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Aim: To examine deprivation measured by the Scottish index of multiple deprivation (SIMD) and its relation to urgent suspicion of head and neck cancer referrals. A secondary aim was to examine the symptomatology generating urgent suspicion of cancer (USOC) referrals by SIMD category. Methods: All “urgent suspicion of cancer” referrals to the GGC ENT department over a one‐year period, between 2015 and 2016, were reviewed. Information was recorded anonymously and included demographics and red flag referral symptoms. Results: A total of 1998 patients were assessed, 43.4% (n = 867) were male. A total of 171 (8.6%) patients had primary head and neck cancer. A total of 61 patients had other types of cancer, giving an all cause cancer rate of 11.6%. About 71.3% of primary patients with head and neck cancer (HNC) were male. The most common SIMD category observed was SIMD1, the most common SIMD category yielding a primary head and neck cancer diagnosis was SIMD1. Neck lump was the commonest symptom amongst all SIMD categories. Conclusion: A link between deprivation and USOC referrals has been established. A difference in gender distribution between referrals and HNC was observed, more females are referred but a significantly higher number of patients with HNC are males. Neck lump is a very strong referral indicator for HNC and intermittent hoarseness is not. The findings from this analysis could be used to refine local referral patterns and priority of referral. [ABSTRACT FROM AUTHOR]

Objective: In Scotland, patients with suspected head and neck cancer are referred on the basis of the Scottish Referral Guidelines for Suspected Cancer, rather than the National Institute for Health and Care Excellence guidelines. A chest X-ray should be requested by the general practitioner at the same time as referral for persistent hoarseness. The evidence for this is level 4. Methods: This audit identified adherence to this recommendation and X-ray results. All ‘urgent suspicion of cancer’ referrals to the ENT department in the National Health Service Greater Glasgow and Clyde for 2015–2016 were audited. Results: Persistent hoarseness for more than 3 weeks instigated referral in 318 patients (15.7 per cent). Chest X-ray was performed in 120 patients (38 per cent), which showed: no abnormality in 116 (96.7 per cent), features of infection in 2 (1.7 per cent) and something else in 2 patients (1.7 per cent). No chest X-ray altered the management of a patient. Conclusion: Performance of chest X-ray does not alter management and its removal from the Scottish Referral Guidelines for Suspected Cancer is recommended. [ABSTRACT FROM AUTHOR]

Objectives To identify the set of referral criteria that will offer optimal diagnostic efficacy in patients suspected to have head and neck cancer ( HNC) in the primary care setting. Design Statistical analysis of referral criteria and outcomes. Setting Two tertiary care cancer centres in the United Kingdom. Participants 4715 patients who were referred via the fast-track system with a suspected HNC between 2007 and 2010. Main outcome measures Parameters of diagnostic efficacy, multivariate regression model to calculate estimated probability of HNC and area under the receiver operating characteristic curve ( AUROC). Results The majority of referring symptoms had a positive predictive value higher than the 3% cut-off point stated to be significant for HNC detection in the 2015 NICE recommendations. Nevertheless, our multivariate analysis identified nine symptoms to be linked with HNC. Of these, only four are included in the latest NICE guidelines. The best fit predictive model for this data set included the following symptoms: hoarseness >3 weeks, dysphagia >3 weeks, odynophagia, unexplained neck mass, oral swelling >3 weeks, oral ulcer >3 weeks, prolonged otalgia with normal otoscopy, the presence of blood in mouth with concurrent sensation of lump in throat and the presence of otalgia with concurrent lump in throat sensation. Intermittent hoarseness and sensation of lump in throat were negatively associated with HNC. The AUROC demonstrated that our model had a higher predictive value (0.77) compared to those generated using the NICE 2005 (0.69) and 2015 (0.68) referral criteria ( P < 0.0001). An online risk calculator based on this study is available at . Conclusions This study presents a significantly refined version of referral guidelines which demonstrate greater diagnostic efficacy than the current NICE guidelines. We recommend that further iterative refinements of referral criteria be considered when referring patients with suspected HNC. [ABSTRACT FROM AUTHOR]