Aims: Head and neck cancer (HNC) disproportionately presents at advanced stages in low- and middle-income settings, contributing to poor survival. While diagnostic delay is often implicated, the relative contributions of patient delay and healthcare-system navigation remain inadequately characterised. This study evaluated diagnostic intervals and determinants of advanced-stage presentation in a resource-constrained North Indian population.
Methods: We conducted a prospective observational study of 150 consecutive patients with biopsy-confirmed HNC treated at a tertiary care centre in northern India between January 2024 and June 2026. Patients were classified as early stage (I–II; n=32) or advanced stage (III–IV; n=118). Categorical variables were analysed using Pearson’s chi-square or Fisher’s exact test, and continuous variables using Welch’s t-test. Associations with advanced-stage presentation were quantified using odds ratios (ORs) with 95% confidence intervals (CIs).
Results: Advanced-stage disease accounted for 78.7% (118/150) of presentations. A higher healthcare navigation burden—defined as consultation with ≥3 providers—was strongly associated with advanced stage (65.3% vs 31.3%; OR 4.13, 95% CI 1.79–9.55; p<0.001). Unemployment (64.4% vs 37.5%; OR 3.02, 95% CI 1.34–6.77; p=0.006) and smoking (72.0% vs 43.8%; OR 3.31, 95% CI 1.48–7.41; p=0.003) were also significant. The mean symptom-to-first-consultation interval was prolonged (5.05±10.57 months) but did not differ between groups (p=0.488), suggesting fragmentation of care rather than initial delay as a key driver. No associations were observed for age, sex, education, cumulative smoking exposure, or provider-related intervals. Squamous cell carcinoma predominated (80.7%), with the oral cavity as the most common site (34.0%).
Conclusion: Advanced-stage HNC presentation remains highly prevalent and is more strongly associated with healthcare navigation complexity than with measured diagnostic intervals. Repeated consultations likely reflect fragmented referral pathways delaying definitive care. Interventions targeting early symptom recognition, streamlined referrals, and improved access to first-contact care are urgently needed. Multivariable analyses are warranted to confirm independent determinants.