Factors Associated with Delay from Diagnosis to Treatment Initiation among Patients with Head & Neck Cancer at a Tertiary Care Hospital in Karachi, Pakistan

Abstract

Objective: Timely initiation of treatment is essential for improving outcomes among patients with head and neck cancer (HNC). Delays between diagnosis and treatment initiation may adversely affect disease progression, treatment efficacy, and survival. This study aimed to identify factors associated with delay from diagnosis to treatment initiation among patients with head and neck cancer presenting to a tertiary care hospital in Karachi, Pakistan.

Methodology: A prospective observational cross-sectional study was conducted at the Department of Otolaryngology–Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan, from July 2021 to July 2022. A total of 155 adult patients with histopathologically confirmed head and neck carcinoma were enrolled using a non-probability consecutive sampling technique. Of these, 142 patients were managed with surgery, while 13 patients were managed with chemoradiation as the definitive primary treatment modality. Data regarding sociodemographic characteristics, clinical variables, and potential factors contributing to treatment delay were collected. The diagnosis-to-treatment interval (DTI) was defined as the time from histopathological confirmation of head and neck cancer to the initiation of definitive primary treatment, either surgery or chemoradiation/Radiotherapy (CRT/RT). Descriptive statistics were computed, while Chi-square and independent sample t-tests were used for univariate analyses. Multivariable logistic regression analysis was performed to identify factors independently associated with treatment delay. A p-value <0.05 was considered statistically significant.

Results: The mean age of participants was 50.8 ± 14.5 years, and 111 (71.6%) were male. Treatment delay was observed in 128 (82.6%) patients. The median diagnosis-to-treatment interval was 4 weeks (IQR: 2–12 weeks), while the mean interval was 11.2 ± 14.5 weeks. Univariate analysis demonstrated significant associations between treatment delay and quality of counselling (p=0.022), alcohol use (p=0.029), and seeking alternative treatment modalities (p=0.033). Among patients with treatment delay, inadequate quality of counselling was the most frequently reported reason in both surgical and concurrent chemoradiotherapy groups. Multivariable logistic regression revealed that adequate counselling was independently associated with lower odds of treatment delay (AOR=0.23, 95% CI: 0.06-0.86; p=0.029). Seeking alternative treatment modalities showed a borderline association with delayed treatment initiation (AOR=8.27, 95% CI: 0.99-69.29; p=0.051). No significant associations were observed for age, marital status, financial constraints, or alcohol use.

Conclusion: Treatment delay was highly prevalent among patients with head and neck cancer. Inadequate counselling emerged as the only independent associate of delayed treatment initiation. Strategies aimed at improving physician-patient communication and counselling may facilitate timely initiation of treatment and improve oncologic outcomes.