22978-25-2 br better and found that few GPs
better, and found that few GPs had attended training on refer-
∗ Fisher’s exact test.
rals to our specialty.12 The two main areas for further work
are the development of communication between primary and
secondary providers before referral, and the delivery of prac-
however, the number of cancer diagnoses that are made after tical educational measures for GPs. The Cancer Research UK
referral to the urgent pathway is quite low.2 This audit reflects toolkit is a potentially valuable resource for professionals and
current practice in a geographical area in which the SES of patients alike, but it 22978-25-2 focuses solely on the oral cavity.13
many patients is low.3,4 The number of referrals over three It has been argued that links between GPs and dentists to
months was sufficient for the results to be meaningful, and the improve the assessment of suspected cancer might lengthen
audit addressed those treated in ENT and in the maxillofacial delay, and that patients at highest risk are the least likely to
go to a dentist.14 Processes, however, could be streamlined
The study, however, has inherent limitations, notably the to avoid delays, and in the case of lesions of the oral cavity,
single hospital and its catchment population, which does not GPs could be assisted by a second opinion from a dentist. To
necessarily reflect the national case mix. Others are the lack of enable earlier detection and better outcomes, professionals
precision in the information on symptoms and delay because should keep their knowledge up to date and should educate
of the pro forma used (although they do provide a useful their patients about the signs and symptoms of cancer.
indication), and the IMD, which is a recognised measure of In conclusion, more patients with a low SES are referred
deprivation, but is not necessarily specific at an individual with suspected cancer of the head and neck, but overall, those
who are referred tend not to have the highest risk in terms of
sex, smoking, and alcohol. Given the large percentage from the lower SES groups, more research is needed to explore how to reduce the number of “worried well” and streamline the referral process.
Conflict of interest statement
We have no conflicts of interest.
Ethics statement/confirmation of patient’s permission
The data, which had been collected as part of a service audit rather than for research, met the criteria of the local Clinical Governance Department for service evaluation.
1. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral NICE guideline (NG12). Available from: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-on-patient-support-safety-netting-and-the-diagnostic-process (last accessed 31 January 2019).
4. Taib BG, Oakley J, Dailey Y, et al. Socioeconomic deprivation and the burden of head and neck cancer − regional variations of incidence and
5. Rylands J, Lowe D, Rogers SN. Outcomes by area of residence depriva-tion in a cohort of oral cancer patients: survival, health-related quality of life, and place of death. Oral Oncol 2016;52:30–6.
6. The English indices of deprivation 2015: frequently asked questions (FAQs). Updated 5 December 2015. Department for Communi-ties and Local Government. Available from: https://www.gov.uk/ government/uploads/system/uploads/attachment data/file/579151/ English Indices of Deprivation 2015 - Frequently Asked Questions Dec 2016.pdf (last accessed 31 January 2019).
8. Hawkes N. Urgent referrals for suspected cancer vary threefold among general practices. BMJ 2012;345:e5195.
9. Rylands J, Lowe D, Rogers SN. Influence of deprivation on health-related quality of life of patients with cancer of the head and neck in Merseyside and Cheshire. Br J Oral Maxillofac Surg 2016;54:669–76.
12. Bethell GS, Leftwick P. Views of general practitioners and head and neck surgeons on the referral system for suspected cancer: a survey. J Laryngol Otol 2015;129:893–7.
13. Oral cancer recognition toolkit. Cancer Research UK and British Dental Association. Available from: https://www.doctors.net.uk/ eclientopen/cruk/oral cancer toolkit 2015 open/ (last accessed 31 January 2019).
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European Journal of Pharmacology
journal homepage: www.elsevier.com/locate/ejphar
Molecular and cellular pharmacology
Auranofin lethality to prostate cancer includes inhibition of proteasomal T deubiquitinases and disrupted androgen receptor signaling