This article identifies which factors are responsible for delays in cancer management by a retrospective case-control series study, statistically comparing two groups, each of 50 patients, one receiving timely treatment and the other breaching set targets. It was observed that age, site and stage of cancer and treatment modality was not associated with delay. However, administrative issues such as outlying location of the hospital of initial consultation and patients not initially being seen by a multidisciplinary team member were important factors causing delays. The authors therefore emphasise the importance of timely communication between clinicians inside and outside the ENT head and neck cancer and maxillofacial units. Initial referrals to these units for obvious benefits, such as rapid triage, imaging and histology would reduce delays. Pathways need to be refined and dedicated slots for investigations should exist. Delays occurred particularly in patients with cancer of unknown primary and this is due to the number of investigations required. An interesting comparison is made with delays occurring in the USA. The time between agreement of a treatment plan and commencing it is longer there, but the time between first appointment and initiating the treatment is less, indicating that the access to diagnostic and staging investigations is much quicker in the UK but the therapeutic intervention gets delayed. It was also observed that advanced disease is treated more quickly in the UK.

Factors associated with delays in head and neck cancer treatment: case controlled study.
Nash R, Hughes J, Sandison A, Stewart S, Clarke P, Mace A.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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