Abstract
Objectives: We aimed to audit current United Kingdom (UK) practice of Head and Neck Cancer (HNC) post-treatment surveillance against national guidelines and determine the outcomes of these practices in detecting recurrence. Design: National cross-sectional study of current HNC surveillance practice. Setting: UK HNC outpatient departments. Participants: HNC patients reviewed for post-treatment surveillance. Main outcome measures: Compliance with UK multidisciplinary guidelines and rates of cancer recurrence detection by time, clinic type and symptoms. Results: Data were analysed from 5,123 consultations across 89 UK centres. 30% of consultations were in dedicated multidisciplinary clinics, with input from allied health professionals (AHPs) available on the day in 23% of all consultations. Recurrence was suspected in 344 consultations and investigated with MRI in 29.6% (n = 102) and PET-CT in 14.2% (n = 49). Patient education regarding recurrence symptoms, and smoking and alcohol advice, was provided in 20.4%, 6.2% and 5.3% of cases, respectively. Rates of recurrence detected were 35% in expedited appointments and 5.2% in planned follow-ups (P =.0001). Of the expedited appointments, 63% were initiated by patients and 37% by clinicians. Recurrence was higher in those with new symptoms (7.1% versus 2.2%). The strongest predictors of recurrence were dyspnoea (positive predictive value (PPV)=16.2%), neck pain (PPV = 10.4%) and mouth/throat pain (PPV = 9.2%). Conclusions: Dedicated multidisciplinary clinics comprise a minority of consultations for HNC surveillance in the UK, with low availability of AHPs. PET-CT and MRI were underutilised for the investigation of suspected recurrence. There may be scope for greater emphasis on patient education and consequent patient-initiated symptom-driven follow-up.
Original language | English |
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Journal | Clinical Otolaryngology |
DOIs | |
Publication status | Accepted/In press - 2020 |
Bibliographical note
Funding Information:This national audit was supported by the British Association of Head & Neck Oncologists (BAHNO). BAHNO had no influence over content.
Publisher Copyright:
© 2020 John Wiley & Sons Ltd
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
Keywords
- audit
- cancer
- guidelines
- head and neck
- recurrence
- surveillance
- treatment
ASJC Scopus subject areas
- Otorhinolaryngology