Introduction
Head and neck cancer (HNC) is a collective term used to describe a group of cancers that arise from tissue in the head and neck region. HNC patients are diagnosed via emergency presentation, routine referral, or via the nationally approved ‘urgent suspected cancer (USC)’ (formerly “‘two-week wait’), pathways having presented with one or more of a set of ‘red flag’ signs or symptoms to their General Practitioner (GP).  A validated HNC risk-calculator, the HaNC-RC-v2, which combines patient demographics, risk factors, and a set of 12 ‘red-flag’ symptoms has been developed to differentiate patients into having a high (≥7%) or low (<7%) probability of having cancer (2).
In 2019/2020 227,665 patients were referred in England with suspected HNC of which 6,466 were subsequently diagnosed with cancer (3).This represents a conversion rate of 2.8%, meaning the overwhelming majority (97%) of patients referred on an urgent suspected head and neck cancer (USHNC) pathway do not have cancer. Once referred on an USHNC pathway, review in secondary care is traditionally done face-to-face by a HNC surgeon who undertakes a history and a physical examination which may include direct examination of the mucosal surfaces of the head and neck region with flexible nasendoscopy (FNE).
In 2020 the global coronavirus disease pandemic (COVID-19) saw a dramatic re-rationalisation of healthcare resources, with a shift to non-contact interactions necessitated to reduce disease spread, protect population health and to prevent overwhelming hospital systems. Ear Nose and Throat (ENT) and HNC specialists were particularly vulnerable due to their interactions with the reservoirs of the virus (nasopharynx), which saw these doctors worldwide unduly affected by nosocomial infection (4). As a result, the national governing bodies of UK HNC surgeons, advised that patients with USHNC should be assessed by telephone using the (HaN-RC-v.2) to help risk-stratify who should be seen face-to-face (1). Despite the recent abatement of the COVID-19 pandemic, telephone consultations have remained across a wide range of healthcare settings, seen as a solution helping to address the ongoing challenge of increasing referrals to secondary care, with limited resources to meet this referral demand. External solutions, such as automation, are increasingly being reviewed as a means to help address this ongoing capacity-demand mismatch.
Ufonia, a digital health company, has created ‘Dora’, an AI-driven clinical assistant which can conduct a natural-language telephone conversation with patients (5). Dora is a UKCA Class 1 approved medical device. In 2022 Ufonia and *INSTITUTION* were awarded a UK Research and Innovation Small Business Research Initiative (SBRI) healthcare grant to develop and pilot this technology to the clinical application of HNC triage. The HNC triage conversation was based on the HaNC-RCv.2 and was co-created with patients from the ‘Heads2Gether’ HNC charity.