title: Diagnostic delay and disease stage in head and neck cancer: a systematic review.
abstract: OBJECTIVE
  The objective of this study was to examine the evidence for an association between patient and/or provider-related diagnostic delay and late stage at diagnosis.
  
  
  METHODS
  We identified all English language published studies worldwide and present a summary of the direction and magnitudes of the associations observed. We consider the role of study population characteristics and symptom variation across the head and neck cancer sites on the delay-stage association.
  
  
  RESULTS
  The 27 eligible studies reviewed varied considerably in the cancer types grouped by analysis, types of delay, and measurement of delay. The relationship between diagnostic delay and stage at diagnosis varied in direction and magnitude, with no consistent positive association in any of the head and neck cancer sites.
  
  
  CONCLUSIONS
  Possible explanations for the lack of an observed relationship between patient delay and stage include: inaccurate measurement of delay, lack of sensitivity of disease stage to delay-related disease progression, and variation in tumor aggressiveness, which could lead to variation in symptom progression rates. We call for better evidence about the relationship between diagnostic delay and disease progression and/or disease outcomes. If demonstrated and validated, such associations would provide a much stronger argument than description of delay alone for education programs around symptom recognition and for more active screening of high-risk individuals.
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Goy
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Hall
authors.forename: Deb
authors.initials: D
authors.lastname: Feldman-Stewart
authors.forename: Patti A
authors.initials: PA
authors.lastname: Groome
mesh_terms: D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D009367:Neoplasm Staging; D012017:Referral and Consultation; D013997:Time Factors