Head and Neck Cancer Risk Calculator (HaNC-RC) - v.2. Adjustments and addition of symptoms and social history factors.

Head and Neck Cancer Risk Calculator (HaNC-RC) - v.2. Adjustments and addition of symptoms and social history factors.:

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Head and Neck Cancer Risk Calculator (HaNC-RC) - v.2. Adjustments and addition of symptoms and social history factors.

Clin Otolaryngol. 2020 Jan 27;:

Authors: Tikka T, Kavanagh K, Lowit A, Jiafeng P, Burns H, Nixon IJ, Paleri V, MacKenzie K

Abstract

OBJECTIVE: Head and neck cancer (HNC) diagnosis through the 2-week-wait, urgent suspicion of cancer (USOC) pathway has failed to increase early cancer detection rates in the UK. A Head and neck cancer risk calculator (HaNC-RC) has previously been designed to aid referral of high-risk patients to USOC clinics (predictive power:77%). Our aim is to refine the HaNC-RC to increase its prediction potential.

DESIGN: Following sample size calculation, prospective data collection was performed from 3531 new patents seen in routine, urgent and USOC head and neck (HaN) clinics. Data collected were: demographics, social history, presenting symptoms and signs and HNC diagnosis. Univariate and multivariate regression analysis was performed to identify significant predictors of HNC. Internal validation was performed using 1000 sample bootstrapping to estimate model diagnostics included the area under the receiver operator curve (AUC), sensitivity, specificity.

RESULTS: The updated version of the risk calculator (HaNC-RC v.2) includes age, gender, unintentional weight loss, smoking, alcohol, positive and negative symptoms and signs of HNC. It has achieved an AUC of 88.6% with two recommended triage referral cut-offs to USOC (cut-off: 7.1%; sensitivity: 85%, specificity:78.3%) or urgent clinics (cut-off:2.2%; sensitivity: 97.1%; specificity of 52.9%). This could redistribute cancer detection through USOC clinics from the current 60.9% to 85.2%, without affecting total numbers seen in each clinical setting.

CONCLUSIONS: The use of the HaNC-RC v.2 has a significant potential in both identifying patients at high risk of HNC early thought USOC clinics but also improving health service delivery practices by reducing the number of inappropriately urgent referrals.

PMID: 31985180 [PubMed - as supplied by publisher]