Post-Treatment Head and Neck Cancer Care : National Audit and Analysis of Current Practice in the United Kingdom
© 2020 John Wiley & Sons Ltd..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:46 |
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| Enthalten in: |
Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery - 46(2021), 1 vom: 05. Jan., Seite 284-294 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
INTEGRATE (The UK ENT Trainee Research Network) [VerfasserIn] |
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| Links: |
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| Themen: |
Audit |
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| Anmerkungen: |
Date Completed 15.04.2022 Date Revised 27.05.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/coa.13616 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM313101957 |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 John Wiley & Sons Ltd. | ||
| 520 | |a 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 | ||
| 520 | |a DESIGN: National cross-sectional study of current HNC surveillance practice | ||
| 520 | |a SETTING: UK HNC outpatient departments | ||
| 520 | |a PARTICIPANTS: HNC patients reviewed for post-treatment surveillance | ||
| 520 | |a MAIN OUTCOME MEASURES: Compliance with UK multidisciplinary guidelines and rates of cancer recurrence detection by time, clinic type and symptoms | ||
| 520 | |a 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%) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a audit | |
| 650 | 4 | |a cancer | |
| 650 | 4 | |a guidelines | |
| 650 | 4 | |a head and neck | |
| 650 | 4 | |a recurrence | |
| 650 | 4 | |a surveillance | |
| 650 | 4 | |a treatment | |
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