Two week wait referral criteria - heading in the right direction?

Area of Science:

• Otolaryngology
• Oncology
• Public Health

Background:

• National Institute for Health and Care Excellence (NICE) updated urgent referral guidelines in 2015.
• New guidelines incorporated additional symptoms with a 3% positive predictive value threshold.
• The effectiveness of these updated guidelines for head and neck cancer referrals was questioned.

Purpose of the Study:

• To evaluate the efficiency and accuracy of current pan-London urgent referral guidelines for suspected head and neck cancer.
• To assess the frequency of presenting symptoms and risk factors in referrals.
• To examine the correlation between symptoms/risk factors and positive cancer diagnoses.

Main Methods:

• Retrospective analysis of 984 consecutive patient referral letters over six months in 2016.
• Data collected from University College London Hospital for suspected head and neck cancer referrals.
• Inclusion of patient symptoms and risk factors.

Main Results:

• Only 3.76% (37 out of 984) of referrals led to a head and neck cancer diagnosis.
• Four of the 23 recommended symptoms showed statistical significance.
• Nine symptoms met the 3% positive predictive value threshold.

Conclusions:

• Current head and neck cancer referral guidelines are not effective in detecting malignancies.
• Referral detection rates have decreased from 10-15% to 3.76%.
• A review of the guidelines and further data collection are recommended for improvement.