When does my treatment start?--The continuum of care for patients with head and neck cancer.

Background And Purpose: The clinical workup of patients with head and neck (H&N) cancer is often time-consuming. The overall time involved is obviously important to the treatment results, since delays in time can increase the risk for clinical upstaging resulting in a worse outcome. Although for ethical considerations, time delay is impossible to study in randomised trials. Major reorganisations for this group of patients have taken place in Stockholm during the 1990s. In this study, we measured the duration of the overall continuum of care experienced by the patients, in different time periods during the 1990s.

Materials And Methods: Two hundred and two patients from the population base of southern Stockholm were identified during different time periods. The continuum of care was identified as the period between the first presentation of the patient to the health care system to the first date of the patient's treatment for his/her cancer. This period was divided into several intervals reflecting the patient's perspective of his or her continuum of care. These intervals were then compared.

Results: Median time from first consultation to start of treatment increased between 1994 and 1999 from 67 to 89 days (P = 0.018). The increase of time occurred from referral from first care provider to ENT-specialist, from first visit to ENT-specialist to date of diagnosis.

Conclusions: Different parameters such as duration of the continuum of care must be monitored before and after reorganisations.