Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON.
Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON.
Curr Oncol. 2020 Oct;27(5):e467-e477. doi: 10.3747/co.27.6547. Epub 2020 Oct 1.
Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting.
Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients.
The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1-7). No significant differences in time to presentation were found based on stage at presentation or anatomic site.
At our tertiary care cancer centre, a patient's clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.
头颈部癌症（hncs）常表现为晚期，导致预后不良。就诊时间较晚可能归因于患者的延迟（例如不愿意接受治疗）或提供者的延迟（误诊、咨询等待时间延长等）。本研究的目的是在加拿大全民医疗保健环境中检查此类延迟的时间和原因。
本研究招募了首次到 hnc 多学科团队（mdt）就诊并经活检证实患有 hnc 的患者。患者完成了一项调查，询问他们最初的症状表现、之前的医疗预约以及预约之间的时间长度。为所有患者收集了临床和人口统计学数据。
患者首次到 mdt 诊所就诊的平均时间为 15.1 个月，其中 3.9 个月是患者自症状出现以来首次看医疗保健提供者，从首次看 hcp 到 mdt 诊所的时间为 10.7 个月。患者在 mdt 诊所就诊前平均看了 3 名 hcp（范围：1-7）。基于就诊时的阶段或解剖部位，就诊时间无显著差异。
在我们的三级癌症中心，患者到 mdt 诊所就诊的临床途径显示出明显的延迟，特别是从首次 hcp 就诊到 mdt 转诊的时间。可能的缓解延迟的方法包括对患者和提供者进行 hnc 教育，以及建立更精简的转诊系统。
