Diagnosis and treatmetn of head and neck cancer is complex and requires co-ordination or providers and resources. Delays in diagnosis is not uncommon. In a Canadian study, median patient, professional and total delays were 4.5 weeks, 11.8 weeks and 22.5 weeks, respectively. Significantly longer delays were found among women(p < 0.01), non-smokers (p < 0.01), patients who were not referred following initial consultation(p < 0.001) and patients who did not visit their dentist (p < 0.05). Delays in diagnosis was a major factor in malparctice litigation in the USA. A 2005 study found that the median delay was 3 months and the patients were responsible for the delay in most cases (n = 319, 81% and n = 160, 78%, respectively). Half the patients in each studies cohort had delayed diagnoses (n = 217, 54% and n = 119, 56%, respectively) and similar percentages (n = 110, 53% and n = 172, 47%) presented with advanced disease (stage III or IV). These were not the same patients for there was no correlation between delay and stage or survival. AN article in the New York Times Health Guide says that “Approximately 25% of people with oral cancer die because of delayed diagnosis and treatment.”(http://health.nytimes.com/health/guides/disease/oral-cancer/overview.html). However, the literature, particularly several studies from Finland, are contradictory in this regard.
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