Possible causes for delay in diagnosis and treatment in head and neck cancer: an institutional study

Nikesh Agarwal, Daulat Singh, Manoj Verma, Shantunu Sharma, R. K. Spartacus, Manish Chaturvedi


Background: Head and neck cancer is one of the leading cancers among Indian population. Early diagnosis and treatment is cornerstone for improving survival in any malignancy, any delay leads to advanced form of disease, leading to higher morbidity and mortality. Given the location, head and neck cancers are easily visible or palpable on clinical examination. In spite of this, many patients are diagnosed at advanced stage.

Methods: A cross sectional observational study was conducted at a tertiary care center of western india including 156 newly diagnosed head and neck cancer patients. Delay in seeking medical attention was defined as time interval of more than 3 months from the first symptom recognition to the first medical consultation. Subjects were then divided into delay and non-delay group and compared to identify the factors associated with delay in seeking medical attention.

Results: Delay in seeking medical consultation was seen in 109 (69.9%) patients. The factors found significantly associated with delay were older age (p<0.001), rural background (p<0.001), illiteracy (p<0.001), joint family (p<0.001), poor socioeconomic status (p<0.001), longer distance from hospital (p<0.001), tobacco chewing (p=0.018), insufficient knowledge (p<0.001) and fear (p=0.031) of the disease.

Conclusions: Many of the identified factors for delay in seeking medical attention in head and neck cancer patients are amenable to improvement. Improving health coverage and awareness of available health services, specially in far rural areas could prevent delay in diagnosis and treatment and thus significantly reduce morbidity and mortality as well as burden on health system.


Delay, Head and neck cancer, Socio-demographic

Full Text:



National Cancer Registry Programme, Indian Council of Medical Research, Three year report of Population Based Cancer Registries 2012-2014, Incidence, Distribution, Trends in Incidence Rates and Projections of Burden of Cancer, Bengluru, India; 2016; Chapter 2; p. 9-26. Available at: http:/ / 012_2014/ALL_ CONTENT/ PD F_Printed_Version/Chapter2_Printed.pdf. Accessed on 12 January 2018.

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No.11. Lyon, France: International Agency for Research on Cancer; 2013. Available at: Accessed 12 January 2018.

Prasad U, Pua KC. Nasopharyngeal carcinoma: a delay in diagnosis. Med J Malaysia. 2000;55(2):230-5.

Andersen BL, Cacioppo JT. Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. Br J Soc Psychol. 1995;34:33-52.

Andersen RS, Vedsted P, Olesen F, Bro F, S√łndergaard J. Patient delay in cancer studies: a discussion of methods and measures. BMC Health Serv Res. 2009;9:189.

Akram M, Siddiqui SA, Karimi AM. Patient related factors associated with delayed reporting in oral cavity and oropharyngeal cancer. Int J Prev Med. 2014;5:915-9.

Agarwal AK, Sethi A, Sareen D, Dhingra S. Treatment delay in oral and oropharyngeal cancer in our population: the role of socio-economic factors and health-seeking behaviour. Indian J Otolaryngol Head Neck Surg. 2011;63:145-50.

Kerdpon D, Sriplung H. Factors related to delay in diagnosis of oral squamous cell carcinoma in southern Thailand. Oral Oncol. 2001;37:127-31.

Patterson RE, Neuhouser ML, Hedderson MM, Schwartz SM, Standish LJ, Bowen DJ, et al. Types of alternative medicine used by patients with breast, colon, or prostate cancer: predictors, motives, and costs. J Altern Complement Med. 2002;8:477-85.

Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer. 1998;83:777-82.

Dubayova T, van Dijk JP, Nagyova I, Rosenberger J, Havlikova E, Gdovinova Z, et al. The impact of the intensity of fear on patient's delay regarding health care seeking behavior: a systematic review. Int J Public Health. 2010;55:459-68.

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;27:939-45.

Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev. 2006;7:108-12.

Allison P, Franco E, Black M, Feine J. The role of professional diagnostic delays in the prognosis of upper aerodigestive tract carcinoma. Oral Oncol. 1998;34:147-53.