Nurse-Led Telephone Triage Clinic Service for Head and Neck Suspected cancer Referrals: A Prospective Study of 986 Referrals.

BACKGROUND: Head and neck cancer (HNC) referral conversion in the UK is less than 3%. A nurse-led telephone assessment clinic (TAC) using the HaNC-RC v.2 triage tool was introduced to identify high-risk (HR) referrals. METHODS: Prospective data were collected from all HNC referrals (n = 986) over 6 months, with descriptive analysis of TAC triage outcomes. RESULTS: Over 6 months, 986 referrals were reviewed, with a 4.4% (n = 43) cancer conversion rate. Of 483 (49.0%) TAC patients, 115 (23.8%) were high-risk (HR) triaged using the HaNC-RC v.2 tool. Cancer was diagnosed in 8 (7.0%) HR and 3 (0.9%) LR patients (early thyroid malignancies), who were subsequently upgraded to HR (p-value = < 0.001) with FDS compliance of 88% (95% CI: 83.5-92.1). Allowing for clinical capacity constraints, the first F2F clinical appointment with an HNC consultant was given to 63.1% of HR patients, and 7.7% of these patients were later confirmed to have cancer. HR and LR patients were seen within a mean of 9.2 and 10.2 days (p-value = 0.043), respectively. The mean waiting time was improved from 10.7 days (1st month) to 5.9 days (6th month) for an HR clinic slot (p-value = 0.04). CONCLUSION: This service evaluation study supports the use of the HaNC-RC v.2 at the 7.1% threshold in a TAC nurse-led clinic model alongside an STT pathway. The TAC service facilitated optimised use of consultant clinic slots, prioritising HR patients without compromising LR patients' outcomes and facilitated a reduction in USoC clinic slot requirements whilst helping FDS target compliance.