Delayed diagnosis to treatment interval (DTI) in head & neck cancers - A systematic review and meta-analysis

Noémie Villemure-Poliquin; Rui Fu; Karolina Gaebe; Jin Kwon; Marc Cohen; Marianne Ruel; Kennedy Ayoo; Andrew Bailey; Madette Galapin; Julie Hallet; Antoine Eskander

doi:10.1016/j.oraloncology.2024.107106

Delayed diagnosis to treatment interval (DTI) in head & neck cancers - A systematic review and meta-analysis

Oral Oncol. 2025 Jan:160:107106. doi: 10.1016/j.oraloncology.2024.107106. Epub 2024 Nov 21.

Authors

Noémie Villemure-Poliquin¹, Rui Fu², Karolina Gaebe³, Jin Kwon⁴, Marc Cohen⁵, Marianne Ruel⁶, Kennedy Ayoo⁷, Andrew Bailey⁸, Madette Galapin⁹, Julie Hallet¹⁰, Antoine Eskander¹¹

Affiliations

¹ Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada. Electronic address: [email protected].
² Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada.
³ Faculty of Medicine, University of Toronto, Toronto, Ontario.
⁴ Faculté de médecine, Université de Montréal, Montréal, Quebec.
⁵ Sunnybrook Research Institute, Toronto, Ontario, Canada.
⁶ Library, Université Laval, Québec, QC, Canada.
⁷ Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Radiation Oncology, Odette Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
⁹ Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
¹⁰ Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
¹¹ Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

PMID: 39577127
DOI: 10.1016/j.oraloncology.2024.107106

Abstract

Introduction: Delayed diagnosis to treatment interval (DTI) in head and neck cancers (HNC) can significantly impact patient outcomes. The need for multimodal treatment in HNC may cause delays in initiation of treatment. This systematic review aims to provide a comprehensive understanding of the consequences of delayed DTI on both oncologic and QoL outcomes, proposing a new quality benchmark along the treatment continuum of HNC patients.

Methods: We searched MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases for trials and cohort studies evaluating the impact of delayed DTI in patients with HNC. Outcomes included overall survival (OS), disease-free survival (DFS), locoregional (LRR) and local recurrences (LR) and distant metastasis.

Results: Our search strategy initially identified 10,779 titles and abstracts, of which 63 articles met inclusion criteria for a total of 873,718 patients. The pooled analysis showed that treatment initiation within 30 days improved OS by 9 % compared to longer intervals (aHR: 1.09 [1.06-1.13]; I² = 80 %), with no significant associations found for DFS, LRR, LR, or distant metastasis.

Conclusion: While adherence to a 30-day DTI may be associated with improved survival in some HNC patients, significant heterogeneity in the data limits the generalizability of this finding. Further research with more refined analyses, including adjustments for treatment modality and cancer stage, is necessary. Additionally, gaps remain in the literature, particularly in the methodological limitations related to DTI classification.

Keywords: Diagnosis-to-treatment interval; Head and neck cancer; Quality metric; Squamous cell carcinoma; Treatment delay.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Delayed Diagnosis
Head and Neck Neoplasms* / diagnosis
Head and Neck Neoplasms* / mortality
Head and Neck Neoplasms* / pathology
Head and Neck Neoplasms* / therapy
Humans
Neoplasm Recurrence, Local
Time-to-Treatment / statistics & numerical data