Abstract
Objectives
To report the incidence of locoregional recurrence in HNC patients under surveillance following treatment undergoing symptom-based remote assessment.
Design
A 16-week multicentre prospective cohort study.
Setting
UK ENT departments.
Participants
HNC patients under surveillance following treatment undergoing symptom-based telephone assessment.
Main outcome measures
Incidence of locoregional recurrent HNC after minimum 6-month follow-up.
Results
Data for 1,078 cases were submitted by 16 centres, with follow-up data completed in 98.9% (n=1,066).
Following telephone consultation, 83.7% of referrals had their face-to-face appointments deferred (n=897/1,072). New symptoms were reported by 11.6% (n=124/1072) at telephone assessment; 72.6% (n=90/124) of this group were called for urgent assessments, of whom 48.9% (n=44/90) came directly for imaging without preceding clinical review.
The sensitivity and specificity for new symptoms as an indicator of cancer recurrence were 35.3% and 89.4%, respectively, with a negative predictive value of 99.7% (p=0.002).
Locoregional cancer identification rates after a minimum of 6 months of further monitoring, when correlated with time since treatment, were: 6.0% (n=14/233) <1 year; 2.1% (n=16/747) between 1 and 5 years; and 4.3% (n=4/92) for those >5 years since treatment.
Conclusions
Telephone assessment, using patient-reported symptoms, to identify recurrent locoregional HNC was widely adopted during the initial peak of the COVID-19 pandemic in the UK. The majority of patients had no face-to-face reviews or investigations. New symptoms were significantly associated with the identification of locoregional recurrent cancers with a high specificity, but a low sensitivity may limit symptom assessment being used as the sole surveillance method.
