See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/41847389 Nasopharyngeal carcinoma in Saudi Arabia: Clinical presentation and diagnostic delay Article in Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al- ṣ i ḥḥī yah li-sharq al-mutawassi ṭ · September 2009 Source: PubMed CITATIONS READS 12 268 6 authors , including: Medhat El-Sebaie Yasser Khafaga King Faisal Specialist Hospital and Research Centre King Faisal Specialist Hospital and Research Centre 28 PUBLICATIONS 393 CITATIONS 63 PUBLICATIONS 1,503 CITATIONS SEE PROFILE SEE PROFILE Ali Alzahrani Guesmi Mohamed King Faisal Specialist Hospital & Research Center-Jeddah Ziane Achour University of Djelfa 117 PUBLICATIONS 2,534 CITATIONS 52 PUBLICATIONS 662 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Molecular genetics of thyroid cancer View project Sarcoma View project All content following this page was uploaded by Yasser Khafaga on 20 May 2014. The user has requested enhancement of the downloaded file.
Eastern Mediterranean Health Journal, Vol. 15, No. 5, 2009 1301 Nasopharyngeal carcinoma in Saudi Arabia: clinical presentation and diagnostic delay N. Al-Rajhi, 1 M. El-Sebaie, 1 Y . Khafaga, 1 A. AlZahrani, 1 G. Mohamed 2 and A. Al-Amro 1 صيخشتلاب رخأتلاو يريسزلا نلبعتسلبا :ةيدوعسلا ةيبرعلا ةكلملنا فً يموعلبلا يفنلؤا ناطسزلا ورمعلا للوادبع ،دممخ لاجن ،نًارهزلا لًع ،يجافخ سزاي ،يعابسلا تحدم ،يحجارلا صزان فً نوثحابلا مُّيق دقو .هصيخشت دنع ًمبقافتم يموعلبلا يفنلؤا ناطسزلا نوكي نأ عئاشلا نم نإ :ةـصلبلدا .يزخأتلا كلذ ليع ترُّـثأ يتلا لماوعلاو صيخشتلا رِّخأتو ضرملل يريسزلا نلبعتسلبا ةساردلا هذه ،ضرلناب مهتباصلئ ًاثيدح اوصخش نيذلا ضيرلنا نم 307 نم ًايقابتسا تايطعلنا نوثحابلا عجن دقو ،ةيحصلا ةياعرلا قاطن فً تاراشتسلباو ،ضيرلنا ةصقو ،ةيفارغوميد ليصافت تايطعلنا تنُّمضتو ءابطلؤل دوعي رِّخأتو ضيرملل دوعي رِّخأت ليإ صيخشتلا فً رِّخأتلا نوثحابلا فُّنص دقو .ةلاحلئا ةيلمعو نلبعتسلبا ضارعأ رثكأ انوأ ليع فنلؤا دادسناو قنعلاب ةلتك دوجو نوثحابلا فُّنص دقو .لًاجنإ رِّخأتو مبك .ةمقافتلنا ةلحرلنا يهبو رثكأ وأ روهش ةثلبثل رِّخأتلا نمز يهب ًايئاصحإ هب دتعي طبارت كانه ناكو ،ًاعويش ةيريسزلا ةلحرلنا تقفارت دقف لًاجنلئا رِّخأتلا يهبو ةيفنلؤا ضارعلؤاو ضيرلنا رمع يهب طبارت كانه ناك فيقثتل نكميو .ةيفارغوميدلاو ةيعمبتجلبا ضيرلنا تافصاوم عم صيخشتلا دنع ةمقافتلنا )ةيكينيلكلئا( .ركبأ صيخشتل ايدؤي نأ ةيلولؤا ةيحصلا ةياعرلا تامدخ يهستخو سانلا ABSTRACT Nasopharyngeal carcinoma is commonly advanced at diagnosis. In this study we evaluat- ed the clinical presentation, diagnostic delay and factors affecting delay in nasopharyngeal carcinoma. Data were collected prospectively for 307 newly diagnosed patients, including detailed demographic data, disease history, health care consultations and referral process. Diagnostic delay was classifjed as patient, professional and overall. Neck lump and nasal obstruction were the commonest presenting symptoms. There was a signifjcant association between delay time of ≥ 3 months and advanced stage. Patient’s age and otological symptoms were associated with increased overall delay time. Advanced clinical stage at diagnosis was associated with paitents’ sociodemographic characteristics. Carcinome nasopharyngé en Arabie saoudite : tableau clinique et retard de diagnostic RÉSUMÉ Lorsqu’un carcinome nasopharyngé est diagnostiqué, la maladie se trouve généralement à un stade avancé. Dans cette étude, nous avons évalué le tableau clinique de cette maladie, le retard au diagnostic et les facteurs ayant une incidence sur ce retard. Une collecte prospective de données (informations démographiques détaillées, histoire de la maladie, consultations médicales et processus d’orientation vers un service spécialisé) a été réalisée auprès de 307 patients récemment diagnostiqués. Le retard au diagnostic a été classé en trois catégories : lié au patient, lié au professionnel et global. Les manifestations cliniques les plus courantes étaient une grosseur au cou et une obstruction nasale. Il existait une association signifjcative entre un retard de diagnostic ≥ à 3 mois et un stade avancé. L’âge du patient et les symptômes otologiques étaient associés à un retard global élevé. Un stade clinique avancé au diagnostic était associé à certaines caractéristiques sociodémographiques des patients . 1 Division of Radiation Oncology; 2 Division of Biostatistics, Epidemiology and Scientifjc Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (Correspondence to N. Al-Rajhi: nrajhi@kfshrc.edu.sa). Received: 18/11/06; accepted: 15/05/07 ٢٠٠9 ،5 ددعلا ،شزع سمالدا دلجلنا ،ةيلناعلا ةحصلا ةمظنم ،طسوتلنا قشزل ةيحصلا ةلجلنا
1302 La Revue de Santé de la Méditerranée orientale, Vol. 15, N° 5, 2009 data, level of education, history of disease Introduction from onset of the patient’s first symptoms Head and neck cancers represent 6% of all to definite diagnosis, number of physicians malignancies diagnosed annually in Saudi involved, availability of health services and Arabia and 33% of these are of nasopharyn- referral process. Informed consent for treat- geal origin, with an annual age-standardized ment was signed by all patients. incidence of 2.5 and 0.8 per 100 000 for Data regarding tumour stage and his- males and females respectively [ 1 ]. topathological type were obtained from Diagnosing nasopharyngeal carcinoma a prospectively collected NPC database. (NPC) at an early stage is a difficult task as The American Joint Committee on Cancer it usually runs silently or with non specific (AJCC)/International Union Against Cancer symptoms. A low index of suspicion and (UICC) tumour node metastasis (TNM) clas- the technical challenges of postnasal space sification and stage grouping was used [ 5 ]. examination may also preclude earlier diag- nosis, resulting in presentation with locally Measures of delay advanced disease that adversely influences Patient-dependent delay was measured from outcome [ 2–4 ]. In general, delay in the the onset of symptoms to initial health care diagnosis and treatment of NPC can be consultation. Professional-dependent delay attributed to patient delay in seeking medi- was calculated from the date of first medi- cal advice or to professional delay, which cal consultation to the date of presentation includes failure to identify the signs and at our institution; this included time spent symptoms suggestive of cancer, time wait- for work-up, establishing the pathological ing for hospital appointments and time wait- diagnosis and the referral process. The total ing for referral to tertiary care centres. delay was the sum of patient and profes- The aim of our study in Riyadh, Saudi sional delays. Arabia was to determine the time lapse be- tween the onset of tumour-related symptoms Statistical analysis and the time of presentation to the tertiary Summary statistics for continuous variables care centre to identify the factors contribut- are presented using median and range. The ing to NPC diagnostic delay and to evaluate chi-squared test was used to test the associa- the impact of delay on tumour staging. tion between categorical variables. For the purpose of statistical analysis, patients were classified according to age (< 65 years or Methods 65+ years) and education level [high (uni- versity graduate or higher degree) or low (all Study design and patient population others)]. Odds ratios (OR) and confidence A hospital-based prospective study was intervals (CI) were estimated for all inde- done with all newly diagnosed, untreated pendent variables using logistic regression. patients with NPC who attended the com- bined head and neck oncology outpatient clinic at King Faisal Specialist Hospital and Results Research Centre (KFSH&RC) between Jan- uary 2000 and December 2003. Structured, Study population and presentation During the study period, 307 patients with face-to-face interviews were performed by the diagnosis of NPC were included; their a medical doctor. The interview contained characteristics are summarized in Table detailed questions concerning demographic ٢٠٠9 ،5 ددعلا ،شزع سمالدا دلجلنا ،ةيلناعلا ةحصلا ةمظنم ،طسوتلنا قشزل ةيحصلا ةلجلنا
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