Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-23T03:37:41.676Z Has data issue: false hasContentIssue false
  • English
  • Français

Two-week-wait referrals in otolaryngology in a tertiary centre: cross-sectional study of benign outcomes, with a systematic review

Published online by Cambridge University Press:  03 November 2021

B Mettias Open the ORCID record for B Mettias [Opens in a new window] ,
A Charlton  and
S Ashokkumar
B Mettias*
Affiliation:
ENT Department, University Hospitals of Leicester NHS Trust, Leicester, UK
A Charlton
Affiliation:
ENT Department, University Hospitals of Leicester NHS Trust, Leicester, UK
S Ashokkumar
Affiliation:
ENT Department, University Hospitals of Leicester NHS Trust, Leicester, UK
*
Author for correspondence: Dr Bassem Mettias, ENT Department, Royal Derby Hospital, Uttoxeter Road, DerbyDE22 3NE, UK E-mail: bassemadel@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The two-week-wait referral is designed to improve early detection in cancer patients. This retrospective study analysed those ENT two-week-wait referrals to out-patient clinics in a tertiary head and neck oncology centre, from January to June 2018, which were not compliant with National Institute for Health and Care Excellence guidelines (2015 update).

Methods

Referral symptoms were statistically analysed against National Institute for Health and Care Excellence guidelines, with detailed analysis of reasons for non-compliance. In addition, a systematic review of similar previously published articles was conducted.

Results

There were 1107 patients referred through the two-week-wait pathway. Of these referrals, 52 per cent were compliant with National Institute for Health and Care Excellence 2015 guidelines. Six errors were identified for non-compliant referrals, most commonly inconsistencies in referral (e.g. globus sensation) and intermittent disease course (e.g. intermittent hoarseness). Of all patients referred, 93 per cent were diagnosed with benign conditions, with laryngopharyngeal reflux being the commonest. Twenty-two per cent of referred patients were discharged after the first visit.

Conclusion

Two-week-wait referral is inappropriately overused. There are many non-compliant referrals, and most of the outcomes are benign.

Keywords

Head And Neck CancerBenignGuideline
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 11 , November 2022 , pp. 1051 - 1055
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr B Mettias takes responsibility for the integrity of the content of the paper

Presented at the Midland Institute of Otorhinolaryngology Winter Meeting, 18 January 2019, Nottingham, UK, and at the British Association of Otorhinolaryngology (‘BACO’) International Meeting, 10–12 January 2021 (virtual conference).

References

NICE. Head and neck cancers - recognition and referral. In: https://cks.nice.org.uk/head-and-neck-cancers-recognition-and-referral#!scenario [30 June 2022]Google Scholar
McKie, C, Ahmad, UA, Fellows, S, Meikle, D, Stafford, FW, Thomson, PJ et al. The 2-week rule for suspected head and neck cancer in the United Kingdom: referral patterns, diagnostic efficacy of the guidelines and compliance. Oral Oncol 2008;44:851–6CrossRefGoogle ScholarPubMed
Hobson, JC, Malla, JV, Sinha, J, Kay, NJ, Ramamurthy, L. Outcomes for patients referred urgently with suspected head and neck cancer. J Laryngol Otol 2008;122:1241–4CrossRefGoogle ScholarPubMed
Tikka, T, Pracy, P, Paleri, V. Refining the head and neck cancer referral guidelines: a two-centre analysis of 4715 referrals. Clin Otolaryngol 2016;41:66–75CrossRefGoogle ScholarPubMed
Douglas, CM, Carswell, V, Montgomery, J. Outcomes of urgent suspicion of head and neck cancer referrals in Glasgow. Ann R Coll Surg Engl 2019;101:103–6CrossRefGoogle ScholarPubMed
Prichard, LS, Whitehead, IJ, Moorthy, R, Pracy, P. The 2-week wait head & neck cancer referrals: is this system working? The Otorhinolaryngologist 2013;6:182–6Google Scholar
Gardner, S, Wijesekara, J. ENT 2-week wait audit. Br J Gen Pract 2009;59:779–80CrossRefGoogle ScholarPubMed
Duvvi, SK, Thomas, L, Vijayanand, S, Reddy, KT. Two-week rule for suspected head and neck cancer. A study of compliance and effectiveness. J Eval Clin Pract 2006;12:591–4CrossRefGoogle ScholarPubMed
Allam, A, Nijim, H. Persistent unilateral sore throat: should it be included in the 2-week wait referral criteria by NICE. Int J Otolaryngol 2019;5:4920514Google Scholar
Lyons, M, Philpott, J, Hore, I, Watters, G. Audit of referrals for head and neck cancer - the effect of the 2-week, fast track referral system. Clin Otolaryngol Allied Sci 2004;29:143–5CrossRefGoogle ScholarPubMed
Tikka, T, Kavanagh, K, Lowit, A, Jiafeng, P, Burns, H, Nixon, IJ et al. Head and neck cancer risk calculator (HaNC-RC)—V.2. Adjustments and addition of symptoms and social history factors. Clin Otolaryngol 2020;45:380–8CrossRefGoogle ScholarPubMed