Assessment of Timelines in the Management and Human Papilloma Virus (HPV) Status of Head and Neck Cancer Patients

Abstract

Background: In Nigeria, many of the patients with Head and Neck cancers (HNCs) usually present late, with advanced disease, thereby reducing the chances of cure and survival. The commonest sites of HNCs among Nigerians are nasopharynx, sinonasal, larynx, oropharynx and oral cavity, with a total prevalence of 3-5%. Human Papilloma Virus (HPV) have been known to be associated with malignant tumours arising from these sites, but with little documentation in literature in Nigeria.  Objectives/Aim: This study is to assess the socio-demographic factors responsible for delay in hospital presentation, diagnosis and treatment and also to determine the presence of HPV which is a risk factor in head and neck cancer, among patients that presented in the Lagos University Teaching Hospital (LUTH), South West Nigeria, during the study period. Patients/Method: This is a prospective study conducted to determine the timelines, socio-demographic factors responsible for delays in presentation, diagnosis, treatment and HPV status, among patients presenting with Head and Neck cancers in the Ears, Nose and Throat (ENT) and Oral and Maxillofacial Surgery (OMFS) clinics in the Lagos University Teaching Hospital (LUTH), South West Nigeria during the study period.  Consecutive patients with HNC who presented to ENT and OMFS clinics were selected until the required sample size was met. Informed consent was taken from the patient. Semi-structured questionnaires were used to collect data on history, physical examination, investigation and treatment. History entailed details about the presenting complaints, duration, site of malignancy, socio-demographic, socioeconomic, time taken for symptom recognition, fear associated with treatment, hospital related delays and health related behaviour data were documented. The tumour type was confirmed by histopathological diagnosis and Immunohistochemistry was used to detect HPV viral particles in pathological specimen of patients. The tumour was staged according to TNM classification of the American Joint Committee on Cancer (AJCC), Head & Neck cancer sites was coded and classified according to ICD-10 (International statistical classification of diagnosis).  Results: Ninety-eight patients were recruited for this study while ninety-one (91) completed the study. The median timeline for presentation to a health facility on account of HNC symptoms was 34 weeks, timeline from hospital presentation to review by an ENT/OMF specialist was 5 weeks, from specialist review to diagnosis was 5 weeks and treatment was 6 weeks. The distribution of the Primary sites of Head and Neck Cancers includes Larynx (29.7%), Nasopharynx (28.6%), Oral cavity (16.5%), Nose and Paranasal sinuses (13.2%), Oropharynx (7.8%), Parotid (2.2%). The other sites were from the External Auditory Canal and the Mastoid. Only 14.3% of the HNCs were positive for HPV. Conclusion: There was delay in presentation and management of patients with HNCs, the economic factor being the major cause. HPV-associated HNCs is higher in this study, compared to other studies in the sub-Saharan Africa