Ambitious new study aims to revolutionise the NHS referral pathway for patients with suspected head and neck cancer.

Over 220,000 people are referred for an urgent specialist opinion with suspected head and neck cancer in England each year. The majority of people are reassured they are cancer-free, but around 5% will be diagnosed with cancer in the head and neck region which includes the voice box, throat, lips, mouth, nose, and salivary and thyroid glands.

Currently, around one third of patients referred to hospital with suspected head and neck cancer will undergo some form of investigation, but the information in a GP referral letter is often not enough for clinicians to decide who may need an investigation, or what type of investigation they may need. Due to the various types of cancer that can occur in the head and neck region, no single laboratory test, scan or diagnostic procedure suitable to assess everyone referred for suspected head and neck cancer. 

The EVEREST-HN study aims to improve the experience of patients who are referred to NHS services with suspected head and neck cancer. The study will develop and test ways that patients can tell specialist cancer doctors about their symptoms, providing clinicians with a more complete picture of a patient’s situation before they even come to hospital. 

How will the EVEREST-HN study work?

The study will recruit over 100,000 patients from across the UK who have been referred with suspected head and neck cancer. They will be asked to complete an electronic questionnaire about their symptoms. This data will be fed into a ‘calculator’ to assess the patient’s individual risk of cancer and this will be shared with clinicians.

It is hoped that the trial will speed up diagnosis of head and neck cancer and reduce anxiety for the thousands of people each year who are referred then found not to have cancer.

If successful, the new system could ensure high-risk patients have targeted investigations arranged much earlier. This will allow treatment to start significantly sooner if they have cancer, which may improve their outcomes. Lower-risk patients may also be able to avoid unnecessary tests and appointments and may be reassured earlier that they are unlikely to have cancer.

Study lead Professor Vinidh Paleri, Consultant Head and Neck Surgeon at The Royal Marsden, said:

“Over the next seven years, we will develop this technology and test ways patients can tell us about their symptoms, through their mobile device, using online forms or even personalised automated phone calls. We hope to transform the NHS head and neck cancer pathway and, if we find this system does improve outcomes for this patient group, it could be replicated across other tumour types too, potentially saving many lives.”

The study is being supported by the National Institute for Health and Care Research (NIHR) and the International Centre for Recurrent Head and Neck Cancer (IReC) via funding from The Royal Marsden Cancer Charity.

"Worst-case scenario, it could be cancer." - Ken's Story

Interior designer Ken Mann, 30 from West London, was referred to The Royal Marsden by his GP after experiencing suspected head and neck cancer symptoms. During the wait to be seen by a specialist - who fortunately found that he didn’t have cancer after surgery and a biopsy - Ken experienced significant anxiety.

“Around August 2022 I noticed a lump underneath my tongue, which was white and spotty" says Ken. "When I ate certain things, the area became inflamed, and I also experienced swelling and pain around my jaw. Concerned it could be something serious, I made an appointment with my GP who said, in a worst-case scenario, it could be cancer."

“Although I was seen at the hospital within two weeks and my results soon followed, it felt like a very long time. The thought I could have cancer played on my mind every five to 10 minutes and I found it hard to concentrate at work. It definitely affected my mental health."

“It turned out I had a salivary gland blockage which was a big relief. I think anything that could have eased the pressure during that time would have really helped."