Diagnostic Pathway of Head & Neck Cancer Patients in Ireland: Audit of patterns of first attendance 1983-2019.

Abstract

##Objectives: This audit explores patterns of HNC patient presentation in primary care in Ireland over four decades and reflects on the possible impact of a 10-year national HNC awareness campaign. ##Materials and Methods: Trends in patient presentation and diagnosis are presented for 920 HNC patients across three time periods: 1983-1990, 2010 and 2018-2019. Descriptive analysis was undertaken using SPSS-v27 on basic demographic details, tumour-related details and primary care referral patterns. ##Results: Patients were generally male (71%), aged 54+ (71%), and 84% were diagnosed with squamous cell carcinoma (SCC). Larynx, tongue and tonsil were the most common sub-sites. General Medical Practitioners (GPs) were the first healthcare contact for 75% cases, with only13% referred by General Dental Practitioners (GDPs). This pattern remained consistent across four decades. GDP role was higher for tongue, floor of mouth and intra-oral tumours (30-47%), with some increase seen in recent years. While symptomology varied by site, symptom burden remained high across the decades with 99.9% exhibiting 1+ NICE ‘red flag signs’ of HNC, suggesting considerable diagnostic delay, despite a 10-year national campaign to raise public and professional awareness. ##Conclusions: This audit highlights the role of GPs in HNC diagnosis, but reveals sub-optimal use of the dental pathway. The high symptom burden reported suggests considerable diagnostic delay. Increased and sustained efforts are required to raise public and professional awareness, encourage regular dental attendance, upskill HCP in opportunistic screening and ensure appropriate responses to symptomatic patients.