Diagnostic delays in laryngeal carcinoma: professional diagnostic delay is a strong independent predictor of survival.
BACKGROUND
Clinical stage at the time of diagnosis is the most important determinant of prognosis in cancers of the head and neck. Accordingly, delay in diagnosis could worsen survival in laryngeal cancer, although this hypothesis has not been verified in previous studies.


METHODS
To determine the effects of patient and professional diagnostic delays on survival in patients with laryngeal squamous cell carcinoma (LSCC), a population-based sample of 66 patients with LSCC in Northern Finland between 1990 and 1995 was investigated. In addition to clinical data from tertiary care units and mortality data from the national death register, we collected data about the first medical visit in primary care that resulted, subsequently, in the diagnosis of malignancy.


RESULTS
Long professional delay in diagnosis (>or=12 months) was an independent and statistically significant determinant of worsened prognosis (adjusted relative hazard of death 4.74, p =.05). There was no correlation between patient delay and prognosis. Another significant factor related to impaired prognosis was advanced stage (IV vs I-III, adjusted relative hazard of death 5.18, p =.02). Long professional delay was not significantly related to any of the demographic or clinical characteristics.


CONCLUSIONS
A long professional delay is a marked and independent determinant of impaired survival in laryngeal carcinoma and equals the effect of advanced stage. However, unlike in most other cancers, early symptoms and slow tumor growth give the physician a fairly long time to reach the correct diagnosis before the delay turns out to be fatal.
Teppo
Heikki
H
Department of Otorhinolaryngology, University of Oulu, BOX 5000, FIN-90014, Finland. heikki.teppo@oulu.fi
Koivunen
Petri
P
Hyrynkangas
Kalevi
K
Alho
Olli-Pekka
OP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors