No time to waste: Evaluation of diagnostic delays in vulvar cancer.

Objectives

To identify patient, provider, and system-level factors associated with delayed diagnosis of vulvar squamous cell cancer (SCC).

Methods

An IRB-approved retrospective single-institution cohort study was conducted in patients with vulvar SCC diagnosed from 2009 to 2020. Patients were compared by time from symptom onset to biopsy using a prespecified threshold of <6 months versus ≥6 months. Demographic, tumor, provider, and healthcare utilization variables were collected. Progression-free survival (PFS) and overall survival (OS) were examined.

Results

Among 157 eligible patients, 39 (24.8%) experienced a diagnostic delay of ≥6 months. Delayed diagnosis was not associated with age, race, smoking status, dermatologic conditions, tumor size, stage, insurance, or income. Patients with delayed diagnosis underwent more clinic visits, examinations, empiric therapies, and encounters before biopsy (all p ≤ 0.003). Initial provider specialty differed significantly between groups: patients diagnosed within 6 months were more likely to first present to a gynecologic provider, whereas those initially evaluated by non-gynecologic providers had longer median time to diagnosis (1.9 vs 4.7 months, p < 0.0001) and were more likely to experience delay ≥6 months (34.7% vs 16.5%, p = 0.0098). On multivariable analysis, higher BMI (aOR 1.05 per kg/m2, 95% CI 1.01-1.10) and initial evaluation by a non-gynecologic provider (aOR 2.24, 95% CI 1.03-5.01) independently predicted delay ≥6 months.

Conclusions

Delayed diagnosis of vulvar SCC was associated primarily with provider and healthcare system-related factors rather than patient or tumor characteristics. Earlier biopsy, timely gynecologic referral, and improved patient and provider education may help facilitate more prompt diagnosis and therapeutic intervention.