Symptom‐based remote assessment in post‐treatment head and neck cancer surveillance: A prospective national study. (9th June 2022)

• Record Type: Journal Article
• Authors: Zhang, Henry; Hardman, John C.; Tikka, Theofano; Nankivell, Paul; Mehanna, Hisham; Paleri, Vinidh
• Is Part Of: Clinical otolaryngology. Volume 47:Number 5(2022)
• Page Start: 561
• Page End: 567
• Publication Date: 2022-06-09
• Subjects: multicentre -- observational -- outpatient -- risk -- triage; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1111/coa.13948
• Languages: English
• ISSNs: 1749-4478

Abstract

Abstract: Objectives: To report the incidence of locoregional recurrence in head and neck cancer (HNC) patients under surveillance following treatment undergoing symptom‐based remote assessment. Design: A 16‐week multicentre prospective cohort study. Setting: UK ENT departments. Participants: HNC patients under surveillance following treatment undergoing symptom‐based telephone assessment. Main outcome measures: Incidence of locoregional recurrent HNC after minimum 6‐month follow‐up. Results: Data for 1078 cases were submitted by 16 centres, with follow‐up data completed in 98.9% ( n = 1066). Following telephone consultation, 83.7% of referrals had their face‐to‐face appointments deferred ( n = 897/1072). New symptoms were reported by 11.6% ( n = 124/1072) at telephone assessment; 72.6% ( n = 90/124) of this group were called for urgent assessments, of whom 48.9% ( n = 44/90) came directly for imaging without preceding clinical review. The sensitivity and specificity for new symptoms as an indicator of cancer recurrence were 35.3% and 89.4%, respectively, with a negative predictive value of 99.7% ( p = .002). Locoregional cancer identification rates after a minimum of 6 months of further monitoring, when correlated with time since treatment, were 6.0% ( n = 14/233) <1 year; 2.1% ( n = 16/747) between 1 and 5 years; and 4.3% ( n = 4/92) for those >5 years since treatment. Conclusions: Telephone assessment, using patient‐reported symptoms, to identify recurrent locoregional HNC was widely adopted during the initial peak of the COVID‐19 pandemic in the United Kingdom. The majority of patients had no face‐to‐face reviews or investigations. New symptoms were significantly associated with the identification of locoregional recurrent cancers with a high specificity, but a low sensitivity may limit symptom assessment being used as the sole surveillance method.