Interventions to reduce times to diagnosis and treatment of head and neck cancer: A systematic review and narrative synthesis.

Abstract

We systematically reviewed evidence of health system interventions to reduce diagnostic and treatment intervals for people with head and neck cancer (HNC). Electronic databases were searched from inception to 30 April 2020 for controlled or uncontrolled comparative studies. Primary outcome was any time interval between first clinical presentation and treatment onset. Thirty-seven studies were included. Four types of interventions were identified: single clinic-based (N = 4), multidisciplinary clinic-based (N = 15), hospital or service re-design (N = 12), and health system re-design (N = 6). There was some evidence that multidisciplinary interventions improve timeliness of diagnosis and treatment; however, evidence of long-term effectiveness was lacking. Study quality was assessed as either low or moderate. Interventions to reduce times to diagnosis and treatment of HNC are heterogeneous, with limited evidence of effectiveness. Future interventions should account for the complex and dynamic nature of health systems and adhere to best-practice principles for early-diagnosis research.