An Observational Cross-sectional Study of Factors Causing Delay in Diagnosis of Head and Neck Cancers at a Rural Tertiary Care Centre in Northern India

Introduction: Cancer is a complex genetic disease derived from the accumulation of a variety of genetic changes, which include activation of proto-oncogenes and inactivation of tumour suppressor genes. Head and Neck Cancers (HNC) are rapidly growing tumours with a median potential doubling time of only 6-7 days. Although these cancers are easily accessible, patients rarely present early. In India, most HNCs present in advanced stages resulting in increased morbidity and mortality. Hence, it is prudent to ascertain the factors which lead to delay in diagnosis of HNC as early diagnosis and treatment is the cornerstone in reducing consequences of HNC. Aim: To identify patient and professional factors causing delay in diagnosis of HNC and to identify association if any with stage of cancer presentation. Materials and Methods: An observational cross-sectional study was conducted in the Department of Ear Nose and Throat, at BPS Government Medical College for women, Sonepat, Haryana, India, from September 2019 to January 2021. Study included 55 newly diagnosed histopathologically confirmed head and neck cancer patients. Clinico-demographic details were inferred using elaborate clinical examination. Data were described in terms of range, mean +/- standard deviation, frequency and relative frequency (percentages). Chi-square and Fisher's-exact test was used for comparing categorical data. Delay due to patient and professional factors were calculated separately and the association of each delay with important variables were compared. Results: Most patients (43.6%) belonged to the age group of 51 to 60 years, and the mean age was 60.25 +/- 9.81 years. Majority of the patients were males (85.5%). The mean total delay from onset of symptoms to final diagnosis was 22.38 +/- 7.23 weeks. Delayed patient presentation was the main cause of total delay in diagnosis. The main factors responsible for patient delay were rural residential status, low educational, socio-economic status and poor cancer awareness. Irrational therapies still contributed significantly for delayed patient presentation. Diagnostic delay led to upstaging of disease. Conclusion: Patient delay is the main factor responsible for delay in diagnosis of HNC. Even in this era of easy availability and accessibility of information, lack of awareness still exists at the fundamental level.