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Analysis of the impact of deprivation on urgent suspected head and neck cancer referrals in the Mersey region between January 2004 to December 2006

  • Paul Brocklehurst
    Affiliations
    Dental Public Health, School of Dentistry, The University of Manchester, Coupland 3, Oxford Road, Manchester, M13 9PL, UK
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  • Raheela Rafiq
    Affiliations
    Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
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  • Derek Lowe
    Affiliations
    Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK

    Edge Hill University, Liverpool and Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk.UK
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  • Simon Rogers
    Correspondence
    Corresponding author at: Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Fazakerley, Liverpool L9 1AL, UK. Tel.: +44 151 529 5287.
    Affiliations
    Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK

    Edge Hill University, Liverpool and Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk.UK
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      Abstract

      Serious delay in patients presenting with head and neck cancer is associated with poor outcomes. We aimed to examine the influence of deprivation on professional delay in the Mersey region from 2004 to 2006. The study sample comprised 6681 patients who were referred between January 2004 and December 2006. The dataset was dominated by the largest hospital (H1), which received 48% of all cases. Median referral overall was 12 days (IQR 8–15 days), and 74% of patients were referred in 14 days or less. Professional delay (percentage 14 days or less) was associated with hospital (from 58% H1 to 97% H5), year of referral (from 64% in 2004 to 80% in 2006), age (from 69% under 55 years to 80% over 75 years), and deprivation (Index of Multiple Deprivation 2000 from 67% most deprived (IMD 1) to 85% least deprived (IMD 5)). Hospital location was associated with these factors and the results imply that by far, the most important variable in predicting professional delay was the hospital that received the referral. Trends over time in age, and to a lesser extent, for deprivation were noted in H1, but were largely absent across other hospitals. Some of them needed to make substantial improvements to meet the two-week referral pathway and it would be interesting to compare these results with current practice. This study highlights the importance of maintaining the standards of the current policy on two-week referrals for suspected head and neck malignancy.

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