Training and competency frameworks used in the preparation of healthcare professionals for head and neck cancer screening: A scoping review protocol.

Objectives: This scoping review aims to identify existing training and competency frameworks for healthcare professionals who assess or screen patients on the suspected Head and Neck Cancer (HNC) pathway or in extended practice models, and to explore how skills are developed, and competence assessed, prior to practice.

Introduction: Up to 97% of people referred with suspected HNC in the UK do not have cancer. This contributes to long wait lists and referral to treatment time in HNC services.

Assessment and interpretation of the status of surgical margins following resective surgery for head and neck squamous cancer: a narrative review.

Background: The two well-known quality-assessment metrics of head and neck oncosurgery are the status of surgical margin (SM) and lymph node yield (LNY). While the clinical importance of LNY has been well-established, several unresolved controversies around the SM have deterred its practical application.

Methods: This article reviews some of the issues with the SM and ongoing efforts to improve its clinical application and reliability.

Multidisciplinary evidence-based consensus statements on salvage surgery for recurrent head and neck cancer (International Centre for Recurrent head and neck Cancer).

Background: Recurrent head and neck squamous cell carcinomas (rHNSCC) are an understudied subgroup, lacking high quality evidence and thus gold standard management recommendations, resulting in significant variations in practice. The aim of this project was to deliver a national multi-disciplinary expert consensus on patients with rHNSCC managed by curative salvage surgery.

Methods: The AGREEII protocol guided the Delphi process.

Lymphatic mapping Of Oropharyngeal Cancer (LOOC): protocol for a phase II surgical imaging trial to evaluate contralateral drainage and occult metastasis in oropharyngeal cancer.

Introduction: Treatment of the node negative contralateral neck in oropharyngeal cancer (OPC) remains debated, with no clear consensus. Prophylactic contralateral neck treatment (either surgically or via irradiation) is generally recommended when the estimated risk of occult nodal metastasis is >20%. Unfortunately, patients undergoing bilateral neck treatment often require long-term supportive care for swallowing dysfunction.

Improving the Usability of a Digital Questionnaire to Elicit Symptoms for Patients Referred via the Cancer Diagnostic Pathway for Suspected Head and Neck Cancer.

We present the usability testing of a digital questionnaire co-designed with patient representatives. Two usability methods, think-aloud and timed usability testing, were employed to assess the system. Twelve participants took part in the study by completing the questionnaire, reporting HNC symptoms.

Clinical Factors Influencing the Compliance With National Head and Neck Cancer Targets in the United Kingdom: Results From a National Cohort Study.

Introduction: In the United Kingdom, it is the standard of care that treatment decisions in all new cases of head and neck cancer (HNC) are discussed at a multidisciplinary team meeting (MDT). The aim of this project was to gain a national perspective on the scope of current HNC treatment, compliance with national cancer pathway targets, and their influence on survival outcomes.

Methods: A multicentre, retrospective, national observational study of primary HNC patients was discussed at a specialist MDT between September and November 2021.

Qualitative study to inform the design and contents of a patient-reported symptom-based risk stratification system for patients referred from primary care on a suspected head and neck cancer diagnostic pathway.

Objectives: This study aims to inform the development of a patient-reported symptom questionnaire for head and neck cancer and outline the requirements for a patient-reported symptom-based risk stratification system. The study objectives are to explore how clinicians ask questions and decide subsequent steps for patients referred with suspected head and neck cancer; the language patients and clinicians use to describe symptoms; how clinicians reassure and discharge low-risk patients; and identify clinician and patient experiences of the head and neck cancer diagnostic pathway and their views on a novel diagnostic pathway using patient-reported symptom-based risk stratification.

Design: The study employed qualitative methods including observation and recordings of clinic consultations and semistructured interviews with clinicians and patients.

Transoral Robotic Surgery in the Multidisciplinary Care of Patients With Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline.

Purpose: To provide evidence-based recommendations for the use of transoral robotic surgery (TORS) in the multidisciplinary management of oropharyngeal squamous cell cancer (OPC).

Methods: ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. The literature search included studies published between January 1, 2002, and August 31, 2024, and comprised systematic reviews, meta-analyses, randomized controlled trials, and observational studies.

Investigations for Suspected Head and Neck Squamous Cell Carcinoma of Unknown Primary (HNSCCUP): A National Cohort Study.

Objectives: Head and neck squamous cell carcinoma from unknown primary (HNSCCUP) is a rare and challenging condition. This study aimed to investigate the diagnostic pathways of suspected HNSCCUP patients in the United Kingdom.

Methods: A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT (PET-CT) within 3 months of diagnosis with metastatic cervical squamous cell carcinoma.

The Burden of Recurrent Head and Neck Squamous Cell Carcinoma Across the United Kingdom: Results From a National Snapshot Study.

Background: To investigate the management of recurrent head and neck squamous cell carcinoma (rHNSCC) and describe survival outcomes.

Methods: Post hoc subgroup analysis of a retrospective national observational cohort was conducted. All patients with rHNSCC who received a definitive treatment decision between September 1, 2021 and November 30, 2021 were included.

Patient and Caregiver Experience of Diagnosis, Treatment, and Living With Recurrent Oropharyngeal Cancer.

Importance: The management of recurrent oropharyngeal cancer (rOPC) is complex. Curative options carry considerable risk of morbidity with overall poor prognosis. Little data exist on function and quality of life (QoL) outcomes for noncurative treatments.

A Review of Contemporary Image Guidance Techniques in Head and Neck Cancer.

Background: Traditional head and neck cancer treatment involves open surgery, cytotoxic chemotherapy, and conventional radiotherapy planning. Emerging techniques aim to improve precision and reduce associated toxicity and functional impairment in current practice. This review article describes four such adaptations in image guidance, tailored to next generation therapies.

Technology for fast-tracking high-risk head and neck cancer referrals: Co-designing with patients.

Background: Head and Neck Cancer (HNC) is the eighth most prevalent global cancer. Timely recognition of symptoms is crucial for reducing mortality rates. The EVolution of a patiEnt-REported symptom-based risk stratification sySTem to redesign the suspected Head and Neck cancer referral pathway (EVEREST-HN) study aims to develop and evaluate a risk stratification tool using patient reported symptoms, which will be populated remotely in the community before the patient is seen by the clinician to hasten HNC diagnosis.

Nomenclature of the symptoms of head and neck cancer: a systematic scoping review.

Introduction: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients' clinical problems more effectively and risk stratify the patient.

Method: The review followed the PRISMA checklist for scoping reviews.

Survival outcomes in head and neck squamous cell carcinoma of unknown primary: A national cohort study.

Introduction: To investigate factors influencing survival in head and neck squamous cell carcinoma of unknown primary (HNSCCUP).

Methods: A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres, of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients treated as HNSCCUP underwent survival analysis, stratified by neck dissection and/or radiotherapy to the ipsilateral neck, and by HPV status.

Qualitative study exploring the design of a patient-reported symptom-based risk stratification system for suspected head and neck cancer referrals: protocol for work packages 1 and 2 within the EVEREST-HN programme.

Introduction: Between 2009/2010 and 2019/2020, England witnessed an increase in suspected head and neck cancer (sHNC) referrals from 140 to 404 patients per 100 000 population. 1 in 10 patients are not seen within the 2-week target, contributing to patient anxiety. We will develop a pathway for sHNC referrals, based on the Head and Neck Cancer Risk Calculator.

New robotic platform for transoral robotic surgery: an IDEAL stage 0 study.

Objectives: This study aims to assess the feasibility to perform transoral robotic surgery (TORS) with a new robotic platform, the Versius Surgical System (CMR Surgical, UK) in a preclinical cadaveric setting in accordance to stage 0 of the IDEAL-D framework.

Design: IDEAL stage 0 preclinical assessment of the Versius Robotic System in TORS in human cadavers.

Setting: All procedures were performed in a simulated operating theatre environment at a UK surgical training centre.

Monoclonal Antibodies for Targeted Fluorescence-Guided Surgery: A Review of Applicability across Multiple Solid Tumors.

This study aims to review the status of the clinical use of monoclonal antibodies (mAbs) that have completed or are in ongoing clinical trials for targeted fluorescence-guided surgery (T-FGS) for the intraoperative identification of the tumor margins of extra-hematological solid tumors. For each of them, the targeted antigen, the mAb generic/commercial name and format, and clinical indications are presented, together with utility, doses, and the timing of administration. Based on the current scientific evidence in humans, the top three mAbs that could be prepared in a GMP-compliant bank ready to be delivered for surgical purposes are proposed to speed up the translation to the operating room and produce a few readily available "off-the-shelf" injectable fluorescent probes for safer and more effective solid tumor resection.

Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta-analysis.

Objective: Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.

CompARE: study protocol for a phase III randomised controlled platform trial comparing alternative regimens for escalating treatment of intermediate and high-risk oropharyngeal cancer.

Background: Patients with intermediate and high-risk oropharyngeal cancer (OPC) have poorer response to standard treatment and poorer overall survival compared to low-risk OPC. CompARE is designed to test alternative approaches to intensified treatment for these patients to improve survival.

Methods: CompARE is a pragmatic phase III, open-label, multicenter randomised controlled trial with an adaptive multi-arm, multi-stage design and an integrated QuinteT Recruitment Intervention.