Relative importance of diagnostic delays in different head and neck cancers

Objectives: Clinical stage at the time of diagnosis is the most important determinant of prognosis in head and neck cancer. Previously, longer diagnostic delay has been shown to worsen prognosis in cancer of tongue, pharynx and larynx. The aim of this study was to evaluate the relative importance of patient and professional diagnostic delays in the prognosis of these head and neck cancers. Design: Population-based retrospective cohort study. Setting: Oulu University Hospital (tertiary referral centre) district, Northern Finland. Participants: Population-based cohort of 221 patients with tongue, pharyngeal or laryngeal cancer diagnosed in 1986-1996. Main outcome measures: Patient and professional diagnostic delays, overall survival. Results: Delays were significantly longer in laryngeal cancer. Moreover, longer diagnostic delays worsened survival markedly only in laryngeal cancer. Cut-off points at which the delays showed significant adverse impact in prognosis of laryngeal cancer were >= 3 months in patient delay and >= 6 months in professional delay. If mirror laryngoscopy was not performed at the initial visit, professional delay in laryngeal cancer turned out to be significantly longer. Conclusions: Diagnostic delays are longer and have a more significant impact on survival in laryngeal cancer than in lingual or pharyngeal cancer. Thus, patients with symptoms suggestive of laryngeal process should always be examined properly at the initial visit in order to shorten the professional diagnostic delay in laryngeal cancer.