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.