Head and Neck Unit, Royal Marsden Hospital, London, UK.
Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK.
Clin Otolaryngol. 2022 Sep;47(5):561-567. doi: 10.1111/coa.13948. Epub 2022 Jun 9.
To report the incidence of locoregional recurrence in head and neck cancer (HNC) patients under surveillance following treatment undergoing symptom-based remote assessment.
A 16-week multicentre prospective cohort study.
UK ENT departments.
HNC patients under surveillance following treatment undergoing symptom-based telephone assessment.
Incidence of locoregional recurrent HNC after minimum 6-month follow-up.
Data for 1078 cases were submitted by 16 centres, with follow-up data completed in 98.9% (n = 1066). Following telephone consultation, 83.7% of referrals had their face-to-face appointments deferred (n = 897/1072). 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 = .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.
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 United Kingdom. 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.
报告在基于症状的远程评估下接受治疗后接受监测的头颈部癌症（HNC）患者中局部区域复发的发生率。
一项 16 周的多中心前瞻性队列研究。
英国耳鼻喉科部门。
在基于症状的电话评估下接受治疗后接受监测的 HNC 患者。
最低 6 个月随访后局部区域复发性 HNC 的发生率。
16 个中心提交了 1078 例病例的数据，98.9%（n=1066）完成了随访数据。在电话咨询后，83.7%（n=897/1072）的转诊患者推迟了面对面预约。在电话评估时，11.6%（n=124/1072）报告了新症状；其中 72.6%（n=90/124）的患者被要求紧急评估，其中 48.9%（n=44/90）直接进行影像学检查，而没有进行先前的临床检查。新症状作为癌症复发的指标的敏感性和特异性分别为 35.3%和 89.4%，阴性预测值为 99.7%（p=0.002）。在进一步监测至少 6 个月后，与治疗时间相关的局部区域癌症检出率分别为：治疗后<1 年为 6.0%（n=14/233）；1 至 5 年为 2.1%（n=16/747）；治疗后>5 年为 4.3%（n=4/92）。
在英国 COVID-19 大流行的最初高峰期，广泛采用电话评估，使用患者报告的症状来识别局部区域复发性 HNC。大多数患者没有面对面的检查或调查。新症状与局部区域复发性癌症的识别显著相关，特异性高，但敏感性低，可能限制了症状评估作为唯一监测方法的应用。
