Exploring pharmacists’ role in spotting early signs of oral cancer

A group of North East researchers and health experts have come together for a major study into the role community pharmacists could play in the early identification and referral of patients with suspected head and neck cancers (HNC).

The study, which begins early spring next year, has the potential to improve the rates of early formal cancer assessment, diagnosis and treatment, and will explore whether community pharmacies could offer a pathway for people with HNC symptoms to seek further medical help and advice.

The research is led by Dr Andrew Sturrock, University of Sunderland, and Dr Susan Bissett, Newcastle University, and is funded by the National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) for the North East and North Cumbria (NENC). The study involves collaboration between pharmacy, dentistry and medicine academics, HNC clinicians and patients.

HNC is the eighth most common cancer in the UK, with the North East having the highest incidence and mortality rates in areas of high deprivation. Most of these cancers are in the mouth and throat and could potentially be identified early by a dentist, but recent research found that patients frequently present late with advanced stages of the disease having not seen their dentist in the two years prior to diagnosis, with uncertainty over costs and dental anxiety cited as the main reasons.

However, community pharmacists now provide an increasing range of healthcare services, routinely offering advice to patients seeking over-the-counter treatments for common symptoms, including those that may be related to HNC. This places them in an ideal position to potentially intervene at an early stage for at-risk patients, to promote and facilitate health seeking behaviours and potentially refer patients at an earlier stage of their disease for formal diagnosis of the condition.

Lead researcher Dr Andrew Sturrock, a Principal Lecturer in Pharmacy at the University of Sunderland and a National Teaching Fellow, said: “Over the course of our study we hope to demonstrate the critical role community pharmacists could play in spotting the first signs of this common cancer, such as non-healing mouth ulcers, potentially providing a life-saving link for people who may have limited contact with other oral and general healthcare services, due to their marginalisation.

“Pharmacist services are easily accessible to most of us, with 95 per cent of the population living within 20 minutes of a pharmacy. Their role has certainly proved critical during Covid 19. For individual reasons people are not going into GP practices or hospitals since the start of the pandemic, yet pharmacists have been accessible for advice throughout to people who are trying to self-manage their conditions. That represents an opportunity for pharmacists to offer an intervention that would enable early identification and offer advice for patients who may be tempted to delay seeking help.”

Dr Sturrock added: “We believe the project is an excellent example of an applied multi-disciplinary research collaboration between pharmacy, dentistry and medicine, HNC clinicians and patients. We hope our results will lead to future funding and to further develop the project nationally and begin a large-scale clinical trial.”

As part of the 18-month project, the research team will conduct interviews with community pharmacists exploring their knowledge, current practice and appetite for delivering HNC early identification. Interviews with HNC patients will explore past engagement with pharmacy services and attitudes towards the roles of pharmacists taking part in this engagement.

Dr Susan Bissett from the School of Dental Sciences at Newcastle University, said: “Awareness is key with cancer. The earlier a suspected lesion is identified, the earlier it can be investigated, diagnosed and treated. In the North East we have access to fantastic HNC services and the clear message is to act quickly. Unfortunately, many people are reluctant to go to the dentist, for many reasons. I am looking forward to working with our collaborative team and finding out more about the potential for a community pharmacy intervention for HNC.”

In the North East we have access to fantastic HNC services and the clear message is to act quickly. I am looking forward to working with our collaborative team and finding out more about the potential for a community pharmacy intervention for HNC.

The Project

‘Opportunities for Optimal Referral Timing in Differential Diagnosis of Suspected Head and Neck Cancer Signs and Symptomology: a qualitative study of attitudes and perceptions of community pharmacists, and head and neck cancer patients in the North East of England’ – was one of 31 chosen for funding from more than 170 registrations of interest and is linked to the NIHR research theme of ‘Prevention, Early Intervention and Behaviour Change’.

Dr Sturrock and Dr Bissett will conduct this research in collaboration with academics from Newcastle and Sunderland Universities; HNC clinicians from Newcastle upon Tyne Hospitals NHS Foundation Trust & Sunderland Royal Infirmary; NENC Cancer Alliance Health Education; Health Education England North East Multidisciplinary Oral Health; Northern Head & Neck Cancer Charity; and PCPI representatives from the region.

The announcement has also been made during Mouth Cancer Action Month, which is held in November every year and organised by the Oral Health Foundation and supported by the Mouth Cancer Foundation.

Dr Nigel Carter OBE, Chief Executive of the Oral Health Foundation, said:“Pharmacists have a key part to play when it comes to educating patients about mouth cancer, especially during COVID-19 when access to other health professionals might be reduced.  We welcome studies such as this to explore the potential impact pharmacists have in the patient journey.

“Ultimately, early intervention and diagnosis saves lives and far too many mouth cancers are caught too late. Being on the frontline of healthcare, pharmacists can provide a critical service that educates and informs patients about mouth cancer, which could do wonders for improving awareness.

“Pharmacists are a trusted and valued source of information, and any patients displaying the symptoms of mouth cancer, can be reassuringly signposted to a dentist or doctor for a visual examination.  This is especially vital given that one of the most common questions asked in pharmacies is about mouth ulcers – which if present for more than three weeks, can be a potential warning sign for mouth cancer.  This early intervention could improve a patient’s chances of beating the disease while drastically increasing their quality of life.”