Factors involved in diagnosis delay and poor prognosis in laryngeal squamous carcinoma: a retrospective study about 86 cases
Keywords:Laryngeal squamous carcinoma, Delay in laryngeal carcinoma, Dysphonia
Background: Squamous cell carcinoma of head and neck seems to be the seventh most common histological type worldwide with a great morbidity and mortality rates. Multiple published papers studied the overall survival of laryngeal squamous carcinoma depending on different factors. The aim of the study was to analyze the different factors that could impact the patient and the professional delays, and hence analyze factors related to poor prognosis and overall survival rates.
Methods: Retrospective descriptive and analytic study between January 2015 and January 2020 in ENT-HNS department in university hospital Mohammed VI of Marrakech. All patients admitted for confirmed histologically with a primary laryngeal squamous carcinoma and who consented to this study were included in our study, grouping 86 patients.
Results: Age and denial of care were the factors related to patient delay (p=0.044), medical doctors (0.030), the first consult decision (0.044) and the malpractice (0.008) were statistically related to the professional delay. The multivariate analysis with disease specific survival found that the tumor location (p=0.022), the disease staging at diagnosis (0.047), the Charlson comorbidity index (p=0.017), the patient delay and professional delay (p<0.001) were associated to a poor survival rate.
Conclusions: Patient and professional delays are factors that could be controlled by emphasizing the importance of medical consult when presenting laryngeal symptoms and the essential role of primary care doctors during 1st consult and how crucial it is to make a full examination and even refer patients to specialist when malignancy is suspected.
Zhu K, Lin R, Zhang Z, Chen H, Rao X. Impact of prior cancer history on the survival of patients with larynx cancer. BMC Cancer. 2020;20(1):1137.
Kowalski LP, Torloni H, Fava AS, De Andrade Sobrinho J, Ramos G, Oliveira BV, Curado MP. Lateness of diagnosis of oral and oropharyngeal carcinoma: factors related to the tumour, the patient and health professionals. Eur J Cancer B Oral Oncol. 1994;30B(3):167-73.
Ildstad DJT, Bigelow ME, Remensnyder JP. A multivariate analysis of determinants of survival for patients with squamous cell carcinoma of the head and neck. Ann Surg. 1989;209(2):237-41.
Amar A, Chedid HM, Franzi SA, Rapoport A. Retardo diagnóstico e terapêutico em pacientes com câncer da laringe em hospital público de referência. Braz J Otorhinolaryngol. 2010;76(6):700-3.
H Teppo 1 O-PA. Relative importance of diagnostic delays in different head and neck cancers. Clin Otolaryngol. 2008;33(4):325-30.
Schutte HW, Heutink F, Wellenstein DJ, van den Broek GB, van den Hoogen FJA, Marres HAM et al. Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review. Otolaryngol Head Neck Surg. 2020;162(4):446-57.
Kompelli AR, Li H, Neskey DM. Impact of Delay in Treatment Initiation on Overall Survival in Laryngeal Cancers. Otolaryngol Head Neck Surg. 2019;160(4):651-7.
Carvalho AL, Schlecht NF, Oliveira BV, Fava AS, Curado MP, Kowalski LP, Franco EL. Predictive Factors for Diagnosis of Advanced-Stage Squamous Cell Carcinoma of the Head and Neck. Arch otolaryngol head neck surg. 2002;128(3):313-8.
Primdahl H, Nielsen AL, Larsen S, Andersen E, Ipsen M, Lajer C et al. Changes from 1992 to 2002 in the pretreatment delay for patients with squamous cell carcinoma of larynx or pharynx: a Danish nationwide survey from DAHANCA. Acta Oncol. 2006;45(2):156-61.
Teppo H, Koivunen P, Hyrynkangas K, Alho OP. Diagnostic delays in laryngeal carcinoma: professional diagnostic delay is a strong independent predictor of survival. Head Neck. 2003;25(5):389-94.
Ramos Innocentini LMA, Teixeira AH, Casemiro LA, Andrade MC, Ferrari TC, Ricz HMA et al. Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience. Int Arch Otorhinolaryngol. 2019;23(3):e299-e304.
Brouha XD, Tromp DM, Hordijk GJ, Winnubst JA, de Leeuw JR. Oral and pharyngeal cancer: analysis of patient delay at different tumor stages. Head Neck. 2005;27(11):939-45.
Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009;141(3-2):S1-S31.
Smith MM, Abrol A, Gardner GM. Assessing delays in laryngeal cancer treatment. Laryngoscope. 2016;126(7):1612-5.
Daniel D. Lydiatt D, MD, FACS. Medical Malpractice and Cancer of the Larynx. Laryngoscope. 2009;112(3):445-8.
Teppo H, Alho OP. Comorbidity and diagnostic delay in cancer of the larynx, tongue and pharynx. Oral Oncol. 2009;45(8):692-5.
Van Harten MC, de Ridder M, Hamming-Vrieze O, Smeele LE, Balm AJ, van den Brekel MW. The association of treatment delay and prognosis in head and neck squamous cell carcinoma (HNSCC) patients in a Dutch comprehensive cancer center. Oral Oncol. 2014;50(4):282-90.
Wang JR, Habbous S, Espin-Garcia O, Chen D, Huang SH, Simpson C et al. Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma. Head Neck. 2016;38(5):736-42.
Gollnitz I, Inhestern J, Wendt TG, Buentzel J, Esser D, Boger D et al. Role of comorbidity on outcome of head and neck cancer: a population-based study in Thuringia, Germany. Cancer Med. 2016;5(11):3260-71.
Multidisciplinary Larynx Cancer Working G, Mulcahy CF, Mohamed ASR, Kanwar A, Hutcheson KA, Ghosh A et al. Age-adjusted comorbidity and survival in locally advanced laryngeal cancer. Head Neck. 2018;40(9):2060-9.
Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP. Comorbidity Is a Prognostic Factor in Elderly Patients with Head and Neck Cancer. Ann Surg Oncol. 2007;14(4):1449-57.
Fong PY, Tan SH, Lim DWT, Tan EH, Ng QS, Sommat K et al. Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC). PLoS One. 2019;14(11):e0224665.
Tiwari V, Yogi V, Ghori HU, Singh OP, Peepre K, Yadav S et al. Identifying the Factors Causing Delayed Presentation of Cancer Patients to a Government Medical College of Central India. J Clin Diagn Res. 2015;9(9):Xc09-xc12.
Pera AME, Galindo L. Prognostic factors in laryngeal carcinoma. A multifactorial study of 416 cases. Cancer. 1986;58(4):928-34.
Allison EF, Black M, Feine J. The role of professional diagnostic delays in the prognosis of upper aerodigestive tract carcinoma. Oral Oncol. 1998;34:147-53.
Walter Habermann M, Berghold A; Trevor TJ, Friedrich G. Carcinoma of the Larynx: Predictors of Diagnostic Delay. Laryngoscope. 2001;111(4 Pt 1):653-6.