Introduction
Head and neck cancer (HNC) is a collective term used to describe a group
of cancers that arise from tissue in the head and neck region. HNC
patients are diagnosed via emergency presentation, routine referral, or
via the nationally approved ‘urgent suspected cancer (USC)’ (formerly
“‘two-week wait’), pathways having presented with one or more of a set
of ‘red flag’ signs or symptoms to their General Practitioner (GP). A
validated HNC risk-calculator, the HaNC-RC-v2, which combines patient
demographics, risk factors, and a set of 12 ‘red-flag’ symptoms has been
developed to differentiate patients into having a high (≥7%) or low
(<7%) probability of having cancer (2).
In 2019/2020 227,665 patients were referred in England with suspected
HNC of which 6,466 were subsequently diagnosed with cancer (3).This
represents a conversion rate of 2.8%, meaning the overwhelming majority
(97%) of patients referred on an urgent suspected head and neck cancer
(USHNC) pathway do not have cancer. Once referred on an USHNC pathway,
review in secondary care is traditionally done face-to-face by a HNC
surgeon who undertakes a history and a physical examination which may
include direct examination of the mucosal surfaces of the head and neck
region with flexible nasendoscopy (FNE).
In 2020 the global coronavirus disease pandemic (COVID-19) saw a
dramatic re-rationalisation of healthcare resources, with a shift to
non-contact interactions necessitated to reduce disease spread, protect
population health and to prevent overwhelming hospital systems. Ear Nose
and Throat (ENT) and HNC specialists were particularly vulnerable due to
their interactions with the reservoirs of the virus (nasopharynx), which
saw these doctors worldwide unduly affected by nosocomial infection (4).
As a result, the national governing bodies of UK HNC surgeons, advised
that patients with USHNC should be assessed by telephone using the
(HaN-RC-v.2) to help risk-stratify who should be seen face-to-face (1).
Despite the recent abatement of the COVID-19 pandemic, telephone
consultations have remained across a wide range of healthcare settings,
seen as a solution helping to address the ongoing challenge of
increasing referrals to secondary care, with limited resources to meet
this referral demand. External solutions, such as automation, are
increasingly being reviewed as a means to help address this ongoing
capacity-demand mismatch.
Ufonia, a digital health company, has created ‘Dora’, an AI-driven
clinical assistant which can conduct a natural-language telephone
conversation with patients (5). Dora is a UKCA Class 1 approved medical
device. In 2022 Ufonia and *INSTITUTION* were awarded a UK Research and
Innovation Small Business Research Initiative (SBRI) healthcare grant to
develop and pilot this technology to the clinical application of HNC
triage. The HNC triage conversation was based on the HaNC-RCv.2 and was
co-created with patients from the ‘Heads2Gether’ HNC charity.