{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:19:01Z","timestamp":1773901141981,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,2,20]],"date-time":"2020-02-20T00:00:00Z","timestamp":1582156800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Pharyngolaryngeal and oesophagogastric cancers present with swallowing symptoms and as such, their clinical evaluation traverses boundaries between different specialties. We studied the incidence and significance of interspecialty cancer referrals (ICRs), that is, pharyngolaryngeal cancers first evaluated by gastroenterology and oesophagogastric cancers first evaluated by otolaryngology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A subset analysis of our Integrated Aerodigestive Partnership's audit dataset, of all ICR patients, and an equal number of controls matched for age, sex and cancer subsite.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Information about patient age and presenting symptoms was recorded. The relationship between symptoms and ICR risk was examined with binary logistic regression. Referral\u2010to\u2010diagnosis latency was compared between ICR and control patients with unpaired Student's <jats:italic>t<\/jats:italic> test. Cox regression was used to identify independent predictors of overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1130 patients with pharyngolaryngeal and oesophagogastric cancers between 2008 and 2018, 60 diagnoses (5.3%) were preceded by an ICR. Referral\u2010to\u2010diagnosis latency increased from 43\u00a0\u00b1\u00a050\u00a0days for control patients to 115\u00a0\u00b1\u00a0140\u00a0days for ICR patients (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001). Dysphagia significantly increased the risk of an ICR (odds ratio 3.34; 95% CI 1.30\u20108.56), and presence of\u00a0classic gastroesophageal\u00a0reflux symptoms (heartburn or regurgitation; OR 0.25; 95% CI 0.08\u20100.83) and \u201cdistal\u201d symptoms (nausea\/vomiting, abdominal pain or dyspepsia; OR 0.23; 95% CI 0.08\u2010068) significantly reduced the risk. Eleven pharyngolaryngeal cancers (of 26; 42%) were missed by gastroenterology, and eight (of 34; 24%) oesophageal cancers were missed by otolaryngology. An ICR was an independent adverse prognostic risk factor on multivariable analysis (hazard ratio 1.76; 95% CI 1.11\u20102.73; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.02; log\u2010rank test). Two systemic root causes were poor visualisation of pharynx and larynx by per\u2010oral\u00a0oesophago\u2010gastro\u2010duodenoscopy (OGD) for pharyngolaryngeal cancers, and poor sensitivity (62.5%) of barium swallow when it was used to 'evaluate' oesophageal mucosa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An interspecialty cancer referral occurs in a significant proportion of patients with foregut cancers. It almost triples the time to cancer diagnosis and is associated with a high incidence of missed cancers and diminished patient survival. It is a complex phenomenon, and its reduction requires an integrated approach between primary and secondary care, and within secondary care, to optimise referral pathways and ensure appropriate and expeditious specialist evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13510","type":"journal-article","created":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T03:54:30Z","timestamp":1580097270000},"page":"370-379","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Interspecialty referral of oesophagogastric and pharyngolaryngeal cancers delays diagnosis and reduces patient survival: A matched case\u2010control study"],"prefix":"10.1111","volume":"45","author":[{"given":"Jon H.","family":"Bird","sequence":"first","affiliation":[{"name":"Department of Ear Nose and Throat Surgery Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate J.","family":"Heathcote","sequence":"additional","affiliation":[{"name":"Department of Ear Nose and Throat Surgery Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lachlan","family":"Ayres","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilantha","family":"De Zoysa","sequence":"additional","affiliation":[{"name":"Department of Ear Nose and Throat Surgery Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma V.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Ear Nose and Throat Surgery Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sally D.","family":"Parry","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5604-1739","authenticated-orcid":false,"given":"S. A. Reza","family":"Nouraei","sequence":"additional","affiliation":[{"name":"Department of Ear Nose and Throat Surgery Poole Hospital NHS Foundation Trust Poole UK"},{"name":"Clinical Informatics Research Unit University of Southampton Southampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.48"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jcag\/gwx008"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl16615"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1037\/e363212004-001"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.6003"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215118001718"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314109"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000128303.05898.ee"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-304269"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13115"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-012-0013-z"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A1605"},{"key":"e_1_2_8_14_1","unstructured":"https:\/\/www.longtermplan.nhs.uk\/areas-of-work\/cancer\/. Accessed February 2 2020."},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i6.1038"},{"key":"e_1_2_8_16_1","first-page":"727","article-title":"Virchow's node revisited. Analysis with clinicopathologic correlation of 152 fine\u2010needle aspiration biopsies of supraclavicular lymph nodes","volume":"119","author":"Cervin JR","year":"1995","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930590406"},{"key":"e_1_2_8_18_1","first-page":"3639","article-title":"Evaluating dysphagia","volume":"61","author":"Spieker MR","year":"2000","journal-title":"Am Fam Physician"},{"key":"e_1_2_8_19_1","volume-title":"Dysphagia: Global Guidelines & Cascades","author":"Malagelada J","year":"2014"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2012-100244"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-015-9605-6"},{"key":"e_1_2_8_22_1","unstructured":"https:\/\/nzsg.org.nz\/training\/endoscopy-training\/. Accessed February 2 2020."},{"key":"e_1_2_8_23_1","volume-title":"JETS User Guide for Trainees","author":"Joint Advisory Group on GI Endoscopy","year":"2017"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-123185"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doy013"}],"container-title":["Clinical Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcoa.13510","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.13510","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/coa.13510","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.13510","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T21:33:47Z","timestamp":1694036027000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/coa.13510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,20]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1111\/coa.13510"],"URL":"https:\/\/doi.org\/10.1111\/coa.13510","archive":["Portico"],"relation":{},"ISSN":["1749-4478","1749-4486"],"issn-type":[{"value":"1749-4478","type":"print"},{"value":"1749-4486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,20]]},"assertion":[{"value":"2019-06-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}