Association between hospital interval and survival in patients with oral cancer: A waiting time paradox

Autoři: José Luis Lopez-Cedrún aff001;  Ana Otero-Rico aff001;  Inés Vázquez-Mahía aff001;  Juan Seoane aff002;  Lucía García-Caballero aff002;  Juan Manuel Seoane-Romero aff003;  Pablo Varela-Centelles aff004
Působiště autorů: Service of Oral and Maxillofacial Surgery, A Coruña University Hospital (CHUAC), Galician Health Service, A Coruña, Spain aff001;  Department of Surgery and Medical-Surgical Specialities, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain aff002;  Department of Surgery and Medical-Surgical Specialities, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain aff003;  Praza do Ferrol Health Centre, EOXI Lugo, Cervo e Monforte de Lemos, Galician Health Service, Lugo, Spain aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224067



In early diagnosis studies on symptomatic cancer, survival was the most recommended outcome. The magnitude and impact of the patient interval and primary care interval is well-known in oral cancer; however, the hospital interval and its influence on surviving this neoplasia are not well known.


To quantify the interval between the first contact with the specialist and the start of treatment for patients with oral cancer and to evaluate whether there was a link between this interval and disease survival.


We designed a hospital-based study that included 228 patients diagnosed with oral/oropharyngeal squamous cell carcinoma between 1998 and 2008 at A Coruña University Hospital (Spain) who were followed up until 2016. The data were extracted retrospectively from hospital medical charts. The study interval was defined in the context of the "pathways to treatment" model as the interval from the first specialist visit (start point) to the start of treatment (end point). We calculated the total interval (from first symptom to treatment) to evaluate the relative length of the hospital interval, and we considered the variables age, sex, location, comorbidity and tumour classification stage. Survival time was defined as the interval from the first treatment to death or censoring.


The median hospital interval was 20 days, with an interquartile range of 15–29.1 days. The most relevant prognostic variable was the tumour stage (III-IV: Exp. ß = 2.8, p = 0.001). The hospital interval was part of the multivariate model, and its association with mortality showed a V-shaped association, where patients with short hospital intervals (3–18 days) and those with long hospital intervals (26–55 days) had significantly higher mortality than those with medium hospital intervals (19–25 days).


The hospital interval represents a relevant interval for the patient’s path towards treatment, has prognostic implications and is subject to a severity bias (waiting time paradox) that should be avoided.

Klíčová slova:

Cancer detection and diagnosis – Cancer treatment – Diagnostic medicine – Oncology – Primary care – Surgical and invasive medical procedures – Surgical oncology – Dental and oral procedures


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2019 Číslo 10