Impact of socioeconomic status on the diagnosis to treatment interval in Waldeyer's ring carcinoma.

OBJECTIVE: To examine the impact of socioeconomic status on the diagnosis to treatment interval in Waldeyer's ring cancers by comparing the experience of a public hospital and an academic tertiary care medical center. DESIGN: Retrospective review. SETTING: Otolaryngology clinic of a public hospital and an academic medical center. PATIENTS: One hundred seven patients with Waldeyer's ring carcinoma who were diagnosed and treated at San Francisco General Hospital (SFGH) or at the University of California, San Francisco Medical Center (UCSFMC) from January 1995 through December 2000 were included in the study. The same departments of otolaryngology-head and neck surgery and radiation oncology staff both hospitals. All radiation therapy was provided at UCSFMC. Patients included in the study had a histologic diagnosis of Waldeyer's ring carcinoma, primary treatment with radiation, and no prior treatment of Waldeyer's ring carcinoma. MAIN OUTCOME MEASURES: The time of diagnosis to start of radiation therapy, dose of radiation, number of treatment days, duration of treatment, and 1 and 3 year survival were recorded. Differences between the two groups were analyzed using Student's t test. RESULTS: The time course from diagnosis of nasopharyngeal carcinoma to start of radiation therapy was 56 days at SFGH compared with 34 days at UCSFMC. This difference was statistically significant (P = .0001). Difference in diagnosis to treatment intervals for base of tongue cancer was also significant at 66 days at SFGH compared with 31 days at UCSFMC (P = .0038). For cancer of the tonsil, the diagnosis to treatment interval was 70 days at SFGH versus 40 days at UCSFMC (P = .0005). Dose of radiation, number of days of treatment, and duration of treatment were not statistically different. Only patients with cancer of the tonsil demonstrated a statistically significant difference in 3 year survival (P = .0175). CONCLUSION: Although radiation therapy delivery appears similar between the public and tertiary care medical centers, there appears to be a statistically significant delay in the initiation of therapy for patients at the public institution. It is possible that this influences 3 year survival in cancer of the tonsil.

Mycobacterial infections of the head and neck.

Mycobacterial infections are grouped into infections caused by M. tuberculosis and those caused by the atypical mycobacterial organisms. Tuberculosis is a systemic disease, with cervical lymphadenitis of the head and neck being the most common extrapulmonary manifestation of the disease. It is important to use imaging, histopathologic examination, and culture to differentiate tuberculosis from atypical mycobacterial infections, because treatments differ. Tuberculosis is best treated as a systemic disease, with anti-tuberculosis medication. The atypical infections can be addressed as local infections and are amendable to surgical therapy.