Outcomes of an Advanced Speech and Language Therapist-Led Low-Risk 2-Week Wait Clinic for Suspected Head and Neck Cancer: A UK-Based Pilot Study

Abstract

To describe outcomes of a pilot Speech and Language Therapist led (SLT-led) 2-week wait (2WW) assessment clinic for head and neck cancer (HNC). A prospective 3-month pilot clinic was conducted. All referrals were triaged by an otolaryngologist. Referrals for unilateral symptoms, palpable neck lumps and/or ear pain were excluded. SLTs performed initial assessment. All patients received oral and neck examinations, and a videolaryngoscopy, including therapy trials. All images and management plans were discussed with an otolaryngologist within one week of the clinic. Images of suspicious lesions were reviewed within 24 hours. Data were collected consecutively for all patients attending the clinic between December 2021 and March 2022. Data included demographics, smoking history, perceptual voice ratings (GRBAS), validated patient-reported outcome measures (PROMs), diagnoses, and clinical plans. Descriptive statistics were conducted within Excel and inferential statistics within SPSS. Over 3 months, 218 patients were seen, 62% were female and the mean age was 63 years. Most patients (54%) opted for "patient initiated follow-up" and 16% received further investigations. No patients required Ear, Nose and Throat (ENT) outpatient review for second opinion. Most (65%) received a functional diagnosis. The diagnostic yield of cancer was 5% (n=11) and high-grade dysplasia was 3% (n=6). At the time of writing, no patients had been re-referred to the service. There was a positive relationship between risk of diagnosis and mean GRBAS score (P < 0.01), and VHI-10 score (p=0.013). Patients with higher-risk diagnoses tended to be male, older, and had a history of smoking. PROMs suggested that laryngeal symptoms, regardless of underlying pathology, affect quality of life. Experienced SLTs working alongside otolaryngologists safely led assessment and directed treatment planning for patients referred to ENT on the 2WW pathway. The rate of high-risk diagnoses was low. Higher GRBAS and VHI-10 scores may be useful indicators for higher risk diagnoses.