{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:57:16Z","timestamp":1791809836172,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"22","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2021,11,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 16\u2010week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6\u2010month follow\u2010up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face\u2010to\u2010face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747;\n                      <jats:italic>P<\/jats:italic>\n                      = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay Summary<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This large national study observed the widespread adoption of telephone assessment (supported by a risk calculator) of patients referred to hospital specialists with suspected head and neck cancer during the initial peak of the coronavirus disease 2019 pandemic.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The authors identified 4568 patients from 41 UK centers (serving a population of more than 26 million people) who were followed up for a minimum of 6 months.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Late cancers were identified, whether reviewed or investigated urgently (0.4%) or nonurgently (0.9%), but the overall rate of harm was low (0.2%), with the highest rate being seen with deferred appointments (0.6%).<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.33800","type":"journal-article","created":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T14:35:07Z","timestamp":1629383707000},"page":"4177-4189","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Remote triage incorporating symptom\u2010based risk stratification for suspected head and neck cancer referrals: A prospective population\u2010based study"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6591-5119","authenticated-orcid":false,"given":"John C.","family":"Hardman","sequence":"first","affiliation":[{"name":"Head and Neck Unit Royal Marsden NHS Foundation Trust London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2828-2874","authenticated-orcid":false,"given":"Theofano","family":"Tikka","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Queen Elizabeth University Hospital Glasgow Glasgow United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7933-4585","authenticated-orcid":false,"given":"Vinidh","family":"Paleri","sequence":"additional","affiliation":[{"name":"Head and Neck Unit Royal Marsden NHS Foundation Trust London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ENT UK, BAHNO and INTEGRATE (The UK ENT Trainee Research Network)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,19]]},"reference":[{"key":"e_1_2_8_2_1","article-title":"Admission avoidance in tonsillitis and peritonsillar abscess: a prospective national audit during the initial peak of the COVID\u201019 pandemic","author":"Smith ME","year":"2020","journal-title":"Clin Otolaryngol"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13716"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30334-X"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2020.0948"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X20985391"},{"key":"e_1_2_8_7_1","article-title":"Surgeon\u2010performed ultrasound in a head and neck surgical oncology clinic: saving time and improving patient care","author":"Kwok MMK","year":"2020","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-021-06729-1"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(20)30194-1"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13511"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7417.745"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00022-X"},{"key":"e_1_2_8_13_1","unstructured":"Suspected cancer: recognition and referral.NICE guideline [NG12]. National Institute for Health and Care Excellence.https:\/\/www.nice.org.uk\/guidance\/ng12\/chapter\/1\u2010Recommendations\u2010organised\u2010by\u2010site\u2010of\u2010cancer#head\u2010and\u2010neck\u2010cancers. Updated January 29 2021. Accessed May 21 2021."},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26219"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_8_16_1","unstructured":"CancerData.National Cancer Registration and Analysis Service.https:\/\/www.cancerdata.nhs.uk. 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Accessed February 16 2021."},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13510"}],"updated-by":[{"DOI":"10.1002\/cncr.34358","type":"erratum","label":"Erratum","source":"publisher","updated":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000}}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33800","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.33800","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33800","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T17:20:52Z","timestamp":1760289652000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.33800"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,19]]},"references-count":26,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2021,11,15]]}},"alternative-id":["10.1002\/cncr.33800"],"URL":"https:\/\/doi.org\/10.1002\/cncr.33800","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,19]]},"assertion":[{"value":"2021-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}