Possible causes for delay in diagnosis and treatment in head and neck cancer: an institutional study

Abstract

Background: Head and neck cancer is one of the leading cancers among Indian population. Early diagnosis and treatment is cornerstone for improving survival in any malignancy, any delay leads to advanced form of disease, leading to higher morbidity and mortality. Given the location, head and neck cancers are easily visible or palpable on clinical examination. In spite of this, many patients are diagnosed at advanced stage.Methods: A cross sectional observational study was conducted at a tertiary care center of western india including 156 newly diagnosed head and neck cancer patients. Delay in seeking medical attention was defined as time interval of more than 3 months from the first symptom recognition to the first medical consultation. Subjects were then divided into delay and non-delay group and compared to identify the factors associated with delay in seeking medical attention.Results: Delay in seeking medical consultation was seen in 109 (69.9%) patients. The factors found significantly associated with delay were older age (p<0.001), rural background (p<0.001), illiteracy (p<0.001), joint family (p<0.001), poor socioeconomic status (p<0.001), longer distance from hospital (p<0.001), tobacco chewing (p=0.018), insufficient knowledge (p<0.001) and fear (p=0.031) of the disease.Conclusions: Many of the identified factors for delay in seeking medical attention in head and neck cancer patients are amenable to improvement. Improving health coverage and awareness of available health services, specially in far rural areas could prevent delay in diagnosis and treatment and thus significantly reduce morbidity and mortality as well as burden on health system.

A Descriptive Study on Diagnostic Timelines, and Factors Influencing Delayed Diagnosis Among Head and Neck Cancer Patients at Uganda Cancer Institute

“…Furthermore, patients with a household income exceeding 136 USD exhibited reduced odds of delayed diagnosis, with an odds ratio of 0.27 and a p-value of 0.043. This corresponds to the results reported by Agarwal et al (5). A higher income allows patients to cover out-of-pocket expenses for investigations, thereby facilitating earlier diagnosis.…”

“…an incidence of 5% is reported (2). About 90% of HNC are squamous cell carcinoma on histopathology (3), males are more affected than females (4,5) and the male-to-female ratio defers depending on the site involved (6). About 51 to 70% of patients with HNC have advanced disease i.e., stage III and IV at the time of diagnosis in low-, middle and high-income countries (LMICs) (7)(8)(9).…”

“…Delay in deciding to seek care may be attributed to factors such as age (5) and proximity to healthcare facilities (15). Additionally, lack of awareness about HNC, nancial limitations, and the educational level of patients and their attendants contribute to this delay (5).…”

“…Delay in deciding to seek care may be attributed to factors such as age (5) and proximity to healthcare facilities (15). Additionally, lack of awareness about HNC, nancial limitations, and the educational level of patients and their attendants contribute to this delay (5). Individuals with formal education were found to seek care sooner (5), and those with family support tended to seek healthcare earlier (23,24).…”

“…Additionally, lack of awareness about HNC, nancial limitations, and the educational level of patients and their attendants contribute to this delay (5). Individuals with formal education were found to seek care sooner (5), and those with family support tended to seek healthcare earlier (23,24). Lifestyle habits, such as tobacco use, have also been associated with diagnostic delays (16).…”