Exploring factors in diagnostic delays of head and neck cancer at a public hospital.

Abstract

Background: Diagnosis and management of squamous cell carcinoma of the head and neck (SCCHN) involves a multidisciplinary approach. Navigation through a public hospital and the involved services often results in frequent diagnostic delays. Aim(s): 1. To quantify "provider delay:" the time between the first contact with health care provider and the time the diagnosis was confirmed by biopsy. 2. To determine what factors influence the delay in diagnosis. Method(s): We extracted data from patients diagnosed with SCCHN in the years of 2007 to 2009. We then performed univariate analysis including Mann-Whitney, chi-square, and ANOVA tests to examine associations between provider delay and the following characteristics: language (English or Non-English), employment, presence of partner, gender, ethnicity, age (<45 or 45), cancer subsite, staging, number of co-morbidities (3 or >3 conditions), number of tobacco pack-years, and history of alcohol dependence. Result(s): We retrieved data on 117 SCCHN patients diagnosed in the years 2007 to 2009. The mean provider delay for all patients was 67.3 days, with a standard deviation (SD) of 116. We found a significant difference in two characteristics. Provider delay was significantly shorter (p= 0.05) for non-English speakers than English speakers. In addition, there was a trend of shorter provider delay (p= 0.06) when patients were unemployed compared to patients with employment. We found no significant associations between provider delay and the other variables listed above. Conclusion(s): These results counter the notion that the lack of English literacy and unemployment present disadvantages to the patient. We hypothesize that shorter provider delays are seen in non-English speakers because they have better social support. Our observation that provider delay is dissimilar in different subsets of patients suggests that this delay is amenable to interventions. Our future analyses will focus on the role of social support and interventions to reduce provider delay. (Table Presented).