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Introduction: Socioeconomic deprivation is a known risk factor for head and neck cancer (HNC). Despite this, there is no current way to acknowledge this in two‐week wait (2WW) referrals. 2WW HNC referrals have continually risen, and a self‐reporting questionnaire was trialled with referrals to the ear, nose and throat (ENT) department with suspected HNC, allowing additional triage information not included in referrals to be obtained. Methods: Patients referred through the 2WW pathway for HNC between February 2021 and March 2022 were asked to complete an electronic self‐reporting symptom questionnaire. The vetting process resulted in the referral being accepted or regraded to less urgent referral streams. Scottish Index of Multiple Deprivation (SIMD) quintiles were derived using the online postcode checker tool. Results: A total of 984 2WW referrals were retrospectively reviewed. The questionnaire was completed by 717 (72.9%) patients. Regrading of urgency resulted in 292 (29.7%) 2WW appointments not required. Of those regraded, 264 (90.4%) patients completed the questionnaire. A significantly greater number of patients (p = 0.03) from SIMD 4 and SIMD 5 were regraded (33.3%) compared to SIMD 1 and SIMD 2 (26.4%). Patients who did not complete the questionnaire had a higher median age (61.0 years, range: 17–96, IQR: 25.0) compared to those who completed the questionnaire (56.0 years, range: 17–88, IQR: 23.5, p < 0.001). Conclusion: A self‐reported symptom questionnaire can help rebalance urgent appointments to those with genuine red flag symptoms. This in turn reduces social inequality in 2WW referrals and reduces the number of inappropriate 2WW appointments. [ABSTRACT FROM AUTHOR]

Objective: Machine learning has been effective in other areas of medicine, this study aims to investigate this with regards to HNC and identify which algorithm works best to classify malignant patients. Design: An observational cohort study. Setting: Queen Elizabeth University Hospital. Participants: Patients who were referred via the USOC pathway between January 2019 and May 2021. Main Outcome Measures: Predicting the diagnosis of patients from three categories, benign, potential malignant and malignant, using demographics and symptoms data. Results: The classic statistical method of ordinal logistic regression worked best on the data, achieving an AUC of 0.6697 and balanced accuracy of 0.641. The demographic features describing recreational drug use history and living situation were the most important variables alongside the red flag symptom of a neck lump. Conclusion: Further studies should aim to collect larger samples of malignant and pre‐malignant patients to improve the class imbalance and increase the performance of the machine learning models. [ABSTRACT FROM AUTHOR]

Objective: To determine differences in insomnia, depression and anxiety between ENT patients with benign and malignant conditions prior to and after an urgent suspicion of cancer appointment. Methods: Out-patients with urgent suspicion of cancer completed three psychometric questionnaires prior to their appointment and at two to four weeks post-diagnosis. Results: There was no significant difference in questionnaire scores between malignant and benign patients prior to the patients' appointments (p > 0.05 for all questionnaires). In benign patients, there was significant improvement in scores for all questionnaires (p < 0.01) and in malignant patients there was significant worsening of scores for all questionnaires (p < 0.01) at follow-up appointments. Conclusion: Prior to appointments, patients with benign and malignant conditions experienced similar levels of insomnia, depression and anxiety. Following diagnosis, cancer patients had significantly poorer scores, indicating worsening of these symptoms. In patients with benign diagnoses, all questionnaire scores improved, indicating resolution of their symptoms and possible association between the appointment and their baseline scores. [ABSTRACT FROM AUTHOR]

Smoking is a well-recognized risk factor for the development of head and neck cancer. The aim of this study was to explore the reasons why patients referred with suspected head and neck cancer to an ENT unit had chosen to quit smoking. A secondary aim was to investigate smoking cessation methods those patients used. 129 consecutive ex-smoking patients were seen in an urgent ENT diagnostic clinic. All patients were asked to complete a smoking behavior questionnaire. Reasons given to quit smoking, methods and support structures utilized were recorded. The most popular method for quitting smoking was willpower alone with no external support. The most common reasons for quitting smoking were present and future health concerns. Knowing the common smoking cessation methods patients have used and the motivational reasons behind their decisions to quit will help clinicians responsible for supporting these patients. By identifying the needs and personal situations of each patient, more specific smoking cessation advice can be provided that may improve the chances of a successful cessation attempt. [ABSTRACT FROM AUTHOR]

Background: There are delays in the head and neck Urgent Suspicion of Cancer (USOC) pathway. Local anesthetic (LA) biopsy with channeled endoscopes in outpatients can reduce time to diagnosis. Methods: Questionnaire‐based prospective study of LA or general anesthetic (GA) biopsy for investigation of cancer from September 2021 to July 2022. Results: 100% (n = 48) were very satisfied or satisfied with their overall experience. 71% (n = 20) of LA patients reported they would prefer to have a biopsy under LA. LA biopsy was 68% sensitive and 100% specific for cancer diagnosis. 28.6% (8) and 10% (2) of LA and GA patients had palliative MDT outcomes. Median time to diagnosis was 44.5 and 49.0 days for LA and GA biopsy, respectively. Conclusion: LA biopsy had a high satisfaction rate and is sensitive for diagnosing cancer. LA biopsy can expedite treatment pathways. LA biopsy should be considered as an option for first line investigation. [ABSTRACT FROM AUTHOR]

Objective: Out-patient channelled endoscopic local anaesthetic biopsy reduces the time to diagnosis and wider use may improve cancer pathway times. This study aimed to assess the practice of ENT surgeons using channelled local anaesthetic biopsy. Method: A survey was distributed nationally, containing questions about out-patient local anaesthetic biopsy. Results: In total, 58 responses were returned; only 12 per cent of respondents (n = 7) used general anaesthetic biopsy. The advantages of local anaesthetic biopsy were: the avoidance of general anaesthetic for patients with poor performance scores (95 per cent, n = 55) and faster cancer pathway times (91 per cent, n = 53). Disadvantages were: clinics running late (29 per cent, n = 17) and complications (24 per cent, n = 14). The main barrier to using local anaesthetic was access to channelled flexible endoscopy (38 per cent, n = 22), with 43 per cent (n = 25) reporting they were not using out-patient channelled endoscopes but would be interested in using them. Conclusion: Surgeons are interested in using channelled endoscopic local anaesthetic biopsy, but they are limited by access to equipment. Increased use of channelled endoscopes may improve national cancer pathway times and avoid challenging general anaesthetics. [ABSTRACT FROM AUTHOR]

Background: Epistaxis affects most people over their lifetime. It is the commonest ear, nose and throat emergency. Hospital admission and socio‐economic deprivation have been associated with mental health disorders, respiratory illness and with emergency hospital admissions. Low socio‐economic status has never previously been associated with epistaxis, a common reason for admission to ear, nose and throat departments throughout the UK. Methods: Demographics from Information Services Division Scotland were analysed over a period of 20 years. This focused on gender, number of admissions, number of bed days, socio‐economic deprivation (Scottish Index of Multiple Deprivation) and mortality within 1 year. Results: Data from 54 501 patients were assessed. Admission numbers and length of stay have significantly decreased (P < 0.0001). Males are more frequently affected (P = 0.001). Admission numbers were higher for patients in more deprived areas (P < 0.001). Mean duration of stay has decreased by 1 bed day. Surgical intervention of epistaxis has increased significantly (P < 0.001). There is an associated 1‐year mortality rate of 9.8% following epistaxis. Conclusion: There has been a significant decrease in hospital admissions and length of hospital stay in patients admitted with epistaxis over the past 20 years. There is a significant association with deprivation and epistaxis admission. [ABSTRACT FROM AUTHOR]