Treatment Intensity and Delays Associated With Antibiotic Prescribing Prior to Head and Neck Cancer Diagnosis

INTRODUCTION: Head and neck oncologic outcomes can be negatively affected by diagnostic delays. This study aimed to assess diagnostic delays and differences in treatment intensity associated with antibiotic prescribing prior to head and neck cancer. METHODS: This retrospective cohort study was conducted using a Midwest multi-institutional database, 2013-2022. Patients with mucosal head and neck cancer were identified. Diagnosis index dates were defined by first instance of diagnosis code or biopsy procedure. Symptom onset was defined by ICD 9/10 codes within 90 days prior to index. Our primary exposure was antibiotic prescription within 90 days before index date. The primary outcome was number of treatment modalities and secondary outcomes included days from first documented symptom to index date. Delays and treatment intensity were assessed with a Quasi-Poisson and ordinal logistic regressions, respectively. RESULTS: The cohort included 2711 patients (69.6% male, mean [SD] age 66 [12.13] years). 1014 patients had a symptom diagnosis prior to index. 1007 patients were included in the treatment analysis. Overall, 388 (14.3%) patients received an antibiotic prescription within 90 days of diagnosis, which was associated with a 14.6% (adjusted rate ratio 1.15, 95% CI [1.02-1.28]) longer time to diagnosis. Patients receiving an antibiotic prescription within 90 days of diagnosis were 39.4% (adjusted odds ratio 1.39, 95% CI [1.001-1.94]) more likely to receive an additional treatment modality. CONCLUSION: For patients receiving an antibiotic within the 90 days prior to head and neck cancer diagnosis, this study demonstrated a longer time to diagnosis and found an increased odds of receiving an additional treatment modality, suggesting advanced disease presentation.