Association between latent classes of healthcare-seeking behavior and treatment delay in patients with nasopharyngeal carcinoma: a retrospective study based on the Andersen model

Abstract Background Delayed treatment initiation in nasopharyngeal carcinoma (NPC) adversely affects prognosis. Healthcare-seeking behavior, encompassing initial institution choice, referral pathways, and symptom recognition, may influence treatment timeliness, yet the heterogeneity of such behaviors and their association with treatment delay remain underexplored. This study aimed to identify distinct patterns of healthcare-seeking behavior using latent class analysis and to investigate their independent association with treatment delay (≥ 30 days) in NPC patients. Methods A total of 3,331 patients with NPC were retrospectively enrolled. Based on the Andersen’s Behavioral Model of Health Services Use, eight variables were selected for latent class analysis (LCA), including marital status, residence, failure of recognition at the first visit, type of medical insurance, level of the first-visit hospital, number of referrals, referral pathway, and initial symptoms, in order to identify subtypes of healthcare-seeking behavior. Multivariate logistic regression was subsequently performed to examine the association between latent classes and treatment delay. Results LCA identified four distinct healthcare-seeking behavior patterns: Initial High-Level Complex Referral (C1, 23.6%), Initial Primary Direct Referral (C2, 10.1%), Initial Primary Delayed Referral (C3, 32.3%), and High-Level Direct Presentation (C4, 34.0%). Using C1 as the reference group, C2 (OR = 0.542, P = 0.0049), C3 (OR = 0.752, P = 0.041), and C4 (OR = 0.602, P < 0.001) were associated with significantly lower odds of treatment delay. Each additional year of age was associated with a 1.0% increase in the odds of treatment delay (OR = 1.010, P = 0.0385). Non-standard treatment modalities were associated with increased odds of treatment delay (OR = 2.034, P < 0.001). Conclusions Healthcare-seeking behavior patterns were independently associated with treatment delay in patients with NPC. Optimizing referral pathways and improving the recognition capability of primary healthcare institutions were associated with shorter treatment waiting times in this cohort.