Are two-week wait clinics appropriate?

Sir, I read with interest the paper by Hook et al. regarding the appropriateness of two-week wait head and neck cancer referrals to their district general hospital. I would like to share the findings of a similar service evaluation that we carried out in 2020 on our two-week wait clinics in a tertiary unit in the South West providing head and neck cancer services.

From the 131 new patients seen, 94% were referred by their GP, with a mean age of 54 years and a M:F ratio of 1:1. From this, 79% and 35% of patients underwent further special investigations which included ultrasound scans and fine needle aspiration, respectively. The overall prevalence of cancer was 20%, with a mean age of 61 years. Twenty-four percent of patients were diagnosed with benign lymphadenopathy and were subsequently discharged.

The findings of our service evaluation show a higher prevalence of malignancy compared to the findings of Hook et al. (20% vs 6%). Rapid identification and intervention of these patients are critical for improved outcomes. However, the success of this pathway is reliant on the availability of diagnostic services, the expertise of healthcare professionals, and the patients' awareness and prompt response to any alarming symptoms. Ongoing training and education of healthcare professionals is needed in order to equip them with the necessary skills to make appropriate, informed and timely referrals.