Factors Associated with and Impact of Diagnosis Delay in Head and Neck Squamous Cell Carcinoma at Tikur Anbesa Hospital and Yekatit 12 Hospital: A Cross-Sectional Study
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Date
2025-02
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Addis Ababa University
Abstract
Background: Advanced-stage presentation of head and neck squamous cell carcinoma (HNSCC) remains prevalent in low-resource settings, often attributable to patient-related and healthcare system delays. Understanding these delays is critical for improving early detection strategies.
Objective: To evaluate factors contributing to diagnostic delays and their association with disease stage at presentation among HNSCC patients at Tikur Anbesa Specialized Hospital and Yekatit 12 Hospital Medical College, Ethiopia (2025).
Methods: In this cross-sectional study, 60 consecutively enrolled HNSCC patients completed structured interviews assessing sociodemographic characteristics and care-seeking timelines. We analyzed intervals from symptom onset to healthcare seeking, specialist consultation, and definitive diagnosis using descriptive statistics and multivariate Poisson regression.
Results: Most patients presented with advanced disease (Stage IV: 55%; Stage III: 26.7%), while only 5% had Stage I disease. Diagnostic delays exceeding six months occurred in 48.3% of cases, with delayed patients showing 93.1% advanced-stage presentation. Patient-related factors dominated, with 73.3% attributing delays to symptom unawareness (median health-seeking delay: 164 days). Healthcare system barriers included prolonged referral times (median: 93 days) and low initial cancer suspicion (only 30% at first visit). Patients initially evaluated by ENT specialists experienced significantly shorter diagnostic intervals (p=0.002). Advanced-stage cases demonstrated 167 days longer total delay than early-stage cases (p<0.001).
Conclusion: Diagnostic delays in HNSCC are prevalent and strongly associated with advanced-stage disease. Multifactorial interventions should prioritize: (1) community education on warning signs, (2) primary provider training in early recognition, and (3) streamlined specialist referral pathways to improve outcomes.
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Head and neck cancer, diagnostic delay, advanced-stage presentation, Ethiopia, healthcare barriers.