In Australia and internationally, there are known variations in timely access to cancer diagnosis and treatment, including head and neck cancer (HNC). Interventions to reduce times to diagnosis and treatment need to account for dynamic and complex health systems. The study aim was to assess the scientific literature supporting health-system interventions to reduce delays in HNC diagnosis and treatment.
A systematic review of international scientific literature was conducted. Three electronic databases (CINAHL, MEDLINE, EMBASE) were searched from inception to May 2020, supplemented by hand searching references. Two independent reviewers screened 269 full-text articles, extracted data, assessed study quality, and cross-checked results.
Of 106 studies included (38 conference abstracts, 68 full articles), majority were based in the United Kingdom (n=72, 68%), with the remainder based in the United States (n=14, 13%), Denmark (n=8, 8%), the Netherlands (n=3, 3%), and other countries (8%). Fifty-six studies (53%) evaluated the ‘urgent suspicion of cancer pathway’ or the two-week wait system in the United Kingdom. ‘Fast-track’ cancer programs or policies involving system re-design were evaluated in Denmark (n=8) and Spain (n=1). Nine studies evaluated ‘rapid-access’ clinics or clinics focusing on assessing specific symptoms (neck lumps or dysphonia). Eleven studies evaluated implementation of a multidisciplinary clinic, three of which specified a ‘single-day’ clinic. Patient-centred or integrated care programs were evaluated in six studies, four studies evaluated the implementation of a specific guideline, and three studies evaluated work-flow re-design. The remaining studies evaluated pro-forma letters or data entry, telemedicine consultations, and universal health coverage.
The scientific literature supporting health system interventions to reduce diagnosis and treatment intervals for HNC is varied, and success depends upon the health-systems’ design and capacity. There appears no ‘one size fits all’ approach, and intensive interventions (eg whole of system re-design) may be successful only in certain contexts.