BACKGROUND: Globally, most people with head and neck cancers (HNCs) are diagnosed with advanced-stage disease. HNC diagnostic stage has multifactorial explanations, with the role of health system factors not yet fully investigated. METHODS: HNC centres (n = 18) from the HEADSpAcE Consortium were surveyed via a bespoke health system questionnaire covering a range of factors. Centres were compared using the least square means for the presence/absence of each health system factor to their proportion of advanced-stage HNC. RESULTS: Health system factors associated with lower proportion in advanced-stage diagnosis were formal referral triaging (14%, 95% CI-0.26, -0.03), routine monitoring of time from referral to diagnosis (16%, 95% CI-0.27, -0.05), and fully publicly funded systems (17%, 95% CI-0.29, -0.06). Several health systems factors had no routinely available data. CONCLUSIONS: Through identifying and monitoring health systems factors associated with lower proportions of advanced stage HNC, interventions could be developed, and systems redesigned, to improve early diagnosis.

A C Camargo Centre Sao Paulo Brazil

Aga Khan University Karachi Pakistan

Araujo Jorge Hospital Brasil Goiânia Cancer Registry Goiania Brazil

Beatson West of Scotland Cancer Centre Glasgow UK

Brazilian Ministry of Health Instituto National De Cancer Rio De Janeiro Brazil

Bristol Dental School University of Bristol Bristol UK

Cancer Epidemiology Unit Department of Medical Sciences University of Turin and CPO Piemonte Turin Italy

Centre Leon Berard Lyon France

Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine Charles University Prague Faculty Hospital Motol Prague Czechia

Department of Pathology and Laboratories Fundacion Santa Fe de Bogota Bogota Colombia

Facultad de Odontología Universidad Nacional de Córdoba Cordoba Argentina

Glasgow Head and Neck Cancer Research Group Glasgow UK

Hospital de Câncer de Barretos Barretos Brazil

Institut Catala D'oncologia Barcelona Spain

International Agency for Research on Cancer Lyon France

Pathology Department Federal University of Espírito Santo Vitória Brazil

Queen Elizabeth University Hospital Glasgow UK

School of Health Education Policing and Sciences Staffordshire University Stafford UK

School of Medicine Dentistry and Nursing University of Glasgow Glasgow UK

Service of Oncology Manuel Quintela Hospital Montevideo Uruguay

Serviço de Cirurgia de Cabeça e Pescoço Associação Feminina de Educação e Combate ao Câncer Vitória Brazil

Tehran University of Medical Sciences Tehran Iran

Universidad De Buenos Aires Buenos Aires Argentina

Universidad Nacional de Asunción Asuncion Paraguay

Virology Institute School of Medicine Universidad Nacional de Córdoba Córdoba Argentina

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