Head and neck cancer (HNC) is a rapidly progressive disease making timely initiation of treatment essential. In contrast, since the majority of patients present with advanced stage disease, complex diagnostic investigations are warranted. Timely treatment initiation is only possible if a well-organized care trajectory is defined, established and maintained. The aim of this symposium is to provide the head and neck oncologist with an overview of available scientific data on the HNC care trajectory. Published literature data, focusing on value-based medicine, identified determinants and the effects of delay on treatment initiation will be summarized. Recommendations will be given for optimizing the logistics of the care pathway. Specific current topics, such as care trajectory of elderly patients, and the effect of the COVID-19 pandemic on the care trajectory, will be highlighted. Care pathway The Care Pathway for newly diagnosed HNC patients starts at suspicion of malignant disease and referral patient to a center with expertise in head and neck oncology. After first consultation, diagnostic procedures are performed to evaluate the extent and nature of disease. Before patients are discussed in the multidisciplinary team and start treatment, their overall health status and treatment preferences are usually examined as well. The care pathway for new HNC patients can be divided into intervals to analyze duration of the different steps. Determinants of delay In order to optimize the care trajectory, insight in the determinants of delay are necessary. Roughly, the duration of the care trajectory is influenced by patient, tumor, treatment and hospital characteristics. When predictors of delay are known, care pathways can be adjusted accordingly. Impact of delay Tumor progression during the waiting time before onset of treatment may possibly result in intensified treatment and inferior outcome. Especially the effect of delayed treatment initiation on overall survival is widely reported. However, the effect of delay on other outcomes are less thoroughly described.