timeframes in an NHS teaching hospital was assessed. Method Four head and neck cancer telephone triage clinics during July 2020 were selected at random. Clinical correspondence and the electronic patient records were reviewed for each patient and cancer pathway timeframes were analysed. Results 31 patients were referred for telephone triage and 100% received specialist review within 14 days. Subsequently 17 (55%) patients were investigated, 12 (71%) of which received a diagnosis within 28 days. 4 patients received a cancer diagnosis, but none received first treatment within 62 days. 24 (77%) patients were seen in a face-to-face clinic after telephone triage on average 7 days after telephone triage. Conclusions In this sample, telephone triage allowed safe initial specialist review by meeting the 14-day standard. However, the 28-day diagnosis and 62-day treatment standards were not adhered to. Telephone triage does not largely reduce overall patient contact, with 77% of patients subsequently reviewed in a patient-facing setting. The addition of telephone triage delayed first clinical examination by a specialist by an average of 7 days, which may be a contributing factor to the delays seen in diagnosis and treatment.

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