Impact of patient and professional diagnostic delays on the risk of recurrence in laryngeal carcinoma

Objectives: To evaluate the impact of patient and professional diagnostic delays on the risk of recurrence in laryngeal squamocellular carcinoma (LSCC). Design: Retrospective study using primary health care records completed before the diagnosis of malignancy. Setting: One primary health care district (onset of symptoms), one tertiary centre (final diagnosis). Participants: A population-based sample of 99 patients, of which 66 fulfilled the entry criteria, with LSCC diagnosed in northern Finland in 1990-1995. Main outcome measures: Impact of patient delay (interval between the onset of symptoms and the first visit to a physician) and professional delay (interval between the first medical visit and histologically verified diagnosis) on the risk of local, neck and distant recurrence in LSCC. Results: Professional delay of 1 year or longer was an independent predictor of both local [adjusted relative hazard (HR) 4.62, P = 0.02] and neck (HR 9.5, P = 0.015) recurrence. Longer professional delay was associated with the risk of recurrence particularly among patients with early stage (stages I-II) disease. Professional delay was almost exclusively because of a delay in referring patients from primary care to an ENT centre. Conclusions: Lengthened professional diagnostic delay is an independent predictor of an increased risk of local and neck recurrence in early stage LSCC. These patients could benefit from more aggressive primary treatment or more meticulous follow-up.