Factors Influencing Delay in Diagnosis of Head and Neck Cancer in Rwanda

• Published in: The Laryngoscope 2024-04, Vol.134 (4), p.1663-1669
• Main Authors: Nteyumwete, Hirwa, Civantos, Alyssa M., Stanford‐Moore, Gaelen B., Yau, Jenny, Tuyishimire, Gratien, Umutoni, Josiane, Nyabyenda, Victor, Ncogoza, Isaie, Shaye, David A.
• Format: Article
• Language: English
• Subjects: Biopsy; Cross-Sectional Studies; delays in care; Follow-Up Studies; global health; Head & neck cancer; head and neck cancer; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - epidemiology; health equity; Hospitals, University; Humans; Prospective Studies; Referral and Consultation; Rwanda - epidemiology
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.31103

Objective Head and neck cancer is a significant contributor to global otolaryngologic disease burden, with a disproportionate impact on low‐ and middle‐income countries. This study investigates the factors contributing to delays in head and neck cancer diagnosis at the University Teaching Hospital of Kigali (CHUK). Methods Cross‐sectional study of all patients with a pathologic diagnosis of head and neck cancer presenting to CHUK between January 2021 and June 2022. Sociodemographic data, tumor characteristics, and reasons for delay were collected. Univariate and multivariable analyses were undertaken to evaluate risk factors for delays. Results Eighty‐one patients met criteria for inclusion. Median duration from patient first reported symptoms to initial medical consultation was 52 weeks, from initial medical consultation to referral to CHUK was 4 weeks, and from referral to final pathologic diagnosis was 6 weeks. The most common reason for delay to referral to CHUK was financial (37.04%). Patients who visited traditional healers had higher odds of delay between symptom onset and medical consultation (OR 3.51, CI 1.05–11.70). Delays in final diagnosis after referral were most commonly due to OR availability for biopsy (37.04%) and time for pathology results after biopsy (35.80%). OR availability had a significant impact on duration to final diagnosis (OR 59.48, CI 7.17–493.67). Stage 4 disease had the shortest time to final diagnosis (OR 0.05, CI 0.01–0.45). Conclusion Understanding the reasons for delayed diagnosis of head and neck cancer may help guide improvements in care, with the goal of reducing global head and neck burden of disease. Level of Evidence 3; prospective non‐random follow‐up study Laryngoscope, 134:1663–1669, 2024 Head and neck cancer has a disproportionate impact on low‐ and middle‐income countries. This study investigates the factors contributing to delays in presentation and diagnosis in head and neck cancer patients at the largest referral hospital in Rwanda, finding long time durations and notable associations with the use of traditional medicine, operating room availability, and disease stage. Understanding the reasons for delayed diagnosis of head and neck cancer may help guide improvements in care, with the goal of reducing global head and neck burden of disease.