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Cited by 36Head and Neck Cancer StudiesCOVID-19 and healthcare impactsCancer Diagnosis and Treatment

Delay in Diagnosis of Patients with Head-and-Neck Cancer in Canada: Impact of Patient and Provider Delay

Open access
Kassirian, S., Dzioba, A., Hamel, S., Patel, K., Sahovaler, A., Palma, D.A., Read, N., Venkatesan, V. +5 more·2020·Current Oncology
DOI 10.3747/co.27.6547PMC PMC7606041
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Abstract

Background: Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting. Methods: Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients. Results: The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1–7). No significant differences in time to presentation were found based on stage at presentation or anatomic site. Conclusions: At our tertiary care cancer centre, a patient’s clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.

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  • The fragmented care pathway for head-and-neck cancer frequently results in prolonged diagnostic delays, mismanagement, and extended waits for essential tests before reaching an accurate diagnosis.

    “This fragmented care pathway frequently results in prolonged diagnostic delays, mismanagement, and extended waits for essential tests before reaching an accurate diagnosis [275].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [275]

    The Introduction reports multiple referrals, misdiagnoses, and prolonged waits for biopsies and imaging before specialist consultation. The Discussion reports substantial provider delay but says the care pathway *might* contribute to it; the paper does not establish that fragmentation frequently causes these problems. Page numbers were not available in the supplied copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Patients with head-and-neck cancer may also need to consult with various specialists due to the symptoms resembling benign conditions.

    “Patients with head-and-neck cancer may also need to consult with various specialists due to the symptoms resembling benign conditions.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [275]

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Research works printed but not linked: 1

  1. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer-Verlag; 2009.

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Authors
Kassirian, S., Dzioba, A., Hamel, S., Patel, K., Sahovaler, A., Palma, D. A., Read, N., Venkatesan, V., Nichols, A. C., Yoo, J., Fung, K., Mendez, A., & MacNeil, S. D.
Affiliations
  • Western University (CA)
  • University of South Florida (US)
Corresponding author
MacNeil, S.D.
ORCID
Venue
Current Oncology
Publisher
MDPI AG
Published
2020-10-01
Volume
27
Issue
5
Pages
467-477
ISSN
  • 1198-0052 (ISSN-L)
  • 1718-7729
DOI
10.3747/co.27.6547
PMC
PMC7606041
OpenAlex
W3096033062
Cited by
36
References
28
Citations by year
2026: 6 · 2025: 4 · 2024: 12 · 2023: 8 · 2022: 4 · 2021: 1
FWCI
2.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Oncology (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Scholarship@Western (Western University) (submittedVersion, cc-by)
  • Scholarship@Western (Western University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Health Sciences › Medicine › Oncology › Cancer Diagnosis and Treatment
Keywords
head and neck cancer, delayed diagnosis, patient delay, provider delay, multidisciplinary team referral, health care access, universal health care, referral pathways, patient education
MeSH terms
Ambulatory Care Facilities, Canada, Head and Neck Neoplasms, Health Personnel, Humans, Referral and Consultation, Delayed Diagnosis

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