OBJECTIVES: Head and neck cancer (HNC) is diagnosed in over 3,000 patients annually in the Netherlands. Nearly half of HNCs are diagnosed at an advanced stage, partly attributed to prolonged time-to-diagnosis (TTD). Primary care is an important setting for strategies to reduce TTD. This study therefore analyzes the healthcare pathway of HNC-patients from their initial visit to the general practitioner (GP) to diagnosis.

METHODS: Patients were selected from a cohort with linked primary care and cancer data (PHARMO GP-NCR cohort) from 2013-2020. HNC-patients (cases) were matched 1:4 with non-HNC patients (controls) on age, sex, and GP practice. Cases and controls were required to have at least 24 months of primary care data and no prior cancer diagnosis. Cases were additionally required to have one of fourteen predefined HNC-specific symptoms recorded in electronic GP records. Baseline characteristics were compared using Chi2-tests, and TTD was analyzed using Kruskal-Wallis tests.

RESULTS: 9,565 individuals were included: 1,913 cases and 7,652 controls. 67% of patients were male, and median age was 66 years. Apart from bleedings in the mouth cavity, all symptoms occurred more often in cases than controls (p<0.0001), with otalgia being the most commonly reported symptom. Compared to controls, cases had a higher alcohol intake, were more often current smokers, and had more comorbidities, e.g. cardiovascular and lung diseases (all p<0.0001). Additionally, cases had more GP visits, received more medication and had more referrals (most common to an otolaryngologist), compared to controls (all p<0.05) prior to cancer diagnosis. Overall median TTD (interquartile range) was 36.2 weeks (9.5 – 74.5) and was affected by gender, comorbidities, tumor location and number of GP visits (all p<0.05).

CONCLUSIONS: This study highlights the demographics and healthcare utilization of HNC patients in the Netherlands, revealing differences in their patient journey compared to controls. Future research should focus on opportunities for earlier diagnosis.