Determinants of delayed specialist presentation in head and neck cancer to Tygerberg Hospital, Western Cape

Abstract

Background: Delayed presentation of head and neck cancers at Tygerberg Hospital often results in tumour progression and clinical upstaging – frequently marking the difference between curative and palliative care. This study aimed to identify factors contributing to prolonged time intervals before specialist consultation in South Africa’s public healthcare sector, and to inform potential interventions to address these delays.
Methods: A cross-sectional, survey-based study was conducted. Patients were recruited weekly, and data were collected through individual interviews. Descriptive statistics were used to analyse responses.
Results: At initial specialist presentation, 58.9% of patients were diagnosed with stage III/IV disease, with oral cavity malignancies being most common. Nearly half (47.06%) experienced delays because of inappropriate antibiotic prescriptions and misdiagnoses. The median time from symptom onset to specialist review was 135 days. The most frequently cited patient-related barrier was poor health literacy (57.84%).
Conclusion: The majority of patients presented with advanced-stage head and neck cancer. Delays were attributed to both clinician-related factors – such as misdiagnosis and unwarranted antibiotic use – and patient-related factors, primarily limited health literacy. The observed median delay exceeds international benchmarks, underscoring the need for targeted interventions.
Contribution: This study highlights the urgent need for earlier referral and specialist assessment of head and neck cancer patients. Findings support the implementation of clinician education, patient awareness initiatives and policy development aimed at reducing diagnostic and referral delays within South Africa’s public healthcare system.