N J A Cozens1. 1. Derbyshire Royal Infirmary, Derby Acute Hospitals NHS Foundation Trust, Derby, UK. neil.cozens@derbyhospitals.nhs.uk
Abstract
BACKGROUND: The National Institute of Clinical Excellence guidance on cancer services produced the Improving Outcomes in Head and Neck Cancers in 2004. One of the seven 'key recommendations' is the stipulation that 'diagnostic clinics should be established for patients with neck lumps'. OBJECTIVE OF REVIEW: The objective of this review was to examine the basis on which the Improving Outcomes Guidance (IOG) makes its specific recommendation for the establishment of neck lump clinics. TYPE OF REVIEW: This review analyses the original explicit questions asked by the NICE review team, cross references the guidance and evidence documents to examine the strength of the supporting evidence. SEARCH STRATEGY: 'One stop clinic' and 'neck lump' were used as search terms, from 1996 to 2008 to include relevant papers, whether cited by IOG or not. EVALUATION METHOD: Original articles of all potentially relevant papers were obtained and analysed with respect to the IOG key recommendation above. RESULTS: Evaluation of both IOG cited and additional evidence does not corroborate the specific key recommendation that one-stop neck lump clinics staffed by a surgeon and pathologist must be established in all Cancer networks. CONCLUSIONS: Overall, the specific NICE IOG guidance does not have the weight of objective evidence to justify such a categorical and specific recommendation. Alternative models of provision of diagnostic clinics may offer equally or more effective patient care than their stipulated 'one-stop' surgeon and pathologist model.
BACKGROUND: The National Institute of Clinical Excellence guidance on cancer services produced the Improving Outcomes in Head and Neck Cancers in 2004. One of the seven 'key recommendations' is the stipulation that 'diagnostic clinics should be established for patients with neck lumps'. OBJECTIVE OF REVIEW: The objective of this review was to examine the basis on which the Improving Outcomes Guidance (IOG) makes its specific recommendation for the establishment of neck lump clinics. TYPE OF REVIEW: This review analyses the original explicit questions asked by the NICE review team, cross references the guidance and evidence documents to examine the strength of the supporting evidence. SEARCH STRATEGY: 'One stop clinic' and 'neck lump' were used as search terms, from 1996 to 2008 to include relevant papers, whether cited by IOG or not. EVALUATION METHOD: Original articles of all potentially relevant papers were obtained and analysed with respect to the IOG key recommendation above. RESULTS: Evaluation of both IOG cited and additional evidence does not corroborate the specific key recommendation that one-stop neck lump clinics staffed by a surgeon and pathologist must be established in all Cancer networks. CONCLUSIONS: Overall, the specific NICE IOG guidance does not have the weight of objective evidence to justify such a categorical and specific recommendation. Alternative models of provision of diagnostic clinics may offer equally or more effective patient care than their stipulated 'one-stop' surgeon and pathologist model.