Global Otolaryngology-Head and Neck Surgery Initiative.
Tufts University School of Medicine, Boston, Massachusetts.
Curr Opin Otolaryngol Head Neck Surg. 2023 Jun 1;31(3):185-193. doi: 10.1097/MOO.0000000000000889. Epub 2023 Apr 4.
Identify patient-perceived barriers to head and neck cancer care and compare differences in barriers by country income status.
Of the 37 articles, 51% ( n = 19) were from low- and middle-income countries (LMICs), while 49% ( n = 18) were from high-income countries. Of the papers from high-income countries, unspecified head and neck cancer (HNC) subtype (67%, n = 12) were the most common cancer type, while upper aerodigestive tract mucosal malignancies (58%, n = 11) were more common in LMICs ( P = 0.02). Based on World Health Organization barriers, level of education ( P = < 0.01) and alternative medicine use ( P = 0.04) were greater barriers in LMICs compared to high-income countries. At least 50% of articles listed barriers at all three 'Three Delays' timepoints. There were no significant differences by country income status for the 'Three Delays' timepoints of deciding to seek care ( P = 0.23), reaching the healthcare facility ( P = 0.75), or receiving care ( P = 1.00).
Patients face barriers to care for head and neck cancer regardless of country income status. There is overlap in several barriers and a need for systemic improvement in access. The differences in education and alternative medicine may guide region-specific interventions to improve the provision of head and neck services.
综述目的：确定患者对头颈癌治疗的认知障碍，并按国家收入状况比较障碍的差异。
最新发现：在 37 篇文章中，51%（n=19）来自中低收入国家（LMIC），49%（n=18）来自高收入国家。在高收入国家的论文中，未具体说明的头颈部癌症（HNC）亚型（67%，n=12）是最常见的癌症类型，而上呼吸道黏膜恶性肿瘤（58%，n=11）在 LMIC 更为常见（P=0.02）。根据世界卫生组织的障碍分类，教育水平（P=0.01）和使用替代疗法（P=0.04）在 LMIC 比高收入国家的障碍更大。至少有 50%的文章在所有三个“三个延误”时间点都列出了障碍。在决定寻求治疗（P=0.23）、到达医疗保健机构（P=0.75）或接受治疗（P=1.00）的“三个延误”时间点上，国家收入状况无显著差异。
总结：无论国家收入状况如何，患者在接受头颈部癌症治疗时都面临着障碍。有几个障碍存在重叠，需要在获得途径方面进行系统改进。教育和替代医学方面的差异可能会指导特定区域的干预措施，以改善头颈部服务的提供。
Zotero 插件