Evidence Hub

Exploring how community pharmacists could help with early identification and referral of patients with suspected head and neck cancer.

Quick-read summary

The early detection of cancer is a worldwide priority, and we need more ways to spot and refer patients who are showing the warning signs and symptoms of head and neck cancer, as early as possible.

Community pharmacies are well located in local communities and often easy to get to. Head and neck cancer has a rage of common symptoms which community pharmacists are well-placed to spot when people go to a pharmacy.

This study found that pharmacists provide opportunities and access to patients and have a good knowledge of key referral criteria.

However, current referral practices rely on signposting and there is a lack of integration of community pharmacy into formal pathways. Further work to develop a sustainable and cost-effective approach to integrating pharmacists into cancer referral pathways is needed, alongside appropriate training for pharmacists to successfully deliver optimum patient care.

Who is this evidence useful for?

NHS service designers/commissioners, cancer pathway clinicians, pharmacists, GPs, patient groups – including head and neck cancer charities.

What is the issue?

• The early detection of cancer is a worldwide health priority
• Signs and symptoms of head and neck cancer can include a range of common symptoms which patients my present with, in primary care, including at pharmacies
• There is limited research into the role the pharmacists can play in the earlier identification, and also referral of patients with signs and symptoms potentially indicative of head and neck cancer

Research summary

• Interviews were carried out with 17 community pharmacists
• Interviews explored the perceptions of, and attitudes towards, the early identification and referral of patients with signs and symptoms indicating potential diagnosis of head and neck cancer in community pharmacy settings.

What the research found

• Pharmacists offer good opportunities and access to patients. Pharmacists frequently consult with patients presenting with potential head and neck cancer symptoms and they are accessible to the public.
• Although pharmacists had good knowledge of key referral criteria, there have limited experience and expertise in undertaking more holistic patient assessments to inform clinical decision making, therefore highlighting training needs to optimise their role.
• Pharmacists reported good working relationships with general medical practices, but limited collaboration with dental services, and a desire to engage with formal referral pathways.
• Current referral practices are based entirely on signposting patients (telling them where to go/what to do next) resulting in a potential lack of safety-netting, no auditable trail, feedback mechanism or integration into the multidisciplinary team
• Clinical decision support tools – such as a validated head and neck cancer risk assessment tool have not previously been used by pharmacists, but pharmacists were positive towards the use of such tools to improve decision making, however these require further investigation in this context.

Why is this important?

The early detection of cancer is a worldwide health priority. Pharmacists could potentially support the earlier identification of cancer. This is particularly important now where access to other NHS services is problem. This could include initiatives to raise awareness of head and neck cancer in the community, as well as formal integration of pharmacists into cancer referral pathways.

However, further work is required to develop a sustainable and cost-effective approach to integrating pharmacists into these pathways.

Work is also needed to develop appropriate training for pharmacists to help them to deliver optimum patient care.

NHS England have recently announced plans to pilot community pharmacy integration into cancer referral pathways. This study is therefore an important and timely piece of evidence to support this work.

How were patients or members of the public involved in this work?

Work with head and neck cancer patients is part of the next phase of work

What’s next?

• A qualitative interview study with head and neck cancer patients is underway, related to this project. This second phase will add to the evidence produced in this work and will be important in supporting the next steps of this programme of research.
• The integration of community pharmacy into cancer referral pathways needs more research; this includes evaluations of the proposed NHS England pilots
• The validated head and neck cancer risk prediction tool needs further research in this context

Lead researcher

Dr Andrew Sturrock and Dr Susan Bisset (co-leads)

Get in touch about this research

[email protected]

Read more:

Is the early identification and referral of suspected head and neck cancers by community pharmacists feasible? A qualitative interview study exploring the views of patients in North East England – Health Expectations, July 2023 (article)

Qualitative interview study exploring the early identification and referral of patients with suspected head and neck cancer by community pharmacists in England – BMJ Open, March 2023