Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma

Abstract

Objective: Failure to recognize symptoms of non-human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(À)OPSCC) at presentation can delay diagnosis and treatment. We aim to identify patient factors and provider practice patterns that delay presentation and care in HPV(À)OPSCC.Methods: Retrospective review at a tertiary care center. Patients with HPV(À)OPSCC receiving treatment from 2006 to 2016. Patients were excluded if their date of symptom onset or diagnosis was unknown after thorough review of the electronic medical record or their tissue was not tested for HPV or p16. Clinical data, workup, and care timelines were abstracted. Univariate and multivariable linear regressions were performed to determine associations between patient and provider factors and delays in care.Results: Of 70 included patients, 52 (74%) were male and mean age was 60.5 (SD = 9.0). Median time to diagnosis was 69 days (IQR = 32-127 days), with a median latency of 30 days (IQR = 12-61 days) from symptom onset to first presentation and 19.5 days (IQR = 4-46 days) from the first presentation to diagnosis. Most patients visited at least 2 providers (n = 52, 74%) before diagnosis. Evaluation by 3 or more providers prior to diagnosis was associated with significant delays in diagnosis of nearly a year (357.7 days, p < 0.001) and being treated or prescribed analgesia prior to diagnosis was significantly associated with delays in diagnosis (p = 0.004) on univariate regression analysis.Conclusions: Delays in care related to evaluations by multiple providers and misdiagnosis prolonged time to diagnosis in HPV(À)OPSCC. Improved patient and provider education is necessary to expedite the diagnosis of HPV(À)OPSCC.

Inequities Associated With Advanced Stage at Presentation of Head and Neck Cancer

“…A total of 2830 studies were initially identified for screening, of which 50 were included in the review . Reasons for exclusion are depicted in the Figure.…”

“…The most studied HNC subsite was laryngeal cancer with 25 studies (50%), followed by oral cavity and oropharynx, each with 19 studies (38%). The most assessed outcome was advanced overall stage at presentation or diagnosis among 37 studies (74%) . Other options included advanced tumor size, advanced nodal disease, metastatic disease at presentation, and delayed diagnosis.…”

Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma

“…Alcohol use was determined by consumption of > 5 alcoholic beverages per week. 6 To assess factors independently associated with diagnostic delay in this population, a multivariable logistic regression analysis was performed (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, USA) using characteristics that were statistically more likely to be present in patients who experienced diagnostic delay versus those who did not.…”

“…Evaluation by three or more providers or being prescribed analgesia prior to diagnosis was associated with significant delays in diagnosis of nearly a year. 6 Additionally, patients with HPVþ OPSCC who were diagnosed at >12 months from symptom onset were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation than patients diagnosed < 12 months from symptom onset. 7 The aim of the present study was to further characterize HPVþ OPSCC by assessing for the presence of diagnostic delay compared with HPV-OPSCC and evaluating the role of various management factors that potentially impact time to diagnosis.…”

“…Evaluation by three or more providers or being prescribed analgesia prior to diagnosis was associated with significant delays in diagnosis of nearly a year. 6 Additionally, patients with HPV+ OPSCC who were diagnosed at >12 months from symptom onset were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation than patients diagnosed < 12 months from symptom onset. 7 …”