Diagnostic Delays and Errors in Head and Neck Cancer Patients: Opportunities for Improvement

Franco, Joel; Elghouche, Alhasan N.; Harris, Michael S.; Kokoska, Mimi S.

doi:10.1177/1062860616638413

Cited by 20 publications

(29 citation statements)

References 16 publications

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“…12 Painless cervical metastatic lumps are the commonest head and neck lumps in adults, and it is prone to misdiagnosis. 2,6,17 This explained why 87.3% of the neck lumps, were of painless malignant neck lumps noted in this present study.…”

Section: Discussionmentioning

confidence: 49%

“…Delay in diagnosis for patients with malignant neck lumps is common. 2,17 The reported average diagnostic delays were between 3-6 months for head and neck squamous cell carcinoma with metastatic neck masses. 2 In contrast to this study, the average duration recorded included all the malignant neck lumps.…”

Section: Discussionmentioning

confidence: 99%

“…Patient and professional delays are recognized factors involved in the delay for making a definitive diagnosis for malignant neck lumps, hence a poor prognostic treatment outcome. 2,17,21 Patients delay were attributed to taking alternative medications, ignorance of clinical features of head and neck cancers, illiteracy and low socioeconomic status. 2 The professional delay includes the delay and failure to make a definitive diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…unorthodox procedures on the neck lump, self-medication with antibiotics, and coupled with the role played by the medical professionals; all these factors contribute to the poor outcome of both the primary and secondary head and neoplastic neck pathologies. [15][16][17] There is a dearth of information on the pre-tertiary hospital management of adults with neoplastic neck lumps.…”

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confidence: 99%

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Pre-tertiary hospital management of neoplastic neck lumps in adults: the need for an appraisal in North Western Nigeria

et al. 2019

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Background: Pathologies in the head and neck sites may manifest as neck lumps, which is an important prognostic significance in the management. The aim of the study was to describe the pre-tertiary hospital management of adult patients with neoplastic neck lumps.Methods: This was a retrospective study of all the patients managed for neoplastic neck lumps from September 2008 to September 2018, at the Department of Otorhinolaryngology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.Results: A total of 118 patients were included in the study. The age ranged from 16-83 years (mean age; 42.3±16.7 years). Majority of the patients 71 (60.2%) were of lower socioeconomic status. Duration of neck swellings was between 3-240 months with an overall mean duration of 30.2 months (mean duration for benign and malignant neck masses respectively; 100±56 and 20.1±47.1 months). Malignant neck lumps 103 (87.3%) constituted most of the neck lumps, and of these, 91 (77.1%) were metastatic neck lumps. Patients delay 94 (79.7%), and professionals delay 24 (20.3%) were responsible for advanced primary head and neck neoplasia and their metastatic deposits. Eighty-seven (73.7%) patients were managed at the tertiary hospital: fifty-two (59.8%) were successfully discharged and were lost to follow up within six months after the intervention. Thirty-five (40.2%) patients died during treatment and 31 (26.3%) signed against medical advice.Conclusions: Malignant lumps, mainly the metastatic neck disease, are common in adults. The notable contributory factors for delay presentation can be preventable through creating public awareness and the improvement of socioeconomic status.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pre-tertiary hospital management of neoplastic neck lumps in adults: the need for an appraisal in North Western Nigeria

et al. 2019

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“…As the mean value for pan endoscopy was 11.5 days and median of 6, these statistics fell far below the expected audit standards. Out of the 23 patients who underwent a diagnostic surgical procedure under general anaesthesia (DL,ML)10 had breached the temporal dead line, similarly Joel Franco MD et al, found delay in employing an appropriate diagnostic test or procedure in(15.2%) which is approximately 1/3 of ours [11] .…”

Section: Procedures Delaymentioning

confidence: 61%

Assessment of head and neck cancer care in District General Hospital Trincomalee

Ekanayake

Vasantharajah

Alex

et al. 2018

Ceylon J Otolaryngology

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Objective To compare whether head and neck cancer treatment provided at the district general hospital in Trincomalee is within the international temporal guidelines and if not the necessary measurements needed for improvement. Methodology A Retrospective clinical audit of head and neck cancer care provided in 2016 and a re-audit in 2017 after application of remedial measures identified in the initial audit Result Patient delay, referral delay, initiationdelay, procedural delay, biopsy delay and treatment delay were minimized to the delays accepted by European guidelines. Conclusion Following the audit, the delays were identified involving all the stakeholders and implementation of an improvement plan done leading to near ideal head & neck cancer care provision.

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Association Between Antibiotic Prescribing and Time to Diagnosis of Head and Neck Cancer

Gallogly,

Armstrong,

Brinkmeier

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceDiagnostic delay can negatively affect patient outcomes in head and neck cancer (HNC). Neck mass and other symptoms of undiagnosed HNC may be treated with antibiotics, delaying diagnosis and treatment, despite current clinical practice guidelines.ObjectiveTo investigate temporal trends, associated factors, and time from symptom onset to antibiotic prescribing before an HNC diagnosis.Design, Setting, and ParticipantsA retrospective cohort study was conducted using data obtained from a deidentified electronic health records data set from January 1, 2011, to December 31, 2018. Patients with HNC enrolled in the data set for at least 1 year before diagnosis date determined by either 1 inpatient encounter or first of 2 outpatient encounters within 6 months were included. Data analysis was conducted from May 1 to November 9, 2022.ExposureAntibiotic prescription within 3 months before HNC diagnosis date.Main Outcomes and MeasuresThe primary outcome was days from the first documented symptom to HNC diagnosis.ResultsThe cohort included 7811 patients with HNC (4151 [53.1%] men, mean [SD] age, 60.2 [15.8] years). At least 1 antibiotic was prescribed for 1219 patients (15.6%) within 3 months before HNC diagnosis. This represented an increase over the 8.9% prescribing rate during the baseline period 12 to 9 months before diagnosis. The rate of antibiotic prescribing within 3 months before diagnosis did not change significantly over time (quarterly percent change, 0.49%; 95% CI, −3.06% to 4.16%). Patients receiving an antibiotic prescription within 3 months of an HNC diagnosis had a 21.1% longer time between symptom onset and HNC diagnoses (adjusted rate ratio [ARR], 1.21; 95% CI, 1.14-1.29). Compared with diagnosis by otolaryngologists, primary care/internal medicine physicians were most likely to prescribe antibiotics for patients who were diagnosed with a presenting symptom (adjusted prevalence ratio, 1.60; 95% CI, 1.27-2.02). In patients presenting with neck mass/swelling, those presenting with other symptoms were more likely to have longer intervals from symptom onset to diagnosis (ARR, 1.31; 95% CI, 1.08-1.59).Conclusions and RelevanceThe findings of this cohort study suggest there is an increased rate of antibiotic prescription in the 3 months before HNC diagnosis, which is associated with an increased time to diagnosis. These findings identify an area for improvement in HNC care and guidelines.

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Diagnostic Delays and Errors in Head and Neck Cancer Patients: Opportunities for Improvement

Cited by 20 publications

References 16 publications

Pre-tertiary hospital management of neoplastic neck lumps in adults: the need for an appraisal in North Western Nigeria

Pre-tertiary hospital management of neoplastic neck lumps in adults: the need for an appraisal in North Western Nigeria

Assessment of head and neck cancer care in District General Hospital Trincomalee

Association Between Antibiotic Prescribing and Time to Diagnosis of Head and Neck Cancer

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