title: Impact of patient and professional diagnostic delays on the risk of recurrence in laryngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the impact of patient and professional diagnostic delays on the risk of recurrence in laryngeal squamocellular carcinoma (LSCC).
  
  
  METHODS
  Retrospective study using primary health care records completed before the diagnosis of malignancy.
  
  
  METHODS
  One primary health care district (onset of symptoms), one tertiary centre (final diagnosis).
  
  
  METHODS
  A population-based sample of 99 patients, of which 66 fulfilled the entry criteria, with LSCC diagnosed in northern Finland in 1990-1995.
  
  
  METHODS
  Impact of patient delay (interval between the onset of symptoms and the first visit to a physician) and professional delay (interval between the first medical visit and histologically verified diagnosis) on the risk of local, neck and distant recurrence in LSCC.
  
  
  RESULTS
  Professional delay of 1 year or longer was an independent predictor of both local [adjusted relative hazard (HR) 4.62, P = 0.02] and neck (HR 9.5, P = 0.015) recurrence. Longer professional delay was associated with the risk of recurrence particularly among patients with early stage (stages I-II) disease. Professional delay was almost exclusively because of a delay in referring patients from primary care to an ENT centre.
  
  
  CONCLUSIONS
  Lengthened professional diagnostic delay is an independent predictor of an increased risk of local and neck recurrence in early stage LSCC. These patients could benefit from more aggressive primary treatment or more meticulous follow-up.
authors.affiliation: Department of Otorhinolaryngology, Kanta-Hame Central Hospital, Hameenlinna, Finland. heikki.teppo@khshp.fi
authors.forename: H
authors.initials: H
authors.lastname: Teppo
authors.forename: K
authors.initials: K
authors.lastname: Hyrynkangas
authors.forename: P
authors.initials: P
authors.lastname: Koivunen
authors.forename: K
authors.initials: K
authors.lastname: Jokinen
authors.forename: O-P
authors.initials: OP
authors.lastname: Alho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods; D011320:Primary Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors