{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:54:05Z","timestamp":1792450445046,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T00:00:00Z","timestamp":1719619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Diagnosis and treatment for pharyngeal cancer are decisive in determining prognosis. Diagnosis delays are frequent, representing a significant cause of avoidable mortality, and an important factor in subpar survival across the continuous HNC care delivery. Methods: The present study represents a retrospective analysis of medical records from Western Romania, which included 180 patients, to evaluate the impact of time-to-treatment delay on patients diagnosed with pharyngeal cancer. The data analyses were performed using the Kaplan\u2013Meier method R (version 3.6.3) packages, including tidyverse, final-fit, mcgv, survival, stringdist, janitor, and Hmisc. Results: The mean days from diagnosis until the end of treatment were higher for the nasopharynx group. Cox regression analysis regarding diagnosis to treatment duration categories showed an increased risk mortality by 3.11 times (95%CI: 1.51\u20136.41, p = 0.0021) with a Harrell\u2019s C-index of 0.638 (95%CI: 0.552\u20130.723). The hypopharynx and oropharynx locations increased risk mortality by 4.59 (95%CI: 1.55\u201313.55) and 5.49 times (95%CI: 1.79\u201316.81) compared to the nasopharynx location. Conclusions: The findings of this study led to the conclusion that it seems there is a trend of mortality risk for oropharynx and hypopharynx cancers due to delays in the time to treatment over 70 days, standing as a basis for further research as there is an imperative need for prospective multicenter studies.<\/jats:p>","DOI":"10.3390\/clinpract14040103","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T09:23:59Z","timestamp":1719998639000},"page":"1270-1284","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Time-to-Treatment Delays and Their Prognostic Implications in Pharyngeal Cancer\u2014An Exploratory Analysis in Western Romania"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4581-8487","authenticated-orcid":false,"given":"Andreea Mihaela","family":"Ki\u0219","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0653-0996","authenticated-orcid":false,"given":"Roxana","family":"Buzatu","sequence":"additional","affiliation":[{"name":"Department of Dental Aesthetics, Faculty of Dental Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3664-1945","authenticated-orcid":false,"given":"Lazar","family":"Chisavu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marioara","family":"Poenaru","sequence":"additional","affiliation":[{"name":"Department of ENT, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Borza","sequence":"additional","affiliation":[{"name":"Department of Functional Sciences\u2013Pathophysiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Centre for Translational Research and Systems Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrada","family":"Iftode","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Silvana","family":"Sarau","sequence":"additional","affiliation":[{"name":"Department of Hematology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Adriana","family":"Dehelean","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Ardelean","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Technology, Faculty of Pharmacy, \u201cVasile Goldi\u0219\u201d Western University, 86 Liviu Rebreanu, 310045 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1093\/aje\/kwm193","article-title":"Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: Results of two multicentric case-control studies","volume":"166","author":"Guha","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.semcancer.2019.09.006","article-title":"Translational genomics of nasopharyngeal cancer","volume":"61","author":"Tsang","year":"2020","journal-title":"Semin. Cancer Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1200\/JCO.2015.61.5906","article-title":"Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States","volume":"34","author":"Murphy","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_4","unstructured":"Albahout, K.S., and Lopez, R.A. (2024). Anatomy, Head and Neck, Pharynx. StatPearls, StatPearls Publishing."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/s41572-020-00224-3","article-title":"Head and neck squamous cell carcinoma","volume":"6","author":"Johnson","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_6","first-page":"146","article-title":"Delay in the diagnosis and treatment of oral cancer","volume":"14","author":"Jafari","year":"2013","journal-title":"J. Dent."},{"key":"ref_7","first-page":"2226","article-title":"Challenges of Pharyngeal Cancer Screening in Lower-Income Countries during Economic and Social Transitions: A Population-Based Analysis","volume":"13","author":"Kis","year":"2023","journal-title":"Eur. J. Investig. Health Psychol. Educ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.3174\/ajnr.A1605","article-title":"The radiology of referred otalgia","volume":"30","author":"Chen","year":"2009","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/coa.13501","article-title":"Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases","volume":"45","author":"Virk","year":"2020","journal-title":"Clin. Otolaryngol."},{"key":"ref_10","unstructured":"National Comprehensive Cancer Center Network (2018). NCCN Guidelines for Head and Neck Cancers, National Comprehensive Cancer Center Network."},{"key":"ref_11","unstructured":"Board of the Faculty of Clinical Oncology, The Royal College of Radiologists, The Society and The College of Radiographers, and Institute of Physics and Engineering in Medicine (2002). Development and Implementation of Conformal Radiotherapy in the United Kingdom, Royal College of Radiologists."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3109\/02841868809090333","article-title":"The hazard of accelerated tumor clonogen repopulation during radiotherapy","volume":"27","author":"Withers","year":"1988","journal-title":"Acta Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Evers, C., Ostheimer, C., Sieker, F., Vordermark, D., and Medenwald, D. (2020). Benefit from surgery with additional radiotherapy in N1 head and neck cancer at the time of IMRT: A population-based study on recent developments. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0229266"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1002\/hed.21125","article-title":"Barriers to early detection and treatment of head and neck squamous cell carcinoma in African American men","volume":"31","author":"Carroll","year":"2009","journal-title":"Head Neck"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1002\/lary.20185","article-title":"Diagnostic delay and disease stage in head and neck cancer: A systematic review","volume":"119","author":"Goy","year":"2009","journal-title":"Laryngoscope"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1001\/jamaoto.2015.3595","article-title":"Association of compliance with process-related quality metrics and improved survival in oral cavity squamous cell carcinoma","volume":"142","author":"Graboyes","year":"2016","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e13589","DOI":"10.1111\/ecc.13589","article-title":"The effect of treatment delay on quality of life and overall survival in head and neck cancer patients","volume":"31","author":"Schoonbeek","year":"2022","journal-title":"Eur. J. Cancer Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3982","DOI":"10.1002\/cncr.33037","article-title":"Impact of optimizing diagnostic workup and reducing the time to treatment in head and neck cancer","volume":"126","author":"Schutte","year":"2020","journal-title":"Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.oraloncology.2016.02.010","article-title":"Clinical impact of prolonged diagnosis to treatment interval (DTI) among patients with oropharyngeal squamous cell carcinoma","volume":"56","author":"Sharma","year":"2016","journal-title":"Oral. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tsai, W.C., Kung, P.T., Wang, Y.H., Huang, K.H., and Liu, S.A. (2017). Influence of time interval from diagnosis to treatment on survival for oral cavity cancer: A nationwide cohort study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0175148"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/S0140-6736(03)14361-9","article-title":"Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomized controlled trial","volume":"362","author":"Overgaard","year":"2003","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gupta, T., Kannan, S., Ghosh-Laskar, S., and Agarwal, J.P. (2018). Systematic review and meta-analyses of intensity-modulated radiation therapy versus conventional two-dimensional and\/or three-dimensional radiotherapy in curative-intent management of head and neck squamous cell carcinoma. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200137"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.oraloncology.2014.12.003","article-title":"Determinants of treatment waiting times for head and neck cancer in the Netherlands and their relation to survival","volume":"51","author":"Hoebers","year":"2015","journal-title":"Oral Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0360-3016(00)00663-5","article-title":"A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003","volume":"48","author":"Fu","year":"2000","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0167-8140(97)00079-0","article-title":"Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: Results of the EORTC 22851 randomized trial","volume":"44","author":"Horiot","year":"1997","journal-title":"Radiother. Oncol."},{"key":"ref_26","first-page":"e42206","article-title":"A Comparative Prospective Study Between Conventional Chemo-Radiotherapy and Pure Accelerated Radiotherapy with Concurrent Chemotherapy for the Treatment of Locally Advanced Head and Neck Cancer","volume":"15","author":"Das","year":"2023","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1056\/NEJMoa0802656","article-title":"Platinum-based chemotherapy plus cetuximab in head and neck cancer","volume":"359","author":"Vermorken","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1080\/07357900701209061","article-title":"Evaluation of the combination of docetaxel\/carboplatin in patients with metastatic or recurrent squamous cell carcinoma of the head and neck (SCCHN): A Southwest Oncology Group Phase II study","volume":"25","author":"Samlowski","year":"2007","journal-title":"Cancer Investig."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3562","DOI":"10.1200\/JCO.2005.01.057","article-title":"Eastern Cooperative Oncology Group. Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck cancer (E1395): An intergroup trial of the Eastern Cooperative Oncology Group","volume":"23","author":"Gibson","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1002\/hed.25025","article-title":"Education Committee of the American Head and Neck Society (AHNS). AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma","volume":"40","author":"Fulcher","year":"2018","journal-title":"Head Neck"},{"key":"ref_31","unstructured":"Leibel, S.A., and Phillips, T.L. (2004). Cancer of the oropharynx. Textbook of Radiation Oncology, Saunders."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1611206","DOI":"10.3389\/pore.2023.1611206","article-title":"Patient delay and its clinical significance among head and neck cancer patients in Hungary","volume":"29","author":"Polony","year":"2023","journal-title":"Pathol. Oncol. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/s41571-022-00603-7","article-title":"HPV-associated oropharyngeal cancer: Epidemiology, molecular biology and clinical management","volume":"19","author":"Lechner","year":"2022","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/coa.13616","article-title":"Post-treatment head and neck cancer care: National audit and analysis of current practice in the United Kingdom","volume":"46","author":"Ellis","year":"2021","journal-title":"Clin. Otolaryngol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1007\/s00405-011-1515-0","article-title":"Prevalence and clinical features of human papillomavirus in head and neck squamous cell carcinoma in Okinawa, southern Japan","volume":"268","author":"Deng","year":"2011","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/dc.24593","article-title":"Utility of p16 and HPV testing in oropharyngeal squamous cell carcinoma: An institutional review","volume":"49","author":"Abdelhakam","year":"2021","journal-title":"Diagn. Cytopathol."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/14\/4\/103\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:08:03Z","timestamp":1760108883000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/14\/4\/103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,29]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["clinpract14040103"],"URL":"https:\/\/doi.org\/10.3390\/clinpract14040103","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,29]]}}}