Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 11.
doi: 10.1007/s12094-025-03968-0. Online ahead of print.

Accelerating diagnosis and refining referral criteria in head and neck cancer: insights from a multidisciplinary fast-track pathway

Pedro Rodríguez Lorenzana  1 , Nicolás González Poggioli  2 , Íñigo Colina Astigarraga  3 , Laura Arias Soilán  2 , Laura Abella Bartrolí  2 , Ángel Iglesias Castro  2 , Miguel Mayo Yáñez  2 , Pablo Parente Arias  2
Affiliations

Accelerating diagnosis and refining referral criteria in head and neck cancer: insights from a multidisciplinary fast-track pathway

Pedro Rodríguez Lorenzana et al. Clin Transl Oncol. .

Abstract

Purpose: Despite advancements, 54% of head and neck cancer patients in Europe are diagnosed at advanced stages. The fast-track head and neck cancer pathway (FTHNCP) was implemented in 2018 in our hospital to reduce diagnostic delays and improve patient outcomes. This study aimed to evaluate the effectiveness of the FTHNCP in reducing diagnostic delays and identifying factors associated with oncological diagnoses.

Methods: A retrospective observational study analyzed 1453 patients referred via the FTHNCP between January 2018 and August 2023. Data collected included demographics, symptoms, diagnostic tests, and timelines from symptom onset to treatment initiation. Statistical analysis was performed to identify factors associated with oncological diagnoses, focusing on variables, such as age, gender, toxic habits, and clinical presentation.

Results: The median age of the cohort was 61 years, with 50.64% being male. The average time from referral to specialist consultation was 11.59 days. Among the referred patients, 19.89% received an oncological diagnosis, with squamous cell carcinoma being the most frequent (11.51%). Statistical analysis identified significant associations between malignancy and male gender, older age, toxic habits, and the presence of oral ulcers.

Conclusions: The FTHNCP demonstrates potential for early diagnosis of head and neck cancer, significantly reducing waiting times for specialist evaluation. However, the high proportion of benign diagnoses or absence of pathology highlights the need to optimize referral criteria. Incorporating risk scoring systems based on epidemiological and clinical factors could enhance diagnostic specificity. A multidisciplinary approach and further studies are recommended to refine the pathway and improve diagnostic efficiency.

Keywords: Early diagnosis; Head and neck neoplasms; Multidisciplinary teams; Referral and consultation; Risk assessment.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no conflicts of interest related to this study. Ethical statement: As this is a quality assessment evaluation, it does not require authorization from a Research Ethics Committee (REC). The Guide for Members of Research Ethics Committees, prepared by the Steering Committee on Bioethics of the Council of Europe, defines clinical audit, which is not subject to prior evaluation by a REC, as reviews carried out in healthcare to"determine whether best practices have been adopted."The publication of results obtained from reviews of the functioning of a department or clinical service is, therefore, not considered research studies subject to REC evaluation. In addition, we would like to point out that, in Galicia, the Resolution of January 15, 2020, of the Technical General Secretariat of the Ministry of Health, which publicizes Instruction 7/2019 regarding the protocol for the processing of complementary data to clinical record registries, regulates the performance of quality assessments in healthcare as activities to evaluate the care provided to patients. The main purpose of these activities is to analyze healthcare protocols to identify whether modifications or improvements are needed. The development of these quality assessments must be authorized by the head of the service or unit involved and by the manager of the healthcare institution, documents that we have attached to the submitted publication for your verification. Informed Consent: This study is a quality assessment evaluation and, therefore, does not involve any intervention, experimentation, or identifiable personal data requiring informed consent. According to the Guide for Members of Research Ethics Committees of the Council of Europe, clinical audits aimed at evaluating the implementation of best practices in healthcare are not subject to REC evaluation or individual informed consent. Additionally, as per Instruction 7/2019 and the Resolution of January 15, 2020, issued by the Technical General Secretariat of the Ministry of Health in Galicia (Spain), quality assessments based on retrospective anonymized data are regulated as healthcare management activities, not biomedical research. These activities were duly authorized by the head of the clinical unit and the healthcare institution. Therefore, informed consent was not required.

References

    1. Gatta G, Botta L, Sanchez MJ, Anderson LA, Pierannunzio D, Licitra L, et al. Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study. Eur J Cancer. 2015;51(15):2130–43. - PubMed
    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86. - PubMed
    1. Machiels JP, Rene Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V, et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS­ ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;3 l(ll):1462–1475.
    1. National Institute for Health and Care Excellence. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. NICE Guideline No. NG36. 2016. Accessed December 19, 2024. https://www.nice.org.uk/guidance/ng36
    1. Shuman AG, Entezami P, Chemin AS, Wallace NE, Taylor JM, Hogikyan ND, et al. Demographics and efficacy of head and neck cancer screening. Otolaryngol Head Neck Surg. 201O;143(3):353–360.

LinkOut - more resources