Patient Factors that Delay Care for Patients with Human Papilloma Virus–Negative Oropharyngeal Squamous Cell Carcinoma

by Linda Kossoff •

What are the patient factors and provider practice patterns that delay presentation and care of oropharyngeal squamous cell carcinoma that is not associated with, or negative for, human papillomavirus (HPV[–]OPSCC)?

BOTTOM LINE

Care delays related to evaluations by multiple providers and misdiagnosis prolong the time to diagnosis in patients with (HPV[–]OPSCC).

BACKGROUND: There are multiple differences between HPV-positive OPSCC (HPV[+]OPSCC) and (HPV[–]OPSCC). The latter is more resistant to treatment and is associated with worse prognosis than (HPV[+]OPSCC), and its initial presenting symptoms are nonspecific, typically arising from the primary disease site. This impedes timely diagnosis and treatment.

STUDY DESIGN: Retrospective review.

SYNOPSIS: Researchers analyzed data on 70 patients with (HPV[–]OPSCC) who received treatment at a tertiary care center from 2006 to 2016. Median time from symptom onset to diagnosis was 69 days. Most patients (75%) saw a primary care provider at their initial visit, and most (86%) saw two or more providers prior to diagnosis. Median time from first visit to diagnosis was 19.5 days. At initial evaluation (most often with a primary care provider), five patients had an identifiable base-of-tongue lesion and 17 had an identifiable tonsil tumor; on otolaryngologist evaluation, 22 patients had a base-of-tongue lesion and 32 had a tonsil lesion. Patient age, sex, body mass index, and medical comorbidities were not significant risk factors for diagnosis delay. Overall, delays in diagnosis were associated with systemic health-care factors including evaluation by multiple providers and initial misdiagnosis. Findings suggested that delays could be avoided with early evaluation by a head and neck cancer care provider after two weeks of persistent symptoms. Study limitations included its retrospective design and small cohort.

CITATION: Karp EE, Yin LX, O’Byrne TJ, et al. Diagnostic delay in human papilloma-virus negative oropharyngeal squamous cell carcinoma [published online ahead of print July 19, 2022]. Laryngoscope. doi:10.1002/lary.30307