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Appropriateness of two-week wait head and neck cancer referrals to a district general hospital

British Dental Journal (2023)Cite this article

Abstract

Objectives The NHS advise urgent referral of patients with suspected head and neck cancers to secondary care to be seen via a two-week wait pathway. The objective of this review was to analyse the two-week wait head and neck cancer referrals to a district general hospital and to identify the prevalence of oral cancer.

Materials and methods Patients referred via an urgent two-week wait cancer pathway during the period of 12 October 2020 to 19 January 2022 were identified. Data were extracted and analysed for referral source, patient sex, whether or not a biopsy was undertaken, and the number of patients with a final positive cancer diagnosis.

Results Overall, 883 two-week wait referrals were received. Most referrals came from general medical practitioners (50%) followed by general dental practitioners (37%). A total of 379 patients (46%) underwent a biopsy, special investigations, or internal referral to another speciality. The overall prevalence of cancer was 6.2%. Most referrals received were for commonly occurring benign conditions.

Conclusion Despite many two-week wait suspected cancer referrals, only a small percentage of patients go on to be diagnosed with head and neck cancer. These results highlight the number of avoidable referrals, which ultimately impact patient waiting lists and clinician time.

Key points

  • Highlights the large number of avoidable referrals received by a district general hospital.

  • Emphasises the use of cross-referral system to enable dentists to review certain oral conditions before referral to secondary care.

  • Increases awareness of the types of referrals received via the urgent two-week wait pathway may help reduce unnecessary referrals.

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Authors and Affiliations

  1. Dental Core Trainee, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Kennington Road, Willesborough, Ashford, TN24 0LZ, UK; Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, United Kingdom

    Hannah Hook

  2. Academic Clinical Fellow and Specialist Trainee Registrar in Oral Surgery, Royal Devon University Healthcare NHS Foundation trust, Barrack Road, Exeter, EX2 5DW, United Kingdom

    Gabriele Baniulyte

  3. Consultant Oral and Maxillofacial Surgeon, Royal Devon University Healthcare NHS Foundation trust, Barrack Road, Exeter, EX2 5DW, United Kingdom

    Michael Esson & John Bowden

Authors
  1. Hannah Hook
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  2. Gabriele Baniulyte
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  3. Michael Esson
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  4. John Bowden
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Contributions

Hannah Hook contributed to the design, data collection, data analysis and write-up. Gabriele Baniulyte participated in the design, data analysis and review. Michael Esson and John Bowden partook in the review of the write-up.

Corresponding author

Correspondence to Hannah Hook.

Ethics declarations

The authors declare no conflicts of interest.

Advice was sought from the NHS HRA website using the online ethical approval tools which confirmed that this retrospective review is not classified as research and therefore ethical approval was not required. Patient consent for the collection, analysis and write-up of the retrospective data was not required as no patient identifiable information was used. Local governance approval was gained for the retrospective data collection.

Data sharing is not applicable to this article.

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Hook, H., Baniulyte, G., Esson, M. et al. Appropriateness of two-week wait head and neck cancer referrals to a district general hospital. Br Dent J (2023). https://doi.org/10.1038/s41415-023-6271-1

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