Post-Treatment Head and Neck Cancer Care: National Audit and Analysis of Current Practice in the United Kingdom

Head and Neck Cancer
31/07/2020

Clin Otolaryngol. 2020 Jul 30. doi: 10.1111/coa.13616. Online ahead of print.

ABSTRACT

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=0.0001). 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.