Advances in Therapy

, Volume 35, Issue 2, pp 153–160 | Cite as

Head and Neck Cancer: A Review of the Impact of Treatment Delay on Outcome

  • Andrés Coca-PelazEmail author
  • Robert P. Takes
  • Kate Hutcheson
  • Nabil F. Saba
  • Missak HaigentzJr.
  • Carol R. Bradford
  • Remco de Bree
  • Primož Strojan
  • Valerie J. Lund
  • William M. Mendenhall
  • Iain J. Nixon
  • Miquel Quer
  • Alessandra Rinaldo
  • Alfio Ferlito


Delay between the initial symptoms, diagnosis, and the definitive treatment of head and neck cancers is associated with tumor progression and upstaging. These delays may lead to poor outcomes and may mandate more aggressive treatments with unnecessary morbidity and even mortality. The multidisciplinary team approach for the treatment of patients with head and neck cancers has improved organization of standard clinical guidelines, but this development has yet to translate into a demonstrable impact on survival. We review the association between waiting times (time between diagnosis and initiation of treatment) and clinical outcomes in patients with head and neck squamous cell carcinoma (HNSCC).


Head and neck cancer Oncology Prognosis Survival Treatment Waiting time 



This article was written by members of the International Head and Neck Scientific Group (


No funding or sponsorship was received for this study or publication of this article.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Andrés Coca-Pelaz, Robert P. Takes, Kate Hutcheson, Nabil F. Saba, Missak Haigentz Jr., Carol R. Bradford, Remco de Bree, Primož Strojan, Valerie J. Lund, William M. Mendenhall, Iain J. Nixon, Miquel Quer, Alessandra Rinaldo, and Alfio Ferlito have nothing to declare.

Compliance with Ethics Guidelines

This article is based on previously conducted and reported studies and does contain studies with human participants performed by some of the authors, but does not contain any studies with animals performed by any of the authors. These previously reported studies are clearly referenced.

Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.


  1. 1.
    Chaturvedi AK, Anderson WF, Lortet-Tieulent J, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol. 2013;31:4550–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gupta B, Johnson NW, Kumar N. Global epidemiology of head and neck cancers: a continuing challenge. Oncology. 2016;91:13–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol. 2012;13:790–801.CrossRefPubMedGoogle Scholar
  4. 4.
    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:359–86.CrossRefGoogle Scholar
  5. 5.
    Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46:765–81.CrossRefPubMedGoogle Scholar
  6. 6.
    Gatta G, Botta L, Sanchez MJ, et al. Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: the EUROCARE-5 population-based study. Eur J Cancer. 2015;51:2130–43.CrossRefPubMedGoogle Scholar
  7. 7.
    Neal RD. Do diagnostic delays in cancer matter? Br J Cancer. 2009;101:9–12.CrossRefGoogle Scholar
  8. 8.
    Brouha X, Tromp D, Hordijk GJ, Winnubst J, De Leeuw R. Role of alcohol and smoking in diagnostic delay of head and neck cancer patients. Acta Otolaryngol. 2005;125:552–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Lund VJ, Howard DJ, Wei WI. Tumors of the nose, sinuses and nasopharynx. Stuttgart: Thieme; 2014. p. 596.Google Scholar
  10. 10.
    Tufano RP, Mokadam NA, Montone KT, et al. Malignant tumors of the nose and paranasal sinuses: hospital of the University of Pennsylvania Experience 1990–1997. Am J Rhinol. 1999;13:117–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Bilimoria KY, Ko CY, Tomlinson JS, et al. Wait times for cancer surgery in the United States: trends and predictors of delays. Ann Surg. 2011;253:779–85.CrossRefPubMedGoogle Scholar
  12. 12.
    Chen Z, King W, Pearcey R, Kerba M, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiother Oncol. 2008;87:3–16.CrossRefPubMedGoogle Scholar
  13. 13.
    Jensen AR, Nellemann HM, Overgaard J. Tumor progression in waiting time for radiotherapy in head and neck cancer. Radiother Oncol. 2007;84:5–10.CrossRefPubMedGoogle Scholar
  14. 14.
    Waaijer A, Terhaard CH, Dehnad H, et al. Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma. Radiother Oncol. 2003;66:271–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Wyatt RM, Beddoe AH, Dale RG. The effects of delays in radiotherapy treatment on tumour control. Phys Med Biol. 2003;48:139–55.CrossRefPubMedGoogle Scholar
  16. 16.
    Mackillop WJ, Bates JH, O‘Sullivan B, Withers HR. The effect of delay in treatment on local control by radiotherapy. Int J Radiat Oncol Biol Phys. 1996;34:243–50.CrossRefPubMedGoogle Scholar
  17. 17.
    van Bockel LW, Verduijn GM, Monninkhof EM, Pameijer FA, Terhaard CH. The importance of actual tumor growth rate on disease free survival and overall survival in laryngeal squamous cell carcinoma. Radiother Oncol. 2014;112:119–24.CrossRefPubMedGoogle Scholar
  18. 18.
    Fortin A, Bairati I, Albert M, Moore L, Allard J, Couture C. Effect of treatment delay on outcome of patients with early-stage head-and-neck carcinoma receiving radical radiotherapy. Int J Radiat Oncol Biol Phys. 2002;52:929–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Kowalski LP, Carvalho AL. Influence of delay and clinical upstaging in the prognosis of head and neck cancer. Oral Oncol. 2001;37:94–8.CrossRefPubMedGoogle Scholar
  20. 20.
    van Harten MC, de Ridder M, Hamming-Vrieze O, Smeele LE, Balm AJ, van den Brekel MW. The association of treatment delay and prognosis in head and neck squamous cell carcinoma (HNSCC) patients in a Dutch comprehensive cancer center. Oral Oncol. 2014;50:282–90.CrossRefPubMedGoogle Scholar
  21. 21.
    van Harten MC, Hoebers FJ, Kross KW, van Werkhoven ED, van den Brekel MW, van Dijk BA. Determinants of treatment waiting times for head and neck cancer in the Netherlands and their relation to survival. Oral Oncol. 2015;51:272–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Caudell JJ, Locher JL, Bonner JA. Diagnosis-to-treatment interval and control of locoregionally advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 2011;137:282–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Murphy CT, Galloway TJ, Handorf EA, et al. Survival impact of increasing time to treatment initiation for patients with head and neck cancer in the United States. J Clin Oncol. 2016;34:169–78.CrossRefPubMedGoogle Scholar
  24. 24.
    Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol. 2003;21:555–63.CrossRefPubMedGoogle Scholar
  25. 25.
    Patel UA, Brennan TE. Disparities in head and neck cancer: assessing delay in treatment initiation. Laryngoscope. 2012;122:1756–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Rogers SN, Pabla R, McSorley A, Lowe D, Brown JS, Vaughan ED. An assessment of deprivation as a factor in the delays in presentation, diagnosis and treatment in patients with oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2007;43:648–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Guizard AV, Dejardin O, Launay L, et al. What are the real waiting times for therapeutic management of head and neck cancer: a study in the general population in the north–west of France. Eur Arch Otorhinolaryngol. 2016;273:3951–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Primdahl H, Nielsen AL, Larsen S, et al. Changes from 1992 to 2002 in the pretreatment delay for patients with squamous cell carcinoma of larynx or pharynx: a Danish nationwide survey from DAHANCA. Acta Oncol. 2015;45:156–61.CrossRefGoogle Scholar
  29. 29.
    Lyhne NM, Christensen A, Alanin MC, et al. Waiting times for diagnosis and treatment of head and neck cancer in Denmark in 2010 compared to 1992 and 2002. Eur J Cancer. 2013;49:1627–33.CrossRefPubMedGoogle Scholar
  30. 30.
    Patil RD, Meinzen-Derr JK, Hendricks BL, Patil YJ. Improving access and timeliness of care for veterans with head and neck squamous cell carcinoma: a multidisciplinary team’s approach. Laryngoscope. 2016;126:627–31.CrossRefPubMedGoogle Scholar
  31. 31.
    Friedland PL, Bozic B, Dewar J, Kuan R, Meyer C, Phillips M. Impact of multidisciplinary team management in head and neck cancer patients. Br J Cancer. 2011;104:1246–8.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Birchall M, Bailey D, King P. Effect of process standards on survival of patients with head and neck cancer in the south and west of England. Br J Cancer. 2004;91:1477–81.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Kelly SL, Jackson JE, Hickey BE, Szallasi FG, Bond CA. Multidisciplinary clinic care improves adherence to best practice in head and neck cancer. Am J Otolaryngol. 2013;34:57–60.CrossRefPubMedGoogle Scholar
  34. 34.
    Starmer H, Sanguineti G, Marur S, Gourin CG. Multidisciplinary head and neck cancer clinic and adherence with speech pathology. Laryngoscope. 2011;121:2131–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Toustrup K, Lambertsen K, Birke-Sørensen H, Ulhøi B, Sørensen L, Grau C. Reduction in waiting time for diagnosis and treatment of head and neck cancer—a fast track study. Acta Oncol. 2011;50:636–41.CrossRefPubMedGoogle Scholar
  36. 36.
    Ouwens MM, Hermens RR, Hulscher MM, et al. Impact of an integrated care program for patients with head and neck cancer on the quality of care. Head Neck. 2009;31:902–10.CrossRefPubMedGoogle Scholar
  37. 37.
    Klausen OG, Olofsson J, Rosengren B. A long waiting time for radiotherapy: not acceptable for patients with neoplasms. Tidsskr Nor Laegeforen. 1989;109:2324–5.PubMedGoogle Scholar
  38. 38.
    León X, de Vega M, Orús C, Morán J, Vergés J, Quer M. The effect of waiting time on local control and survival in head and neck carcinoma patients treated with radiotherapy. Radiother Oncol. 2003;66:277–81.CrossRefPubMedGoogle Scholar
  39. 39.
    Barton MB, Morgan G, Smee R, Tiver KW, Hamilton C, Gebski V. Does waiting time affect the outcome of larynx cancer treated by radiotherapy? Radiother Oncol. 1997;44:137–41.CrossRefPubMedGoogle Scholar
  40. 40.
    Lee AW, Chan DK, Fowler JF, et al. T1 nasopharyngeal carcinoma: the effect of waiting time on tumor control. Int J Radiat Oncol Biol Phys. 1994;30:1111–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Healthcare Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Andrés Coca-Pelaz
    • 1
    Email author
  • Robert P. Takes
    • 2
  • Kate Hutcheson
    • 3
  • Nabil F. Saba
    • 4
  • Missak HaigentzJr.
    • 5
  • Carol R. Bradford
    • 6
  • Remco de Bree
    • 7
  • Primož Strojan
    • 8
  • Valerie J. Lund
    • 9
  • William M. Mendenhall
    • 10
  • Iain J. Nixon
    • 11
  • Miquel Quer
    • 12
  • Alessandra Rinaldo
    • 13
  • Alfio Ferlito
    • 14
  1. 1.Department of OtolaryngologyHospital Universitario Central de AsturiasOviedoSpain
  2. 2.Department of Otolaryngology-Head and Neck SurgeryRadboud University Medical CenterNijmegenThe Netherlands
  3. 3.Department of Head and Neck Surgery, Section of Speech Pathology and AudiologyMD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Hematology and Medical OncologyThe Winship Cancer Institute of Emory UniversityAtlantaUSA
  5. 5.Division of Hematology/Oncology, Department of MedicineMorristown Medical Center/Atlantic Health SystemMorristownUSA
  6. 6.Department of Otolaryngology-Head and Neck SurgeryUniversity of MichiganAnn ArborUSA
  7. 7.Department of Head and Neck Surgical OncologyUMC Utrecht Cancer Center, University Medical Center UtrechtUtrechtThe Netherlands
  8. 8.Department of Radiation OncologyInstitute of OncologyLjubljanaSlovenia
  9. 9.Professorial Unit, Ear InstituteUniversity College LondonLondonUK
  10. 10.Department of Radiation OncologyUniversity of FloridaGainesvilleUSA
  11. 11.Department of Surgery and Otolaryngology, Head and Neck SurgeryEdinburgh UniversityEdinburghUK
  12. 12.Department of OtolaryngologyHospital Santa Creu i Sant PauBarcelonaSpain
  13. 13.University of Udine School of MedicineUdineItaly
  14. 14.Coordinator of the International Head and Neck Scientific GroupPaduaItaly

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