Health System Factors in Head and Neck Cancer Diagnosis: A HEADSpAcE Consortium Qualitative Study in Glasgow and Montevideo

Background: Head and neck cancer (HNC) is a devastating diagnosis, with advanced-stage disease leading to poorer outcomes. This qualitative study aimed to identify health system factors associated with stage of HNC diagnosis. Methods: Qualitative semistructured interviews with HNC patients and clinicians were undertaken in two purposively selected regional cancer centers in Scotland and Uruguay. Transcripts were analyzed thematically via Template Analysis, utilizing conventional cancer diagnostic intervals and a systems engineering model of how patient and organizational outcomes emerge from complex interactions. Results: Sixteen health system themes and 45 subthemes were identified from 29 interviews. Themes important for timely diagnosis included: public awareness of risk/symptoms; patient ability to access and navigate through HNC pathways; socioeconomic/geographic inequalities; and ways of working between healthcare teams. Conclusions: Health system factors associated with diagnostic stage were identified across centers and participant groups that could inform service changes to support earlier stage diagnosis of HNC.