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Predictive Factors for Diagnosis of Advanced-Stage Squamous Cell Carcinoma of the Head and Neck
André L. Carvalho, MD;
Javier Pintos, MD, MS;
Nicolas F. Schlecht, MS;
Benedito V. Oliveira, MD;
Antonio S. Fava, MD, PhD;
Maria P. Curado, MD;
Luiz P. Kowalski, MD, PhD;
Eduardo L. Franco, PhD
Arch Otolaryngol Head Neck Surg. 2002;128:313-318.
Objective To identify the predictive factors (with emphasis on diagnostic delay)
associated with the diagnosis of an advanced–clinical stage head and
neck cancer.
Design Cross-sectional study of patients with head and neck cancer originally
recruited for a case-control study.
Setting Three referral oncological centers in metropolitan areas in southern
Brazil: São Paulo, Curitiba, and Goiânia.
Patients The study population comprised 679 patients recently diagnosed as having
a previously untreated head and neck squamous cell carcinoma.
Main Outcome Measure Diagnosis of advanced disease (clinical stage III-IV) head and neck
cancer.
Results Patients with laryngeal and hypopharyngeal cancers were more likely
to be diagnosed as having advanced disease than those with lip, oral, and
oropharyngeal cancers (88.0% vs 74.6%) (P<.001).
Patient delay was inversely associated with clinical stage at diagnosis in
patients with the same cancers, while professional delay was directly associated
with a higher risk of advanced clinical stage at diagnosis (P = .001 and P = .006, respectively). In the
analysis of laryngeal and hypopharyngeal cancer, both patient and professional
delays were associated with advanced disease, with patient delay being a stronger
predictive factor than professional delay.
Conclusions Clinical stage at diagnosis was associated with sociodemographic characteristics,
patient delay, and professional delay. Our results indicate that continued
educational programs for the population and health care professionals regarding
the identification of early symptoms of head and neck cancers are warranted.
From the Hospital do Cancer A. C. Camargo, São Paulo, Brazil
(Drs Carvalho and Kowalski); the Division of Cancer Epidemiology, McGill University,
Montreal, Quebec (Drs Pintos and Franco and Mr Schlecht); Hospital Erasto
Gaertner, Curitiba, Brazil (Dr Oliveira); Hospital Heliópolis, São
Paulo (Dr Fava); and Hospital Araújo Jorge, Goiânia, Brazil (Dr
Curado).
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