The role of professional diagnostic delays in the prognosis of upper aerodigestive tract carcinoma.
Despite the belief that cancer mortality can be reduced if lesions are detected, diagnosed and treated at an early stage, only one study, among a number concerning cancers of the upper aerodigestive tract (UADT), has found any relationship between such delays and prognosis for this population of cancer patients. The aim of this study was, therefore, to investigate the relationship between patient and professional diagnostic delays and patient prognosis in a group of UADT cancer patients. Patients diagnosed with squamous cell carcinoma of oral cavity sites (ICD-9 141, 143-5)oro-, naso- and hypopharynx (ICD-9 146-8) and larynx (ICD-9 161) were included in the study. Stepwise multiple logistic regression was used to calculate the odds ratio (OR) of late versus early stage disease for selected study variables. The sample comprised 188 subjects. Multivariate analysis found that having a pharyngeal cancer (OR 9.26; 95% CI 4.02-21.32; P: 0.0001) a professional delay > 1 month (OR 2.28; 95% CI 1.13-4.64; P: 0.022) and age > or = 65 years (OR: 0.45; 95% CI: 0.22-0.91; P: 0.024) were predictive of late stage disease. A dose-response relationship between professional delay and OR for late stage disease for the whole sample (P for trend 0.03) and among those with oral cancer (P for trend 0.0001) was found. The results of this study suggest that, among patients with an UADT cancer, professional delays > 1 month are contributing to an increased risk for being diagnosed with late stage disease.
Faculty of Dentistry, McGill University, Montreal, Canada.
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Allison
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Franco
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Black
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Feine
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D002983:Clinical Competence; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000175:diagnosis; D011379:Prognosis; D011792:Quebec; D013997:Time Factors