Patient Perceptions and Type 1 Delay in Head and Neck Cancer: A Scoping Review of High- and Low-/Middle-Income...

To identify and compare how patient perceptions contribute to Type 1 Delays, defined as delays in deciding to seek care, among individuals with head and neck cancer (HNC) in high-income countries (HICs) and low- and middle-income countries (LMICs).

We conducted a scoping review and systematic search of MEDLINE, Embase, Cochrane Library, and Scopus from inception through November 20, 2023. Eligible studies included patients with HNC in HICs or LMICs who reported patient perceptions contributing to Type 1 Delays. Data extraction was performed in duplicate, and barriers were categorized thematically. Fisher's exact test was used to compare the frequency of reported barriers between HIC and LMIC studies.

Seventeen studies met inclusion criteria, of which 64.7% (n = 11) were conducted in HICs and 35.3% (n = 6) in LMICs, representing 9 countries and 1410 participants. The most frequently cited perceptions contributing to delay were symptom unawareness, misinterpretation, and minimization. Additional barriers included fear of diagnosis, stigma, alternative medicine use, financial challenges, and geographic barriers. Transport/geographic barriers showed a trend toward being more common in LMIC studies (p = 0.05). Descriptive patterns suggested LMIC patients more often reported structural and sociocultural barriers, whereas HIC patients more commonly cited psychosocial or perceptual barriers.

Type 1 Delays in HNC are common across both HICs and LMICs, with overlapping and region-specific contributors. Tailored interventions, such as patient education, stigma reduction, and improved access to diagnostic services, may promote earlier detection and improve global HNC outcomes.

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