Zubair Ahmed, Nadeem Sheikh, Shamsul Jalil.
Delay in Diagnosis of Head and Neck Tumors.
Pak J Med Health Sci Jan ;6(2):311-6.

Objectives: To determine frequency of patients who consult at advanced stage [stage III or VI] of the disease and to Identify factor responsible for late consultation Setting & duration: CMH-Rawalpindi for a period of 1.5 years, between Jan-2009 to June-2010 Design: Cross-sectional survey Patients& methods: All patients (n=88) with head & neck tumors presenting at Head & Neck/Oncology clinic, with a confirmed diagnosis of malignancy on the basis of histopathology were included in the study. Non-probability purposive sampling was used. Demographic characters of the patient such as age, gender, education, residence (Rural/Urban) and socioeconomic status were noted. Clinical stage of the disease was established after careful history taking clinical examination and radiological and endoscopic examination. Tumor in the category of Tx were excluded from the study. All patients were questioned about the time interval between appearance of first tumor related symptom and seeking medical advice from a qualified medical practitioner [Patient delay] and the time interval between first medical advice and diagnosis at specialist clinic. Statistical analysis was carried out using SPSS version-16, median, and mode were calculated for age, total delay in consultation. Frequencies were calculated for gender, education level. Socioeconomic status, stage and region of the tumor. Contingency table [Chi-sq test] was used to determine association between gender, socioeconomic status, education level, and tumor region and the delay in diagnosis; association with age and early and late presentation was calculated using univariate analysis on general linear model. Results: Stage III and IV tumors together constituted 70.7% of total. Less than 5% of the cases were at stage-1. Median patient delay was 3-months [0.2-144] while median professional delay was found to be 1- month [0.2-71.5] No significant correlation was found between tumor stage and age, sex, education, socio-economic status and whether patient was from urban/rural background. Conclusions: Our study confirms that majority of patients with Head & tumors present at a very late stage for treatment. Patient delay is significantly greater than the professional delay; thus patient himself/herself is largely responsible for the delay. No significant correlation between the stage of the tumor and age, sex, education, socioeconomic status and rural/urban background could be established. Further studies are needed to determine the cause of delay in diagnosis.

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