Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK.
Freeman Hospital, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne NE7 7DN, UK.
Int J Environ Res Public Health. 2022 Dec 13;19(24):16723. doi: 10.3390/ijerph192416723.
Head and neck cancers (HNC) are often late stage at diagnosis; stage is a major determinant of prognosis. The urgent cancer referral pathway (two week wait; 2WW) within England's National Health Service aims to reduce time to diagnosis. We investigated factors associated with HNC route to diagnosis. Data were obtained from the English population-based cancer registry on 66,411 primary invasive HNCs (ICD C01-14 and C31-32) diagnosed 2006-2014. Multivariable logistic regression determined the likelihood of different diagnosis routes by patients' demographic and clinical characteristics. Significant socio-demographic inequalities were observed. Emergency presentations declined over time and 2WW increased. Significant socio-demographic inequalities were observed. Non-white patients, aged over 65, residing in urban areas with advanced disease, were more likely to have emergency presentations. White males aged 55 and older with an oropharynx cancer were more likely to be diagnosed via 2WW. Higher levels of deprivation were associated with both emergency and 2WW routes. Dental referral was more likely in women, with oral cancers and lower stage disease. Despite the decline over time in emergency presentation and the increased use of 2WW, socio-demographic variation is evident in routes to diagnosis. Further work exploring the reasons for these inequalities, and the consequences for patients' care and outcomes, is urgently required.
头颈部癌症（HNC）在诊断时常常处于晚期；分期是预后的主要决定因素。英国国民保健制度中的紧急癌症转诊途径（两周等待；2WW）旨在减少诊断时间。我们调查了与 HNC 诊断途径相关的因素。数据来自英格兰基于人群的癌症登记处，涉及 66411 例原发性侵袭性 HNC（ICD C01-14 和 C31-32），诊断时间为 2006-2014 年。多变量逻辑回归确定了患者人口统计学和临床特征对不同诊断途径的可能性。观察到显著的社会人口不平等现象。紧急就诊呈下降趋势，2WW 增加。观察到显著的社会人口不平等现象。非白人患者、65 岁以上、居住在城市地区且疾病晚期的患者更有可能出现紧急就诊。55 岁及以上、患有口咽癌的白人男性更有可能通过 2WW 进行诊断。较高的贫困水平与紧急和 2WW 途径都有关。女性、口腔癌和较低分期疾病更有可能通过牙科转诊。尽管紧急就诊呈下降趋势，2WW 的使用增加，但诊断途径仍存在明显的社会人口差异。迫切需要进一步研究这些不平等现象的原因，以及对患者护理和结果的影响。
