Antibiotic prescription prior to HNC diagnosis associated with increased time to diagnosis

Oral cancer is reported to be eleventh most common cancer in the world with an estimated 267,000 cases and 128,000 deaths in around 2000, two-third of which occur in developing countries. The incidence of oral cancer is increasing in several parts of the world, particularly in Australia, Japan and parts of Europe.

More the antibiotic use longer the diagnostic delay. Diagnostic delay negatively impacts patient outcomes in head and neck cancer (HNC). Neck mass and other symptoms of undiagnosed HNC may be treated with antibiotics, delaying diagnosis and treatment, despite current clinical practice guidelines.

The findings of a recent study in JAMA Otolaryngology- Head and neck Surgery, suggests that antibiotic-associated HNC diagnostic delays frequently occur, indicating room for improvement in current clinical practice guidelines. The cohort study of 7811 patients with HNC, 15.6% received an antibiotic within 3 months of HNC diagnosis, resulting in a statistically significant 21.1% longer time to HNC diagnosis.

The retrospective cohort study was conducted using data obtained from a deidentified electronic health records data set from January 1, 2011, to December 31, 2018. Patients with HNC enrolled in the data set for at least 1 year before diagnosis date determined by either 1 inpatient encounter or first of 2 outpatient encounters within 6 months were included. Data analysis was conducted from May 1 to November 9, 2022. The primary outcome was days from the first documented symptom to HNC diagnosis.

The key findings of the study are

• The cohort included 7811 patients with HNC (4151 [53.1%] men, mean [SD] age, 60.2 [15.8] years). At least 1 antibiotic was prescribed for 1219 patients (15.6%) within 3 months before HNC diagnosis.

• This represented an increase over the 8.9% prescribing rate during the baseline period 12 to 9 months before diagnosis.

• The rate of antibiotic prescribing within 3 months before diagnosis did not change significantly over time (quarterly percent change, 0.49%; 95% CI, −3.06% to 4.16%).

• Patients receiving an antibiotic prescription within 3 months of an HNC diagnosis had a 21.1% longer time between symptom onset and HNC diagnoses (adjusted rate ratio [ARR], 1.21; 95% CI, 1.14-1.29).

• Compared with diagnosis by otolaryngologists, primary care/internal medicine physicians were most likely to prescribe antibiotics for patients who were diagnosed with a presenting symptom (adjusted prevalence ratio, 1.60; 95% CI, 1.27-2.02).

• In patients presenting with neck mass/swelling, those presenting with other symptoms were more likely to have longer intervals from symptom onset to diagnosis (ARR, 1.31; 95% CI, 1.08-1.59).

Researchers concluded that “The findings of this cohort study suggest there is an increased rate of antibiotic prescription in the 3 months before HNC diagnosis, which is associated with an increased time to diagnosis. These findings identify an area for improvement in HNC care and guidelines.”

Reference: Gallogly JA, Armstrong AT, Brinkmeier JV, et al. Association Between Antibiotic Prescribing and Time to Diagnosis of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online August 24, 2023. doi:10.1001/jamaoto.2023.2423.