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MDLinxHead and Neck Cancer Diagnostic Delays Linked to Antibiotics Despite Clinical Practice Guidelines

Diagnostic Delays in Head and Neck Cancer Patients Worsened by Inappropriate Antibiotic Prescribing

A recent study from Saint Louis University School of Medicine highlights the urgent need for improved dissemination of clinical practice guidelines for head and neck cancer (HNC). The research reveals that diagnostic delays are common and often exacerbated by the prescription of antibiotics instead of immediate cancer evaluation, leading to more complicated and less effective treatment options.

HCN Medical Memo
For physicians, particularly those in primary care, this study underscores the critical importance of adhering to current clinical guidelines for HNC. Diagnostic delays not only prolong patient suffering but also necessitate more aggressive treatments that come with higher toxicity and lower cure rates. It’s imperative to consider immediate cancer evaluation for patients presenting with symptoms like neck swelling, rather than defaulting to antibiotic prescriptions.

Key Points:
  • Researchers analyzed data from 7,811 HNC patients and found that 15.6% received antibiotics within three months of their cancer diagnosis.
  • This antibiotic prescribing led to a statistically significant 21.1% longer time to HNC diagnosis.
  • Sean Massa, MD, the paper’s senior author, emphasized the need for better education among primary care physicians about HNC symptoms and diagnosis.
  • Despite the release of clinical practice guidelines, the rate of antibiotic prescribing before HNC diagnosis has not decreased.

“ENT doctors usually are quite familiar with this cancer diagnosis and can use their training and tools to parse out whether it be symptoms caused by cancer or some other cause. But it’s much more challenging for primary care doctors to make that determination, and I worry that this knowledge is not being disseminated to the broader medical community.”
– Sean Massa, MD, Senior Author of study and Associate Professor of Otolaryngology at St. Louis University School of Medicine

Additional Points:
  • The study used a deidentified electronic health records data set spanning from Jan. 1, 2011, to Dec. 31, 2018.
  • Data analysis was conducted from May 1 to Nov. 9, 2022.
  • Specific clinical and oncologic factors were associated with higher antibiotic prescription rates.

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