Socioeconomic Inequality in the Head and Neck Cancer Referral System: Redressing the Balance

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY Clinical Otolaryngology Pub Date : 2024-09-26 DOI:10.1111/coa.14232

Sabrina Tengku, Aislinn FitzGerald, Alison E. Lim, Jenny Montgomery

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Abstract

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.

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头颈部癌症转诊系统中的社会经济不平等：纠正平衡。

导言：社会经济贫困是头颈癌（HNC）的一个已知风险因素。尽管如此，目前还没有办法在两周等待（2WW）转诊患者中确认这一点。2WW HNC转诊率持续上升，我们对耳鼻喉科（ENT）的疑似HNC转诊患者进行了自我报告问卷调查试验，以便获得转诊患者未包含的其他分诊信息：方法：2021 年 2 月至 2022 年 3 月期间，通过 2WW 途径转诊的 HNC 患者被要求填写一份自我症状电子问卷。审核过程的结果是接受转诊或将其重新分级为不太紧急的转诊流。苏格兰多重贫困指数（SIMD）五分位数是通过在线邮编检查工具得出的：共对 984 份 2WW 转诊病例进行了回顾性审查。717名（72.9%）患者填写了调查问卷。对急诊进行重新分级后，有 292 名（29.7%）患者不需要进行 2WW 预约。在重新分级的患者中，有 264 名（90.4%）患者填写了调查问卷。与 SIMD 1 和 SIMD 2（26.4%）相比，来自 SIMD 4 和 SIMD 5 的患者（33.3%）被重新分级的比例明显更高（p = 0.03）。未完成问卷调查的患者的年龄中位数（61.0 岁，范围：17-96 岁，IQR：25.0）高于完成问卷调查的患者（56.0 岁，范围：17-88 岁，IQR：25.0）：P 结论：自我报告症状的问卷调查有助于重新平衡紧急预约，让那些真正有明显症状的人接受治疗。这反过来又减少了两岁以下儿童转诊中的社会不平等现象，并减少了不适当的两岁以下儿童预约数量。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.