title: A systematic review that evaluates one-stop neck lump clinics.
abstract: BACKGROUND
  The National Institute of Clinical Excellence guidance on cancer services produced the Improving Outcomes in Head and Neck Cancers in 2004. One of the seven 'key recommendations' is the stipulation that 'diagnostic clinics should be established for patients with neck lumps'.
  
  
  OBJECTIVE
  The objective of this review was to examine the basis on which the Improving Outcomes Guidance (IOG) makes its specific recommendation for the establishment of neck lump clinics.
  
  
  METHODS
  This review analyses the original explicit questions asked by the NICE review team, cross references the guidance and evidence documents to examine the strength of the supporting evidence.
  
  
  METHODS
  'One stop clinic' and 'neck lump' were used as search terms, from 1996 to 2008 to include relevant papers, whether cited by IOG or not.
  
  
  METHODS
  Original articles of all potentially relevant papers were obtained and analysed with respect to the IOG key recommendation above.
  
  
  RESULTS
  Evaluation of both IOG cited and additional evidence does not corroborate the specific key recommendation that one-stop neck lump clinics staffed by a surgeon and pathologist must be established in all Cancer networks.
  
  
  CONCLUSIONS
  Overall, the specific NICE IOG guidance does not have the weight of objective evidence to justify such a categorical and specific recommendation. Alternative models of provision of diagnostic clinics may offer equally or more effective patient care than their stipulated 'one-stop' surgeon and pathologist model.
authors.affiliation: Derbyshire Royal Infirmary, Derby Acute Hospitals NHS Foundation Trust, Derby, UK. neil.cozens@derbyhospitals.nhs.uk
authors.forename: N J A
authors.initials: NJ
authors.lastname: Cozens
mesh_terms: D000554:Ambulatory Care Facilities; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000628:therapy*; D009333:Neck; D012017:Referral and Consultation; D016896:Treatment Outcome