Abstract
Introduction In 2017, Cheshire and Merseyside Local Dental Network introduced an Oral Cancer Care Guide for dental teams, emphasising the importance of early detection, appropriate referral, and effective patient communication. This study looks at the effect on two-week-wait (TWW) referrals to one unit, following the introduction of the guide and regional educational intervention.
Methods Somerset Cancer Register, provided data from two three-month cohorts of TWW suspected head and neck cancer referrals, before and after introduction of the guide.
Results There were 390 and 481 referrals respectively during the two three-month time-periods. The number of general dental practitioner (GDP) referrals rose from 24 to 59 (6.2% to 12.3%, P = 0.002) following introduction of the guide. The cancer conversion rate remained the same for general practitioner (GP) referrals (6.3% and 6.2%) but was lower for GDP referrals (21% vs 12%, P = 0.31).
Conclusions We observed an increase in referrals following the introduction of the guide; however, the conversion rate for GDP referrals reduced. Education and ease of referral are essential for reducing the number of advanced cancers presenting to secondary care, but more research is required to inform an improvement in specificity. Future work is required looking at the long-term impact of the guide including adaption for local GP usage.
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References
Department of Health. The NHS Cancer Plan. 2000. Available online at https://www.thh.nhs.uk/documents/_Departments/Cancer/NHSCancerPlan.pdf (accessed 28 December 2018).
Rogers S N, Brown J S, Woolgar J A et al. Survival following primary surgery for oral cancer. Oral Oncol 2009; 45: 201-211.
Cancer Research UK. Mouth cancer rates soar over 20 years. Press release. 2016. Available online at. https://www.cancerresearchuk.org/about-us/cancer-news/press-release/20161125mouthcancerratessoarover20-years (accessed 28 December 2018).
Brocklehurst P R, Baker S R, Speight PM. A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer. Br Dent J 2010; 208: E3; discussion 72-73.
Brocklehurst P R, Baker S R, Speight P M. Factors which determine the referral of potentially malignant disorders by primary care dentists. J Dent 2010; 38: 569-578.
Carter L M, Ogden G R. Oral cancer awareness of general medical and general dental practitioners. Br Dent J 2007; 203: E10; discussion 248-249.
Cheshire and Merseyside Local Dental Network. Oral Cancer CareAdvice and guidance for the primary dental care team. 2017. Available online at https://www.dental-referrals.org/wp-content/uploads/2018/08/OralCancerGuide.pdf (accessed 28 December 2018).
Department of Health. Delivering better oral health, an evidence-based toolkit for prevention (3rd edition). 2017. Available onine at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (accessed 7 July 2019).
National Institute of Clinical Excellence (NICE). NICE Guideline (NG12): Suspected cancer: recognition and referral. 2017. Available online at https://www.nice.org.uk/guidance/ng12 (accessed 7 July 2019).
Brown K F, Rumgay H, Dunlop C et al. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Br J Cancer 2018; 118: 1130-1141.
Rogers S, Staunton A, Girach R, Langton S, Lowe D. Audit of the two-week pathway for patients with suspected cancer of the head and neck and the influence of socioeconomic status. Br J Oral Maxillofac Surg; 2019; 57: 419-424.
Al-Haboubi M, Klass C, Jones K, Bernabé E, Gallagher J E. Inequalities in the use of dental services among adults in inner South East London. Eur J Oral Sci 2013; 121: 176-181.
Pytynia K B, Dahlstrom K R, Sturgis E M. Epidemiology of HPV-associated oropharyngeal cancer. Oral Oncol 2014; 50: 380-386.
Langton S, Siau D, Bankhead C. Two-week rule in head and neck cancer 2000-2014: a systematic review. Br J Oral Maxillofac Surg 2016; 54: 120-131.
Gibson J. Oral cancer - CPD and the GDC. Br Dent J 2018; 225: 884-888.
Tajmehr N. Appropriateness of referrals on the suspected cancer referral pathway - a secondary care perspective. Br Dent J 2019; 226: 539.
McGurk M, Scott S E. The reality of identifying early oral cancer in the general dental practice. Br Dent J 2010; 208: 347-351.
Lewis M. Mouth cancer - What's it to you? Br Dent J 2018; 225: 789-790.
Rafiq R, Brocklehurst P, Rogers S N. Effect of Mouth Cancer Awareness Week on urgent suspected head and neck cancer referrals. Br J Oral Maxillofac Surg 2013; 51: e183-185.
Allgar V L, Oliver S E, Chen H, Oviasu O, Johnson M J, Macleod U. Time intervals from first symptom to diagnosis for head and neck cancers: An analysis of linked patient reports and medical records from the UK. Cancer Epidemiol 2019; 59: 37-45.
Rogers S N, Lowe D, Catleugh M, Edwards D. An oral cancer awareness intervention in community pharmacy. Br J Oral Maxillofac Surg 2010; 48: 498-502.
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Metcalfe, C., Dailey, Y., Lowe, D. et al. Introduction of a referral pathway guide for general dental practitioners in Cheshire & Merseyside: the effect on two-week suspected cancer referrals. Br Dent J 227, 1058–1062 (2019). https://doi.org/10.1038/s41415-019-1003-2
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DOI: https://doi.org/10.1038/s41415-019-1003-2
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