Dr. Groome is the Canada Research Chair in Cancer Care Evaluation. This research was undertaken thanks to funding from the Canada Research Chairs Program and to grant support to Dr. Groome from the Canadian Institutes of Health Research.
Diagnostic delay and disease stage in head and neck cancer: A systematic review†
Article first published online: 19 MAR 2009
Copyright © 2009 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 119, Issue 5, pages 889–898, May 2009
How to Cite
Goy, J., Hall, S. F., Feldman-Stewart, D. and Groome, P. A. (2009), Diagnostic delay and disease stage in head and neck cancer: A systematic review. The Laryngoscope, 119: 889–898. doi: 10.1002/lary.20185
Presented at the Canadian Otolaryngology Society Annual Meeting, Montreal, Quebec, Canada, May 2007 and the Canadian Society for Epidemiology and Biostatistics Conference, Calgary, Alberta, Canada, May 2007.
- Issue published online: 20 APR 2009
- Article first published online: 19 MAR 2009
- Manuscript Accepted: 2 OCT 2008
- Diagnostic delay;
- patient-related delay;
- provider delay;
- head and neck cancers;
- disease stage
The objective of this study was to examine the evidence for an association between patient and/or provider-related diagnostic delay and late stage at diagnosis.
We identified all English language published studies worldwide and present a summary of the direction and magnitudes of the associations observed. We consider the role of study population characteristics and symptom variation across the head and neck cancer sites on the delay-stage association.
The 27 eligible studies reviewed varied considerably in the cancer types grouped by analysis, types of delay, and measurement of delay. The relationship between diagnostic delay and stage at diagnosis varied in direction and magnitude, with no consistent positive association in any of the head and neck cancer sites.
Possible explanations for the lack of an observed relationship between patient delay and stage include: inaccurate measurement of delay, lack of sensitivity of disease stage to delay-related disease progression, and variation in tumor aggressiveness, which could lead to variation in symptom progression rates. We call for better evidence about the relationship between diagnostic delay and disease progression and/or disease outcomes. If demonstrated and validated, such associations would provide a much stronger argument than description of delay alone for education programs around symptom recognition and for more active screening of high-risk individuals. Laryngoscope, 2009