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 (greater than or equal to 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. (C) 2001 American Cancer Society.