Waiting times and determinants of delay for head and neck cancer in England-a population cohort study using real world data.

backgroundIn Head and Neck Cancer (HNC), even short delays in treatment can worsen prognosis. We used real-world data to quantify waiting times and identify patient, tumour and health service factors associated with treatment delay in England.

methodsUsing linked national datasets (Cancer Registry, Cancer Waiting Times, Hospital Episodes Statistics, Radiotherapy and Chemotherapy), we calculated waiting times from referral to first treatment (surgery or (chemo)radiation) and used multivariable logistic regression models to examine factors associated with delay.

resultsOf 30,506 patients, 43% experienced treatment delay ( > 62 days from referral). Long delays ( > 90 days) affected 11% of patients treated with primary surgery and 20% of those receiving primary (chemo)radiation. Non-urgent referral (30% of patients) was the strongest predictor of long delay (aOR 4.07, CI: 3.54-4.68). Additional risk-factors included initial assessment at non-specialist (spoke) hospitals, non-oropharyngeal cancers, and higher socio-economic deprivation.

conclusionsTreatment delays in HNC are worsening, particularly for patients treated with primary (chemo)radiation. Referral route is the strongest determinant. Interventions should focus on optimising referral pathways, increasing awareness of HNC symptoms among the public and primary care, and acknowledging the different drivers of delay associated with surgery and (chemo)radiation therapy.