Predictive factors for diagnosis of advanced-stage squamous cell carcinoma of the head and neck

Abstract

Objective: To identify the predictive factors (with emphasis on diagnostic delay) associated with the diagnosis of an advanced-clinical stage head and neck cancer.

Design: Cross-sectional study of patients with head and neck cancer originally recruited for a case-control study.

Setting: Three referral oncological centers in metropolitan areas in southern Brazil: São Paulo, Curitiba, and Goiânia.

Patients: The study population comprised 679 patients recently diagnosed as having a previously untreated head and neck squamous cell carcinoma.

Main outcome measure: Diagnosis of advanced disease (clinical stage III-IV) head and neck cancer.

Results: Patients with laryngeal and hypopharyngeal cancers were more likely to be diagnosed as having advanced disease than those with lip, oral, and oropharyngeal cancers (88.0% vs 74.6%) (P<.001). Patient delay was inversely associated with clinical stage at diagnosis in patients with the same cancers, while professional delay was directly associated with a higher risk of advanced clinical stage at diagnosis (P =.001 and P =.006, respectively). In the analysis of laryngeal and hypopharyngeal cancer, both patient and professional delays were associated with advanced disease, with patient delay being a stronger predictive factor than professional delay.

Conclusions: Clinical stage at diagnosis was associated with sociodemographic characteristics, patient delay, and professional delay. Our results indicate that continued educational programs for the population and health care professionals regarding the identification of early symptoms of head and neck cancers are warranted.