Abstract
Introduction Patient worry and concern of cancer adds to the latent distress associated with referral on the two-week suspected pathway (2WW). For oral cancer, as the conversion rate is in the region of 5-10%, the majority of people will have needless cause for concern.
Aim This study aims to report how worried/concerned patients were that the reason for referral might mean that they had cancer and to relate to referral characteristics.
Materials/methods All patients referred on the 2WW to two oral and maxillofacial departments in the three months from January to March 2021 were sent a one-off anonymised study-specific post-consultation survey.
Results In total, 107 of 353 patients responded to the survey (30%). The response rate increased notably in the older group (p <0.001). The cancer conversion rate overall was 5.4% (19/353), stratified as 2.4% (4/167) for general dental practitioner and 8.1% (15/186) for general medical practitioner (p = 0.02). When asked how worried/concerned they were that the reason for referral might have been for cancer, the response was 'very much' (34%, 33/98), and 'somewhat' (24%, 24/98). Concerns tended to be higher in women and those under 40.
Conclusions In recognition of the proportion of patients on the 2WW pathway without cancer who have 'very much worry and concern', it is appropriate to explore ways to alleviate this anxiety, and the best means to achieve this needs careful consideration.
Key points
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Most patients referred on the two-week suspected pathway do not have cancer and should be given reassuring information around the reason for referral.
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There is the potential for high levels of worry and concern for those on the two-week suspected pathway.
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Patients should be seen without undue delay in order to reduce the delay to cancer diagnosis and also minimise the time of anxiety in the worried.
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Acknowledgements
We acknowledge with thanks the patients who completed the survey.
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Catherine E. P. Rowlands: conception and design of study/review/case series; acquisition of data: laboratory or clinical/literature search; analysis and interpretation of data collected; drafting of article and/or critical revision. Peter James: acquisition of data: laboratory or clinical/literature search; drafting of article and/or critical revision. Derek Lowe: conception and design of study/review/case series; analysis and interpretation of data collected; drafting of article and/or critical revision. Simon N. Rogers: drafting of article and/or critical revision; final approval and guarantor of manuscript.
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We have no conflicts of interest. The data was collected for service evaluation and approved by the local Clinical Governance Department.
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Rowlands, C., James, P., Lowe, D. et al. Patient worry and concern associated with referral on the two-week suspected head and neck pathway. Br Dent J (2022). https://doi.org/10.1038/s41415-022-4444-y
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DOI: https://doi.org/10.1038/s41415-022-4444-y
