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Effect of Mouth Cancer Awareness Week on urgent suspected head and neck cancer referrals
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British Journal of Oral and Maxillofacial Surgery 51 (2013) e183–e185
Short communication
Effect of Mouth Cancer Awareness Week on urgent suspected head and neck cancer referrals Raheela Rafiq a,∗ , Paul Brocklehurst b , Simon N. Rogers a,c a b c
Oral and Maxillofacial Surgery, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, UK School of Dentistry, University of Manchester, UK Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St. Helens Road, Ormskirk L39 4QP, UK
Accepted 30 April 2012 Available online 6 July 2012
Abstract The purpose of this study was to find out whether Mouth Cancer Awareness Week and associated activities made any difference to the number of urgent or two-week urgent referrals to the oral and maxillofacial department at University Hospital, Aintree, whether they were appropriate, and the number of patients who were found to have cancer. A prospective audit over six months before, during, and after the awareness week showed a rise in the number of referrals over time, with the highest number in February. Of the 120 patients evaluated, cancer was confirmed in 13 (11%). © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Mouth Cancer Awareness Week; Urgent suspected head and neck cancer referrals; Appropriateness; Cancer positive cases
Introduction Delayed presentation is an important factor in poor survival for oral cancer.1 There is generally a lack of awareness of mouth cancer among the lay public in the Mersey region2 and among those treated for oral and oropharyngeal cancer.3 It seems that general dental practitioners recognise the signs of early oral cancer better than general medical practitioners,4–7 which is important as more patients present to their doctor (59%) than to their dentist (29%).8 The first national Mouth Cancer Awareness Week was held in 2001 and has become an annual health campaign that aims to raise the profile of mouth cancer by increasing awareness among the public and among health professionals.9 For many years, the oral and maxillofacial department at Aintree University Hospital has held events locally to coincide with the awareness week. During the week in November ∗
Corresponding author. Tel.: +44 07736969544; fax: +44 01515295288. E-mail addresses: raheela [email protected] (R. Rafiq), [email protected] (S.N. Rogers).
2010, in addition to daily drop-in outpatient clinics and several open invitation talks, dental practices across the region were given an awareness DVD. There was also an awareness day in a local shopping centre, which was advertised on local radio and featured on North West Tonight on BBC television. We aimed to find out whether the awareness week and associated activities made any difference to the number of urgent or two-week urgent referrals to the department, and to ascertain how appropriate these were, and the number of patients who had cancer.
Method We prospectively audited data collected in clinic by consultants and specialist registrars from 1 September 2010 to 28 February 2011, on patients who were referred with urgent suspected head and neck cancer. The study was approved by the clinical audit department. Clinicians completed a data collection form and were asked about the appro-
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.04.270
e184
R. Rafiq et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e183–e185
Table 1 Summary of all urgent and two-week urgent referrals to the oral and maxillofacial surgery department at the University Hospital, Aintree from 1 September 2010 to 28 February 2011. Month
Total no of urgent referrals No of referrals included in the audit Proforma GP GDP Letter GP GDP MCAWa No of appropriate referrals in the audit: Appropriate GP GDP MCAWa Not appropriate GP GDP MCAWa No of cases of cancer identified in the audit GP GDP MCAWa Total no of referrals in the audit
Sept
Oct
Nov
Dec
Jan
Feb
22
27
28
34
18
47
11 1
14 1
15 3
14 2
10 –
24 2
2 3 –
1 2 –
4 3 –
2 1 6
– 1 –
2 2 –
10 2 –
12 1 –
11 6 –
6 3 4
5 – –
15 1 –
3 2 –
3 2 –
8 – –
10 – 2
5 1 –
11 3 –
2 1 – 17
4 – – 18
– 2 – 25
– – – 25
2 – – 11
2 – – 30
a MCAW (Mouth Cancer Awareness Week): these are additional referrals to the unit for further evaluation having been seen in drop-in clinics and the shopping centre during the week.
priateness of the referral based on the likelihood of the lesion being cancerous. Follow-up data, such as results of biopsy examination, was collected from a review of the case notes.
low (n = 2) in November, and no cases of oral cancer were diagnosed in December.
Discussion Results From a total of 176 patients who presented during the six months, 120 (68%) had audit forms completed (Table 1). There were 99 (83%) referrals from general medical practitioners and 21 (18%) from general dental practitioners. Eighty-eight (89%) referrals by general medical practitioners and 9 (43%) by general dental practitioners used the urgent suspected proforma. A total of 48 (40%) referrals were deemed inappropriate. The proportion of appropriate to inappropriate referrals was similar for both groups (general practitioners: 60% compared with 40%; dentists 62% compared with 38%). Thirteen (11%) cases of cancer were detected during the period, which is similar to other studies on urgent suspected head and neck cancer referrals. The number of referrals rose during the audit period with the highest number in February. The highest number of referrals by dentists was in November, when they also used the urgent suspected proforma more. The number of referrals and therefore the proportion of inappropriate referrals by general medical practitioners increased during November and December; it is not known whether this was related to greater awareness as a result of the awareness week. The cancer rates were
Although this audit was limited to 68% of the urgent referrals over a six-month period, it seems to be representative as the cancer rate at the department was 9%; for those included in the audit it was 11%. Changes to junior staff made the audit difficult to maintain for more than six months. Innovative ways to raise awareness among patients and professionals around the time of awareness week need to be explored further, and the long-term effects evaluated.
Acknowledgement The authors would like to thank the Head and Neck Practice Development Unit at the University Hospital Aintree department for assistance with data collection.
References 1. Cancer Research UK. UK oral cancer statistics. Available from URL: http://info.cancerresearchuk.org/cancerstats/types/oral/ 2. Rogers SN, Hunter R, Lowe D. Awareness of oral cancer in the Mersey region. Br J Oral Maxillofac Surg 2011;49:176–81.
R. Rafiq et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e183–e185 3. Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. Br J Oral Maxillofac Surg 2011;49:349–53. 4. Brocklehurst PR, Baker SR, Speight PM. A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer. Br Dent J 2010;208(E3): 72–3. 5. Brocklehurst PR, Baker SR, Speight PM. Factors which determine the referral of potentially malignant disorders by primary care dentists. J Dent 2010;38:569–78.
e185
6. Carter LM, Ogden GR. Oral cancer awareness of general medical and general dental practitioners. Br Dent J 2007;203(E10):248–9. 7. Greenwood M, Lowry RJ. Primary care clinicians’ knowledge of oral cancer: a study of dentists and doctors in the North East of England. Br Dent J 2001;191:510–2. 8. Rodgers J, Macpherson LM, Smith GL, Crighton AJ, Carton AT, Conway DI. Characteristics of patients attending rapid access clinics during the West of Scotland Cancer Awareness Programme oral cancer campaign. Br Dent J 2007;202(E28):680–1. 9. British Dental Health Foundation. Mouth cancer action. Available from URL: http://www.mouthcancer.org/
British Journal of Oral and Maxillofacial Surgery 51 (2013) e183–e185
Short communication
Effect of Mouth Cancer Awareness Week on urgent suspected head and neck cancer referrals Raheela Rafiq a,∗ , Paul Brocklehurst b , Simon N. Rogers a,c a b c
Oral and Maxillofacial Surgery, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, UK School of Dentistry, University of Manchester, UK Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St. Helens Road, Ormskirk L39 4QP, UK
Accepted 30 April 2012 Available online 6 July 2012
Abstract The purpose of this study was to find out whether Mouth Cancer Awareness Week and associated activities made any difference to the number of urgent or two-week urgent referrals to the oral and maxillofacial department at University Hospital, Aintree, whether they were appropriate, and the number of patients who were found to have cancer. A prospective audit over six months before, during, and after the awareness week showed a rise in the number of referrals over time, with the highest number in February. Of the 120 patients evaluated, cancer was confirmed in 13 (11%). © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Mouth Cancer Awareness Week; Urgent suspected head and neck cancer referrals; Appropriateness; Cancer positive cases
Introduction Delayed presentation is an important factor in poor survival for oral cancer.1 There is generally a lack of awareness of mouth cancer among the lay public in the Mersey region2 and among those treated for oral and oropharyngeal cancer.3 It seems that general dental practitioners recognise the signs of early oral cancer better than general medical practitioners,4–7 which is important as more patients present to their doctor (59%) than to their dentist (29%).8 The first national Mouth Cancer Awareness Week was held in 2001 and has become an annual health campaign that aims to raise the profile of mouth cancer by increasing awareness among the public and among health professionals.9 For many years, the oral and maxillofacial department at Aintree University Hospital has held events locally to coincide with the awareness week. During the week in November ∗
Corresponding author. Tel.: +44 07736969544; fax: +44 01515295288. E-mail addresses: raheela [email protected] (R. Rafiq), [email protected] (S.N. Rogers).
2010, in addition to daily drop-in outpatient clinics and several open invitation talks, dental practices across the region were given an awareness DVD. There was also an awareness day in a local shopping centre, which was advertised on local radio and featured on North West Tonight on BBC television. We aimed to find out whether the awareness week and associated activities made any difference to the number of urgent or two-week urgent referrals to the department, and to ascertain how appropriate these were, and the number of patients who had cancer.
Method We prospectively audited data collected in clinic by consultants and specialist registrars from 1 September 2010 to 28 February 2011, on patients who were referred with urgent suspected head and neck cancer. The study was approved by the clinical audit department. Clinicians completed a data collection form and were asked about the appro-
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.04.270
e184
R. Rafiq et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e183–e185
Table 1 Summary of all urgent and two-week urgent referrals to the oral and maxillofacial surgery department at the University Hospital, Aintree from 1 September 2010 to 28 February 2011. Month
Total no of urgent referrals No of referrals included in the audit Proforma GP GDP Letter GP GDP MCAWa No of appropriate referrals in the audit: Appropriate GP GDP MCAWa Not appropriate GP GDP MCAWa No of cases of cancer identified in the audit GP GDP MCAWa Total no of referrals in the audit
Sept
Oct
Nov
Dec
Jan
Feb
22
27
28
34
18
47
11 1
14 1
15 3
14 2
10 –
24 2
2 3 –
1 2 –
4 3 –
2 1 6
– 1 –
2 2 –
10 2 –
12 1 –
11 6 –
6 3 4
5 – –
15 1 –
3 2 –
3 2 –
8 – –
10 – 2
5 1 –
11 3 –
2 1 – 17
4 – – 18
– 2 – 25
– – – 25
2 – – 11
2 – – 30
a MCAW (Mouth Cancer Awareness Week): these are additional referrals to the unit for further evaluation having been seen in drop-in clinics and the shopping centre during the week.
priateness of the referral based on the likelihood of the lesion being cancerous. Follow-up data, such as results of biopsy examination, was collected from a review of the case notes.
low (n = 2) in November, and no cases of oral cancer were diagnosed in December.
Discussion Results From a total of 176 patients who presented during the six months, 120 (68%) had audit forms completed (Table 1). There were 99 (83%) referrals from general medical practitioners and 21 (18%) from general dental practitioners. Eighty-eight (89%) referrals by general medical practitioners and 9 (43%) by general dental practitioners used the urgent suspected proforma. A total of 48 (40%) referrals were deemed inappropriate. The proportion of appropriate to inappropriate referrals was similar for both groups (general practitioners: 60% compared with 40%; dentists 62% compared with 38%). Thirteen (11%) cases of cancer were detected during the period, which is similar to other studies on urgent suspected head and neck cancer referrals. The number of referrals rose during the audit period with the highest number in February. The highest number of referrals by dentists was in November, when they also used the urgent suspected proforma more. The number of referrals and therefore the proportion of inappropriate referrals by general medical practitioners increased during November and December; it is not known whether this was related to greater awareness as a result of the awareness week. The cancer rates were
Although this audit was limited to 68% of the urgent referrals over a six-month period, it seems to be representative as the cancer rate at the department was 9%; for those included in the audit it was 11%. Changes to junior staff made the audit difficult to maintain for more than six months. Innovative ways to raise awareness among patients and professionals around the time of awareness week need to be explored further, and the long-term effects evaluated.
Acknowledgement The authors would like to thank the Head and Neck Practice Development Unit at the University Hospital Aintree department for assistance with data collection.
References 1. Cancer Research UK. UK oral cancer statistics. Available from URL: http://info.cancerresearchuk.org/cancerstats/types/oral/ 2. Rogers SN, Hunter R, Lowe D. Awareness of oral cancer in the Mersey region. Br J Oral Maxillofac Surg 2011;49:176–81.
R. Rafiq et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) e183–e185 3. Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. Br J Oral Maxillofac Surg 2011;49:349–53. 4. Brocklehurst PR, Baker SR, Speight PM. A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer. Br Dent J 2010;208(E3): 72–3. 5. Brocklehurst PR, Baker SR, Speight PM. Factors which determine the referral of potentially malignant disorders by primary care dentists. J Dent 2010;38:569–78.
e185
6. Carter LM, Ogden GR. Oral cancer awareness of general medical and general dental practitioners. Br Dent J 2007;203(E10):248–9. 7. Greenwood M, Lowry RJ. Primary care clinicians’ knowledge of oral cancer: a study of dentists and doctors in the North East of England. Br Dent J 2001;191:510–2. 8. Rodgers J, Macpherson LM, Smith GL, Crighton AJ, Carton AT, Conway DI. Characteristics of patients attending rapid access clinics during the West of Scotland Cancer Awareness Programme oral cancer campaign. Br Dent J 2007;202(E28):680–1. 9. British Dental Health Foundation. Mouth cancer action. Available from URL: http://www.mouthcancer.org/