Missed Opportunities in Early Diagnosis of Head and Neck Cancer in Patients in Tamil Nadu - A Mixed Method Study

Background: Evidence suggests that cancer-associated mortality and morbidity may be substantially reduced when diagnosed early and prompt treatment is initiated. Assessing the reasons for delays may assist in formulating strategies to enhance treatment outcomes that will benefit the community, health sector, and policymakers. This study aimed to assess the pathways and reasons for head and neck cancer (HNC) diagnostic delays in a South Indian setting. Methodology: The Exploratory Mixed Method analysis was conducted at the Government Royapettah Cancer Institute, Chennai, Tamil Nadu. The study included 172 patients with a confirmed diagnosis of the stage III to IV of HNC during their first diagnostic examination. Quantitative data were collected from 117 participants using a semi-structured questionnaire, and in-depth interviews were conducted to identify the reasons (qualitative data) for delays. The median delay (both primary and secondary) and the association of the delay with various factors were analyzed. Results: The median primary delay was 86 days, and the secondary delay was 23 days. There was a statistically significant (P < 0.05) difference in the type of residence (P = 0.018) and importance given to health (P = 0.057) in primary delay. The secondary delay was associated with a family history of smoking/tobacco habits (P = 0.006). Conclusion: Factors causing the delay are evadable and can be reduced by improving health literacy to enhance symptom appraisal and amalgamation of various levels of health care in screening and early diagnosis of HNC.