The Integrated Foregut Clinical History: enabling nurse-led, joined-up initiation of suspected-cancer pathways

Prompt diagnosis of aerodigestive cancers and other time-sensitive conditions improves survival and reduces morbidity and anxiety. However, early symptoms do not reliably differentiate between different pathologies and, in isolation, seldom localise the disease anatomically.

To disseminate a multidisciplinary foregut (head and neck, oesophagogastric, and respiratory) diagnostic dataset, using patients' integrated clinical histories to initiate diagnostic pathways, reassure patients, and communicate information between stakeholders.

260 patients had their clinical histories taken either by two nurse specialists following training and then supported by a digital proforma (n=81), or by one laryngologist (n=179). The discriminative performance of the clinical history to ascertain specific symptoms was tested against validated Patient-Reported Outcome Measures (PROMs) using Receiver Operating Characteristic Area Under the Curve (ROC AUC) statistics.

There were 103 men and 157 women. Mean age was 58±16 years. All ROC AUCs were significantly greater than 0.5. For dysphagia, against the Eating Assessment Tool, AUC was 0.86±0.02 [0.81-0.90]. For hoarseness, against the 10-item Voice Handicap Index, AUC was 0.82±0.03 [0.77-0.0.86]. There were no significant differences in symptom ROCs between the laryngologist and trained nurse specialists using a digital proforma.

The Integrated Foregut Clinical History implements the clinical history as diagnostic technology to guide clinical pathways. It performs well against validated PROMs and can form the basis of nurse-led pre-visit planning to support head and neck and upper gastrointestinal timed diagnostic pathways.