Telephone and 'Straight-to-Test' Model in Triaging Urgent Suspected Cancer Referrals in a Head and Neck Clinic

In the face of challenging times characterized by high referral volumes, limited resources, and service constraints, our Head and Neck Cancer service at the Broomfield Hospital (Mid and South Essex NHS Foundation Trust) adopted a telephone triage system to streamline patient management and prioritise high-risk cases. To improve efficiency and expedite cancer pathways, we implemented a telephone triage and 'straight-to-test' model (STT), whereby high-risk patients are referred directly for diagnostic imaging following telephone triage, bypassing an initial face-to-face consultation. This study evaluated the effectiveness of this approach in a regional Head and Neck Cancer hub, with the malignancy detection rate as the primary outcome.

We conducted a retrospective observational pilot study at a regional Head and Neck Cancer hub in the United Kingdom. The study included 94 consecutive patients referred via the urgent two-week wait (2WW) pathway for suspected head and neck cancer. All patients underwent an initial telephone consultation with an Ear, Nose, and Throat (ENT) clinician, during which they were triaged and referred directly for appropriate imaging investigations, typically cross-sectional imaging, without a prior face-to-face clinical assessment. Patient demographics, imaging modality, final diagnosis, and clinical outcomes were collected. The primary outcome was the malignancy detection rate using this telephone triage and STT/telephone-and-test (TnT) model. Secondary outcomes included imaging utilisation, discharge following imaging, and the requirement for subsequent face-to-face assessment.

The study included 40 (42.6%) male and 54 (57.4%) female patients, with a mean age of 56.2 ± 17.6 years (range, 19-89 years). During the study period, 495 two-week wait referrals were received. Of these, 104 (21.0%) patients were discharged following their initial telephone consultation. Ninety-four patients (19.0%) were referred directly for imaging investigations after telephone triage through the STT pathway. Malignancy was identified in 14 (14.9%) patients and included squamous cell carcinoma, well- differentiated thyroid carcinoma, lymphoproliferative disease, and metastatic malignancy. A further 40.4% (n=38) of patients were diagnosed with benign conditions, including benign salivary gland tumours, benign thyroid disease, and physiological lymphadenopathy. Following radiological investigation, 49 (52.1%) patients were discharged without requiring any further consultations. Cross-sectional imaging (CT/MRI) was performed significantly more frequently in patients with malignant pathology than in those with non-malignant findings (50.0% vs. 12.5%, p=0.003).

The telephone triage and straight-to-test approach is an effective model for managing head and neck 2WW referrals. It enables early identification of malignant disease while reducing unnecessary outpatient appointments and may be safely implemented in high-volume centres, particularly where clinical resources are limited.