Introduction
The coronavirus disease 2019 (Covid-19) pandemic presented an
unprecedented challenge to the global medical community. Various
strategies were implemented to limit disease transmission and to
preserve resources for pandemic response. In March 2020, a
recommendation was issued by NHS England to adapt telephone triage for
the urgent suspected cancer two-week-wait pathway.1This was proposed in order to maintain sufficient levels of patient care
whilst minimising in-person hospital attendances. As an adjunct, ENTUK
– the official membership body of British Otolaryngologists, had also
advised the use of the Head and Neck Cancer Risk Calculator (HaNC-RCv2),
a validated risk scoring system for head and neck cancer (HNC) based on
patient demographics and symptomatology, to assist with the remote
assessment process.2
The current HNC two-week-wait pathway was introduced in 2005 by the
National Institute for Health and Care Excellence (NICE) in the
UK.3 On this pathway, general practitioners can refer
patients with suspected HNC for fast-tracked specialist appointments.
These appointments typically consist of physical examinations including
flexible nasal endoscopy (FNE). Early in the pandemic FNE was classed as
an aerosol generating procedure and as such examination in this manner
was only targeted for those where it was deemed to alter management. The
absence of physical examination of patients clearly raises concerns that
telephone clinics would not be as robust in detecting HNC compared to
traditional face-to-face clinics.