To examine geographical variations in times to diagnosis and treatment of head and neck cancer (HNC) in patients from metropolitan and regional/remote New South Wales (NSW), and implications for survival.
Patients diagnosed with oral cavity, oropharynx or cutaneous squamous cell carcinoma (SCC) from 01/07/2008 to 30/06/2013, and treated at the Mid North Coast Cancer Institute (Coffs Harbour and Port Macquarie, Australia) or Royal Prince Alfred Hospital (Sydney, Australia) were retrospectively identified. Primary outcome was the treatment interval (time from diagnosis to treatment). Secondary outcomes were survival, and additional time intervals along the diagnostic pathway.
Four-hundred and seventy-one patients were eligible (78% male), mean age was 68 years, and 59% had advanced stage HNC. At diagnosis, 40% and 60% lived in metropolitan and regional/remote NSW, respectively. The treatment interval was longer for regional/remote patients with oropharynx SCC compared to metropolitan patients (median 46 [IQR 29-71] vs 36 [IQR 28-42] days, P=0.007). Time from first symptom to treatment was longer for regional/remote patients with oropharynx SCC (median 4.6 [IQR 3.5-6.9] vs 3.6 [IQR 2.2-6.2] months, P=0.04) and oral cavity SCC (median 5.7 [IQR 3.1-12.2] vs 3.3 [IQR 2.4-6.4] months, P=0.01). Among 211 patients requiring post-operative radiotherapy, 28% (95%CI 21-35%) of regional/remote patients received radiotherapy within the recommended six weeks from surgery, compared to 55% (95%CI 42-68%) of metropolitan patients. Only 14% (95%CI 6-22%) of regional/remote patients commenced definitive radiotherapy within four weeks of diagnosis, compared to 31% (95%CI 19-43%) of metropolitan patients. On multivariate analysis, regional/remote patients had an increased risk of death from HNC (HR 1.80 [95%CI 1.04-3.10]).
Regional/remote HNC patients experience longer times to treatment than metropolitan patients, and poorer survival outcomes. Understanding patient and health-system factors mediating pathways to treatment can inform changes to health policy to improve timely HNC diagnosis and treatment, and survival outcomes in NSW.