Head and neck cancer: A 6-year retrospective analysis and review of three common triaging systems

Abstract

Objectives: In the United Kingdom, head and neck cancer (HNC) cases continue to rise and are the fourth commonest cancers in men. Additionally, in the last decade, the incidence rise in women is twice their male counterpart, signifying the need for robust and dynamic triaging systems to maintain high pick-up rates across both genders. This study investigates local risk factors associated with HNC and reviews the most commonly used guidelines and risk calculator tool for two-week-wait (2ww) HNC clinics.

Design: Six-year retrospective case-control analysis of 2ww HNC clinics within a district general hospital in Kent studying symptoms and risk factors.

Results: Two hundred cancer patients (128M:72F) were identified and compared against 200 randomised non-cancer patients (78M:122F). Increasing age, male gender, smoking, previous cancer and neck lumps were statistically relevant risk factors for HNC (p < .001). HNC mortality at 1 and 5 years was 21% and 26%, respectively. Adjusting guidelines to improve local services obtained the following area under curve (AUC) scores: NICE guidelines 67.3, Pan-London 58.0 and HNC risk calculator version 2 (HaNC-RC V.2) 76.5. Our adjusted HaNC-RC V.2 improved sensitivity by 10% to 92%, and theoretically reduces local general practice referrals by 61% when utilising triaging staff.

Conclusion: Our data portray the primary risk factors as increasing age, male gender and smoking for this demographic. The presence of a neck lump was the most significant symptom within our cohort. This study demonstrates a critical balance when adjusting sensitivity and specificity of guidelines and proposes that departments adjust diagnostic tools for their local demographic to improve referral numbers and patient outcomes.

Keywords: cancer; head; neck; otolaryngology; surgery.