A "package solution" fast track program can reduce the diagnostic waiting time in head and neck cancer

In 2007, a fast track program for patients with suspicion of head and neck cancer (HNC) was introduced in Denmark to reduce unnecessary waiting time. The program was based on so called "package solutions" including pre-booked slots for outpatient evaluation, imaging, and diagnostic surgical procedures. The purpose of this study is to present a model for fast track handling of patients suspicious of cancer in the head and neck region and to evaluate the effect of implementation on the diagnostic work up time. Patients with suspicion of HNC referred to the same university department of ENT Head and Neck Surgery during three comparable time intervals 2006-2007, 2007-2008, and 2011-2012 (groups 1-3) were investigated. We recorded the time from patient referral, to first consultation and final diagnosis. The first interval was before initiation of the "package solution", the second just after the introduction, and the third interval represents the current situation. The median time from referral to first consultation was reduced from eight calendar days in group 1 to only one day in groups 2 and 3 (p < 0.001). The combined median time from referral to the final cancer diagnosis decreased from 24 calendar days in group 1 to 7 and 10 days in groups 2 and 3, respectively (p < 0.005). The hit rate of finding malignancy was 41% in group 1, 49% in group 2, and 43% in group 3 with no difference among the groups (p = 0.13). The frequency of newly diagnosed HNC was 19% in group 1, 21% in group 2, and 17% in group 3 (p = 0.52). A "package solution" including pre-booked slots for diagnostic procedures is feasible and can significantly reduce the waiting time for patients with suspicion of HNC.