THE ROLE OF PROFESSIONAL DIAGNOSTIC DELAYS IN THE PROGNOSIS OF UPPER AERODIGESTIVE TRACT CARCINOMA

Despite the belief that cancer mortality can be reduced if lesions are detected, diagnosed and treated at an early stage, only one study, am ong a number concerning cancers of the upper aerodigestive tract (UADT ), has found any relationship between such delays and prognosis for th is population of cancer patients. The aim of this study was, therefore , to investigate the relationship between patient and professional dia gnostic delays and patient prognosis in a group of UADT cancer patient s. Patients diagnosed with squamous cell carcinoma of oral cavity site s (ICD-9 141, 143-5) oro-, naso- and hypopharynx (ICD-9 146-8) and lar ynx (ICD-9 161) were included in the study. Stepwise multiple logistic regression was used to calculate the odds ratio (OR) of late versus e arly stage disease for selected study variables. The sample comprised 188 subjects. Multivariate analysis found that having a pharyngeal can cer (OR 9.26; 95%Cl 4.02-21.32; P: 0.0001) a professional delay > 1 mo nth (OR 2.28; 95%Cl 1.13-4.64; P: 0.022) and age greater than or equal to 65 years (OR: 0.45; 95%Cl: 0.22-0.91; P: 0.024) were predictive of late stage disease. A dose-response relationship between professional delay and OR for late stage disease for the whole sample (P for trend 0.03) and among those with oral cancer (P for trend 0.0001) was found . The results of this study suggest that, among patients with an UADT cancer, professional delays > 1 month are contributing to an increased risk for being diagnosed with late stage disease. (C) 1998 Elsevier S cience Ltd. All rights reserved.