Disparities in head and neck cancer: assessing delay in treatment initiation

Objectives/Hypothesis: Disparities in outcome for head and neck cancer (HNC) treatment are related to diverse factors including tumor stage, socioeconomic status, and treatment compliance. Latency to initiation of therapy may contribute to worse outcomes for underserved populations. The objectives of this study were to measure the interval from diagnosis of HNC to initiation of cancer treatment (DTI) and to identify factors that prolong DTI. Study Design: Retrospective study. Methods: We identified 150 consecutive patients treated for squamous cell HNC at a tertiary-care public hospital between 2005 and 2007. Outcome measures used were 1) interval between cancer diagnosis and treatment initiation and 2) factors that predict prolonged DTI. Results: We included 100 patients in the analysis. Median time to perform biopsy was 8 days; time to obtain final diagnosis was 14 days; time to complete staging scans was 18 days; time to discuss treatment plan was 23 days; time to initiation of therapy was 56 days. Median DTI was 48 days. DTI was prolonged for patients receiving primary radiotherapy compared to surgical therapy: 57 versus 30 days (P < .001). Early stage tumors had shorter DTI than late-stage tumors: 38 versus 57 days (P = .02). Presenting with outside biopsy demonstrating HNC also reduced DTI (P = .03). Obtaining a computed tomography scan in the emergency department was not found to significantly affect DTI. Conclusions: DTI was found to be prolonged among HNC patients in this study when compared to previously published treatment intervals. Advanced stage of tumor, primary radiotherapy, and need for biopsy prolonged DTI. Future studies should better identify causes of delay and reduce latency for patients at highest risk for delay. Laryngoscope, 2012