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Patient factors associated with delay in primary care among patients with head and neck carcinoma: a case-series analysis.

BACKGROUND
Head and neck cancer patients are often diagnosed with advanced stage disease, while the location is easily accessible for examination or distinct symptoms are present. Professional delay in primary care affects tumour stage and survival. There has been little research on the role of the patient in delaying referral or diagnosis once the patient has visited a primary health care professional.


OBJECTIVES
Our aim was to identify patient-related factors which are associated with delay in primary care and the referral to hospital.


METHODS
Case-series analysis using semi-structured interviews combined with questionnaires was conducted among 306 consecutive patients newly diagnosed in a tertiary referral centre for head and neck oncology patients in The Netherlands. The main outcome measure was delay in returning to the GP or dentist after the first consultation. Logistic regression analyses were performed to test which patient-related variables made delay more likely.


RESULTS
155 patients (53%) were not referred or followed up after the first medical contact with the GP or dentist. Fifty per cent (n = 78) of them delayed returning to the health professional for more than three weeks. Patients were more likely to delay when they experienced voice change, were not familiar with head and neck cancer, were not suspicious of cancer or were generally not inclined to seek support.


CONCLUSIONS
Delay in returning to the health professional is partly dependent on patient-related factors. Therefore, patients should be educated about the possible meaning and expected time-course of the symptoms and be strongly advised to return, or be followed up, within three to four weeks if the symptoms do not disappear.