1. ¹School of Biological Sciences, University of East Anglia, Norwich NR4 7TJ, UK
2. ²Department of Oncology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK

Correspondence: Dr M Pitchers, E-mail: m.pitchers@uea.ac.uk

Received 25 July 2005; Revised 13 February 2006; Accepted 13 February 2006; Published online 21 March 2006.

Abstract

Squamous carcinoma of the oropharynx presents with symptoms common to many benign diseases, and this can cause delay in referral to secondary care. We investigate delay in referral, defining this as the time from symptom-onset to date of general practitioners referral letter to secondary care, and the effect of that delay, using a retrospective case notes based study of patients presenting at our institution with oropharyngeal squamous carcinoma between 1995 and 2005. Using correlation analysis and ordinal regression, we examined the relationship between increased referral delay from primary care, clinical stage at presentation, and survival. Increasing time from symptom onset to referral to secondary care was positively correlated with more advanced disease stage at presentation (r_s=+0.346, P=0.004). This was confirmed with ordinal regression modelling (delay estimate=0.045, P=0.042). Patients with delay of less than 6 weeks had significantly improved survival compared to those with a delay of greater than 6 weeks (P=0.032). For every 1 week of delay in referral, we estimate that the stage of presentation will progress by 0.045 of 'a stage'.