Increased Antibiotic Prescribing Period Associated with Delayed Head and Neck Cancer Diagnosis

by Linda Kossoff •

What are the temporal trends, associated factors, and diagnostic times between antibiotic prescribing and a diagnosis of head and neck cancer (HNC)?

BOTTOM LINE

Antibiotic prescribing is associated with diagnostic delays that are known to be harmful to patients.

BACKGROUND: HNC frequently presents with symptoms potentially attributable to infectious causes; however, treatment of presumed infectious causes may prolong time to HNC diagnosis and subsequent treatment. Adherence to clinical practice guidelines that could decrease diagnostic delays has not been assessed in a large sample.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Mo.

SYNOPSIS: Researchers gathered a data set of 7,811 patients diagnosed with HNC from Jan. 1, 2011, to Dec. 31, 2018, from across all 50 states. The exposure of interest was whether patients with HNC received an antibiotic within three months of their HNC diagnosis. The primary outcome was days from the first documented symptom to HNC diagnosis. Findings showed that at least one antibiotic was prescribed for 1,219 patients (15.6%) within three months before HNC diagnosis, which is nearly double the baseline antibiotic rate in this cohort, and ultimately was associated with a 21.1% longer time between symptom onset and HNC diagnosis. The week of HNC diagnosis had the highest antibiotic prescription percentage (7.6%). The most common class of antibiotic was penicillin. Compared with diagnosis by otolaryngologists, primary care/internal medicine physicians were most likely to prescribe antibiotics for patients who were diagnosed with presenting symptoms. Authors state that these findings identify an area for improvement in HNC care and guidelines. Study limitations included its non-random sample that may not generalize to the national population.

CITATION: Gallogly JA, Armstrong AT, Brinkmeier JV, et al. Association between antibiotic prescribing and time to diagnosis of head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2023;vol: e232423.