Management of head and neck cancer around the world: an international survey by the world ear, nose, and throat federation

Victorine Maso; Jerome R Lechien; Isabelle Gengler; Carlos Chiesa-Estomba; Johannes J Fagan; Sheng-Po Hao; Luiz P Kowalski; Bernard Lyons; Emmanuel Babin; Mohamad Yunus Mohd Razif; Hani Z Marzouki; Angel Ramos Macias; Hector E Ruiz; Antonino Maniaci; Bernard Fraysse; Matthew White; Justin Michel; Nicolas Fakhry

doi:10.1016/j.oraloncology.2025.107766

Management of head and neck cancer around the world: an international survey by the world ear, nose, and throat federation

Oral Oncol. 2025 Dec:171:107766. doi: 10.1016/j.oraloncology.2025.107766. Epub 2025 Nov 4.

Authors

Victorine Maso¹, Jerome R Lechien², Isabelle Gengler³, Carlos Chiesa-Estomba⁴, Johannes J Fagan⁵, Sheng-Po Hao⁶, Luiz P Kowalski⁷, Bernard Lyons⁸, Emmanuel Babin⁹, Mohamad Yunus Mohd Razif¹⁰, Hani Z Marzouki¹¹, Angel Ramos Macias¹², Hector E Ruiz¹³, Antonino Maniaci¹⁴, Bernard Fraysse¹⁵, Matthew White⁵, Justin Michel¹⁶, Nicolas Fakhry¹⁶

Affiliations

¹ Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, Marseille, France; Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France. Electronic address: victorinemaso24@gmail.com.
² Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Departement of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium,; Elsan Hospital, Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital Paris Saclay University, Paris, France.
³ Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastics and Reconstructive Surgery, Johns Hopkins Medical University, Baltimore, MD, USA.
⁴ Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.
⁵ Division of Otolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa.
⁶ Department of Otolaryngology, Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
⁷ Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil; Head and Neck Surgery, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
⁸ St. Vincent's Health Melbourne, Australia.
⁹ Service d'ORL-CCF, CHU de Caen, université de Caen-Normandie, Caen, France.
¹⁰ Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology, Kuala Lumpur, Malaysia.
¹¹ Department of Otolaryngology- Head & Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
¹² Hospital Universitario Materno Infantil de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
¹³ Dr. Héctor E. Ruiz E.N.T. Center, Rosario, Argentina.
¹⁴ Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy.
¹⁵ Clinique Rive Gauche, Innov Pol Santé, Toulouse, France.
¹⁶ Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, Marseille, France; Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.

PMID: 41187612
DOI: 10.1016/j.oraloncology.2025.107766

Abstract

Objectives: To evaluate worldwide medical practices of otolaryngology centers in managing patients with Head And Neck Cancer (HNC) MATERIALS AND METHODS: We performed an online survey sent to otorhinolaryngologists worldwide via the IFOS between February and March 2024. The following aspects were evaluated: personal characteristics, diagnostics modalities, treatments, global management, cultural specificities and clinical cases. We compared results between centers in different geographical areas: Europe, North America, South and Central America, Asia, Africa Sub-Saharan, Oceania, and Middle East & North Africa (MENA).

Results: A total of 566 otorhinolaryngologists from 457 centers in 101 countries responded. International guideline adherence was lower in North America (45.5 %) than globally (74.5 %; p = 0.005). HPV/p16 testing was less common in Africa (28.9 %) and MENA (60.8 %) versus other regions (92.8 %; p < 0.001). PD-L1 testing was frequent in Europe (84.6 %) but rare in Africa (5.3 %; p < 0.001). Multidisciplinary Tumor Boards were systematic in Europe (88.9 %) and Oceania (87.5 %) but used selectively elsewhere. Intensity-modulated radiation therapy use was lower in Africa (28.9 %) and MENA (64.6 %; p < 0.001). A total of 95.7 % of centers had access to chemotherapy, with no differences between regions (p = 0.236). African centers cited cost as a major barrier (79.5 % vs. 33.8 %; p < 0.001). MRI and PET/CT access was significantly lower in Africa (51.2 % and 5 %), Central/South America (79.5 % and 47.7 %), and MENA (80.9 % and 43.8 %) than other regions (89.5 % and 73.2 %; p < 0.001).

Conclusion: The management of HNC exhibits significant variability worldwide. International guidelines should consider the economic, cultural, and geographic specificities of each continent to ensure context-sensitive care.

Keywords: Head and Neck Cancer; Healthcare Disparities; International Guidelines; Multidisciplinary Management; Otorhinolaryngology; Survey.

MeSH terms

Female
Global Health
Guideline Adherence / statistics & numerical data
Head and Neck Neoplasms* / diagnosis
Head and Neck Neoplasms* / therapy
Humans
Male
Surveys and Questionnaires