The impact of patient and professional diagnostic delays on survival in pharyngeal cancer

BACKGROUND Cancers of the head and neck still are detected mostly at an advanced stage, especially pharyngeal cancers. METHODS To study the impact of patient and professional delay on survival, the authors collected the data from 84 patients with pharyngeal cancer. In addition to clinical data from the tertiary care center, the authors evaluated the data from the first medical visit in primary care before the diagnosis of malignancy had been made. RESULTS The patients who had a patient delay of 2 months or more had a significantly higher relative hazard of death (HR; HR, 2.5; 95% confidence interval (CI), 1.39–4.38) compared with the patients with less than 2 months of patient delay. This risk was significant among the patients with oropharyngeal (P = 0.008) and nasopharyngeal cancer (P = 0.03), but not in those with hypopharyngeal cancer (P = 0.56). In contrast, there was no relation between professional diagnostic delay and prognosis. Advanced stage (International Union Against Cancer [UICC] TNM; Stage IV vs. Stage I–III; HR, 3.19; CI, 1.61–6.35) and age (≥ 65 vs. < 65 years; HR, 2.47; CI, 1.32–4.62) also were associated with an impaired prognosis. CONCLUSIONS Shortening of patient delay would substantially improve survival in pharyngeal cancer, but this goal seems difficult to attain because symptoms emerge late in pharyngeal cancer, and no specific symptoms or patient characteristics were related to a long patient delay. Professional delay does not have an impact on survival in pharyngeal cancer. Cancer 2001;92:2885–91. © 2001 American Cancer Society. A long patient delay has a significant impact on survival in pharyngeal cancer, but only in oropharyngeal and nasopharyngeal cancer and not in hypopharyngeal cancer regardless of the TNM classification. Even though pharyngeal cancer often is misdiagnosed in primary care, professional delay does not have an influence on survival.