Effects of diagnostic delays in head and neck cancer patients presenting to the emergency department

Abstract

Delayed diagnosis of head and neck cancer leads to poorer survival, and whether initial presentation to the Emergency Department (ED) expedites or delays diagnosis is unclear. We retrospectively studied patients aged 65 or older, diagnosed with head and neck cancer between 2011 and 2015 using SEER Medicare data, comparing those who received first imaging in the ED with those who received it as outpatients. Both overall and disease-specific survival were assessed using Cox Proportional Hazards analysis, and bootstrapping was performed to determine an ideal interval between imaging and biopsy. Of 2282 included patients, 211 received initial imaging in the ED and were propensity score matched to 633 outpatients. ED patients had longer intervals between imaging and biopsy (44.6 % vs 11.7 % with an interval > 34 days, p < 0.001) and poorer two-year overall (47.8 % vs 60.3 %, p < 0.01) and cancer-specific (56.2 % vs 67.3 %, p < 0.01) survival compared to outpatients. Those biopsied within 34 days of imaging had statistically similar survival compared to those biopsied prior to imaging (HR = 1.13, 95 % CI 0.90–1.43), and those biopsied 34 or more days after imaging demonstrated worse survival (HR = 1.32, 95 % CI 1.01–1.72). These findings suggest that patients presenting to the ED for initial imaging may experience delays in biopsy leading to inferior survival, underscoring the importance of ensuring timely tissue diagnosis.