Delay in diagnosis of patients with head-and-neck cancer in Canada: impact of patient and provider delay

  • S. Kassirian London Health Sciences Centre, Western University
  • A. Dzioba London Health Sciences Centre, Western University
  • S. Hamel London Health Sciences Centre, Western University
  • K. Patel Moffitt Cancer Center and Research Institute, University of South Florida
  • D.A. Palma Western University
  • N. Read London Health Sciences Centre, Western University
  • V. Venkatesan London Health Sciences Centre, Western University
  • A.C. Nichols London Health Sciences Centre, Western University
  • J. Yoo London Health Sciences Centre,Western University
  • K. Fung London Health Sciences Centre, Western University
  • A. Mendez London Health Sciences Centre, Western University
  • S.D. MacNeil London Health Sciences Centre, Western University
Keywords: Delay of diagnosis, Delay in presentation, head and neck cancer, patient reported outcomes

Abstract

Background Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting.

Methods Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients.

Results The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1–7). No significant differences in time to presentation were found based on stage at presentation or anatomic site.

Conclusions At our tertiary care cancer centre, a patient’s clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.


Author Biographies

S. Kassirian, London Health Sciences Centre, Western University

Department of Medicine

 

A. Dzioba, London Health Sciences Centre, Western University

Department of Otolaryngology, Schulich School of Medicine and Dentistry

S. Hamel, London Health Sciences Centre, Western University

Department of Otolaryngology, Schulich School of Medicine and Dentistry

K. Patel, Moffitt Cancer Center and Research Institute, University of South Florida

Department of Otolaryngology

D.A. Palma, Western University

Department of Radiation Oncology, Schulich School of Medicine and Dentistry

N. Read, London Health Sciences Centre, Western University

Department of Radiation Oncology, Schulich School of Medicine and Dentistry

V. Venkatesan, London Health Sciences Centre, Western University

Department of Radiation Oncology, Schulich School of Medicine and Dentistry

A.C. Nichols, London Health Sciences Centre, Western University

Department of Otolaryngology, Schulich School of Medicine and Dentistry

J. Yoo, London Health Sciences Centre,Western University

Department of Otolaryngology, Schulich School of Medicine and Dentistry

K. Fung, London Health Sciences Centre, Western University

Department of Otolaryngology, Schulich School of Medicine and Dentistry

A. Mendez, London Health Sciences Centre, Western University

Department of Otolaryngology, Schulich School of Medicine and Dentistry

S.D. MacNeil, London Health Sciences Centre, Western University

Department of Otolaryngology, Schulich School of Medicine and Dentistry

Published
2020-06-22
How to Cite
Kassirian, S., Dzioba, A., Hamel, S., Patel, K., Palma, D., Read, N., Venkatesan, V., Nichols, A., Yoo, J., Fung, K., Mendez, A., & MacNeil, S. (2020). Delay in diagnosis of patients with head-and-neck cancer in Canada: impact of patient and provider delay. Current Oncology, 27(5). https://doi.org/10.3747/co.27.6547
Section
Surgical Oncology