Compliance and Effectiveness of the Scottish Referral Guidelines for Suspected Head and Neck Cancer: A Comparative Audit of 7088 Referrals

INTRODUCTION: In Scotland, patients with suspected head and neck cancer are referred based on the Scottish Referral Guidelines for Suspected Cancer (SRGSC). These were most recently updated in 2014 and 2019. A study using 2015-2016 data reported a compliance rate with the 2014 guidance of 55.1% and an all-cancer detection rate of 11.6% (8.6% primary head and neck cancer). This audit assessed referral compliance with the 2019 SRGSC and investigated what effect this update had on rates of head and neck cancer detection. METHODS: All 'urgent suspicion of cancer' referrals to the ENT department in the National Health Service Greater Glasgow and Clyde (NHS GGC) for 2021-2022 were audited and compared to corresponding data from 2015 to 2016. RESULTS: The number of referrals increased by 110% between 2015-2016 and 2021-2022. SRGSC compliance in referral letters was 72.5%, but only 48.9% when those patients were assessed in the ENT clinic. The all-cancer detection rate was 8.6% (6.2% primary head and neck cancer). The most common reasons for referral were neck lump (28%), persistent hoarseness (15%), and persistent throat pain (11%). The most common primary head and neck cancer sites were oropharynx (18%), larynx (17%), and thyroid (11%). There were significant differences between the 2015-2016 and 2021-2022 cohorts in age at referral, sex, and risk factors. CONCLUSION: Compared to corresponding data from 2015 to 2016, there is increased workload in 'urgent suspicion of cancer' clinic for fewer cancer diagnoses. When compliant, the SRGSHNC criteria are a valuable predictive tool for cancer diagnosis.