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As healthcare workers, we are committed to ensuring that our patients continue to receive the optimum care that we are set up to deliver. However, the last year has shown that we need to be mindful of balancing this with protecting those who deliver key services and the vulnerable in society. The situation has forced all aspects of healthcare to develop novel ways of assessing and delivering key services without compromising care. The paper discussed in our Editors’ Choice review looks at utilising a validated and published methodology of stratifying potential cancer referrals into risk groups and managing them accordingly. The authors show a sound process for ensuring that care is not delayed for the high-risk group and, at the same time, ensuring the low-risk group are managed and not simply added to an ever-growing outpatient waiting list. Thank you to all our reviewers for their hard work and contributions.

Nazia Munir and Hannah Cooper





The prevailing COVID-19 pandemic calls for urgent modification of the diagnostic protocol for suspected head and neck cancer patients being referred through the two-week wait system. The authors emphasise the use of risk stratification, using the established risk calculator for probability of head and neck cancer. On the basis of this triage, the patients can be categorised into low (less than 2%), intermediate (2-7%) and high (over 7%) risk of having cancer. A third of total referrals fell into each group. The first group was referred back to primary care with the patient advised to seek review in primary after three months if concerns prevailed and be re-referred. The intermediate and high-risk patients underwent investigations, mainly cross-sectional imaging and ultrasound-guided FNA and, where necessary, these modalities were complemented to each other. If tissue diagnosis was unavailable, referral to MDT was made with a view to diagnostic transoral resection or biopsy. Guidance for thyroid nodules varies between The British Society of Head and Neck Imaging, who suggest postponing ultrasound scanning unless nodules enlarge and cause onset of breathing and swallowing problems, and the British Association of Endocrine and Thyroid surgeons who prefer regular scanning but FNA limited to the ‘U’ class. The authors support the former. Ultrasound guided core biopsy prior to clinical review is recommended for patients referred by the haematology-oncology department. The essential message is to reduce hospital visits with aerosol-generating procedures and minimise diagnostic and therapeutic surgical procedures within an algorithm of robust safety netting.

North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients.
Warner E, Schofield D W, Adams A, et al.



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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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