Barriers to head and neck cancer care in high-income and low- and middle-income countries: a scoping review

Abstract

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.