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.