Regional Disparities in Head and Neck Cancer Management: A Global Cross-Sectional Survey of the World Federation of ENT Societies.

Abstract

Objective: To outline global variations in head and neck cancer care practices and resource availability across disparate geographic locations and sites of care.

Methods: We conducted a cross-sectional worldwide survey following STROBE and CHERRIES guidelines in September-December 2024 under the aegis of the World Federation of ENT Societies (IFOS) and Young Otolaryngologists of IFOS (YO-IFOS). The survey was conducted in the form of standardized case vignettes for common clinical scenarios for various head and neck subsites, practice setting characteristics, and resource availability assessment. Head and neck condition specialists were approached by professional organizations from seven geographic locations. Statistical analysis involved chi-square testing and Benjamini-Hochberg adjustment for multiple comparisons.

Results: One hundred eighty-five European specialists, 27 North American specialists, 50 Central/South American specialists, 123 Asian specialists, 53 African specialists, 12 Oceania specialists, and 114 Middle East/North African specialists responded to the survey. Management of standardized case vignettes was very different by region (p < 0.001). The rate of TORS for early oropharyngeal cancer differed significantly between nations (59.1% in North America, 52.3% in Europe, 14.8% in Asia, and 7.1% in Africa). Preferred management of advanced laryngeal cancer was also heterogeneous, with primary chemoradiotherapy being the option for 72.7% of North Americans but only 43.5% of Asians, 21.9% of Europeans, and 4.8% of Africans. Wide resource variations existed globally, with the most advanced treatment, such as IMRT, being available in 86.9% of European but only 75.6% of Central/South American and 27.1% of African centers. By contrast, tumor board review by an interdisciplinary team in all patients was noted in 91.2% of cases in Europe and Oceania compared with 48.8% in Asia and 22.4% in Central/South America. Economic barriers to access varied geographically and were noted in 83.7% of African, 63% of Central/South American, and 44.4% of North American, but just 8.9% of European respondents.

Conclusions: This global survey documents notable variations in the management of head and neck cancer reflecting complex interactions between training models, resource settings, and cultural paradigms. These findings identify regional variations in clinical decision-making for standardized case presentations, confirming the need for resource-adjusted guideline development and country-specific education programs. Future research must tackle the way in which these patterns of treatment influence outcomes in diverse healthcare systems.