Socio-demographic variation in routes to diagnosis in head and neck cancer: a population-based analysis


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Jennifer Deane1,Joanne Patterson1,Linda Sharp1
1Newcastle University



Patients with HNC are often diagnosed at a late stage. Some HNC symptoms can present in seemingly benign way and this may influence how and where patients present and progress through the health system. This study aimed to investigated which patient-related factors were associated with two distinct routes to diagnosis: (i) emergency presentation and (ii) for patients who presented through primary care, two week wait (2ww).


Data was analysed for patients diagnosed with a primary invasive HNC (ICD10 C01-14, C31-32) during 2006 - 2014. Multivariable logistic modelling assessed factors influencing the route taken, comparing (i) emergency presentation with all other routes and (ii) 2WW with all other primary care initiated referrals.


68,752 HNC were diagnosed 2006-2014, 8.3% of whom were diagnosed as an emergency and 38.1% through 2ww. Emergency admissions were significantly more likely to be older, non-white, be resident in a more deprived area, and have a cancer elsewhere than in the oral cavity. They were also significantly more likely to be diagnosed with a higher stage and grade cancer. Patients who came through a primary care initiated route were significantly more likely to be a 2WW referral if they were aged 55-64, male, white, more deprived and had an oropharyngeal or larynx cancer. There was a trend over time for an increase in 2WW referrals and a decrease in those diagnosed after an emergency admission.


The results suggest improvements over time in the way people with HNC are diagnosed (i.e. decline in emergency admission and increase in 2WW). However, differences in diagnostic route were found in relation to patients’ socio-demographic characteristics. Effective interventions are needed to change the stage distribution of HNC and outcomes improve. This findings help identify potential problems in the HNC diagnostic pathway and suggest areas for action for policy-makers.