Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain. Relative contribution of patient interval

  1. Pablo Ignacio Varela Centelles 3
  2. José Luis López-Cedrún Cembranos 4
  3. J. Fernández Sanromán 5
  4. Pablo Álvarez Nóvoa 1
  5. Ramón Luaces Rey 4
  6. María Pombo Castro 4
  7. María Pía López Jornet 2
  8. Juan Manuel Seoane Lestón 1
  1. 1 Dept of Medical-Surgical Specialities. University of Santiago de Compostela. Santiago de Compostela (A Coruña). Spain
  2. 2 Faculty of Medicine. University of Murcia. Murcia. Spain
  3. 3 Primary Care Clinics. CS Praza do Ferrol. EOXI Cervo, Lugo, e Monforte de Lemos. Galician Health Service. Lugo. Spain; Dept of Medical-Surgical Specialities. University of Santiago de Compostela. Santiago de Compostela (A Coruña). Spain
  4. 4 Service of Oral and Maxillofacial Surgery. Complexo Hospitalario Universitario de A Coruña (CHUAC). Galician Health Service. A Coruña. Spain
  5. 5 Service of Oral and Maxillofacial Surgery. POVISA Hospital. Vigo. (Pontevedra). Spain
Revista:
Medicina oral, patología oral y cirugía bucal. Ed. inglesa

ISSN: 1698-6946

Ano de publicación: 2017

Volume: 22

Número: 4

Páxinas: 7

Tipo: Artigo

DOI: 10.4317/MEDORAL.21676 DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Medicina oral, patología oral y cirugía bucal. Ed. inglesa

Objetivos de desarrollo sostenible

Resumo

Despite continuous advances in diagnosis and therapy, oral cancers are mostly diagnosed at advanced stages with minor survival improvements in the last two decades. Both phenomena have been attributed to delays in the diagnosis. This study aims at quantifying the time elapsed until definitive diagnosis in these patients and the patient interval’s contribution. A hospital-based, ambispective, observational study was undertaken on incident cases with a pathological diagnosis of oral squamous cell carcinoma recruited during 2015 at the Oral and Maxillofacial Surgery services of CHUAC (A Coruña) and POVISA (Vigo) hospitals. 74 consecutive oral cancer patients (59.5% males; median age: 65.0 years (IQ:57-74)) were studied. Most cases (52.7%; n=39) were at advanced stages (TNM III-IV) at diagnosis. The period since first sign/symptom until the patient seeks health care was the longest interval in the pathway to diagnosis and treatment (median: 31.5 days; IQR= 7.0 – 61.0) and represents >60% of the interval since symptom onset until referral to specialised care (pre-referral interval). The average interval assigned to the patient resulted to be relatively larger than the time elapsed since the patient is seen at primary care until a definitive diagnosis is reached (diagnostic interval). Median of the referral interval for primary care professionals: 6.5 days (IQR= 0.0 – 49.2) and accounts for 35% (19% - 51%) of the diagnostic interval. The patient interval is the main component of the pathway to treatment since the detection of a bodily change until the definitive diagnosis. Therefore, strategies focused on risk groups to shorten this interval should be implemented in order to ease an early diagnosis of symptomatic oral cancer.

Referencias bibliográficas

  • Warnakulasuriya, S. (2009). Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 45. 309-316
  • Warnakulasuriya, S. (2009). Significant oral cancer risk associated with low socioeconomic status. Evid Based Dent. 10. 4-5
  • Scott, SE, Grunfeld, EA, McGurk, M. (2005). The idiosyncratic relationship between diagnostic delay and stage of oral squamous cell carcinoma. Oral Oncology. 41. 396-403
  • Gao, W, Guo, CB. (2009). Factors related to delay in diagnosis of oral squamous cell carcinoma. J Oral Maxillofac Surg. 67. 1015
  • Gómez, I, Seoane, J, Varela-Centelles, P, Diz, P, Takkouche, B. (2009). Is diagnostic delay related to advanced-stage oral cancer?. A meta-analysis. Eur J Oral Sci. 117. 541-546
  • Seoane, J, Takkouche, B, Varela-Centelles, P, Tomás, I, Seoane-Romero, JM. (2012). Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta-analysis. Clin Otolaryngol. 37. 99-106
  • Pack, GT, Gallo, JS. (1938). The culpability for delay in treatment of cancer. Am J Cancer. 33. 443
  • Güneri, P, Epstein, JB. (2014). Late stage diagnosis of oral cancer: components and possible Solutions. Oral Oncol. 50. 1131
  • Stefanuto, P, Doucet, JC, Robertson, C. (2014). Delays in treatment of oral cancer: a review of the current literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 117. 424
  • Brouha, XD, Tromp, DM, Hordijk, GJ, Winnubst, JA, de Leeuw, JR. (2005). Oral and pharyngeal cancer: analysis of patient delay at different tumor stages. Head Neck. 27. 939
  • McLeod, NM, Saeed, NR, Ali, EA. (2005). Oral cancer: delays in referral and diagnosis persist. Br Dent J. 198. 681
  • Tromp, DM, Brouha, XD, De Leeuw, JR, Hordijk, GJ, Winnubst, JA. (2004). Psychological factors and patient delay in patients with head and neck cancer. Eur J Cancer. 40. 1509
  • Weller, D, Vedsted, P, Rubin, G, Walter, FM, Emery, J, Scott, S. (2012). The Aarhus statement: improving design and reporting of studies on early cancer diagnosis. Br J Cancer. 106. 1262
  • Varela-Centelles, P, López-Cedrún, JL, Fernández-Sanromán, J, Seoane-Romero, JM, Santos de Melo, N, Álvarez-Nóvoa, P. (2017). Key points and time intervals for early diagnosis in symptomatic oral cancer: A systematic review. Int J Oral Maxillofac Surg. 46. 1-10
  • Walter, F, Webster, A, Scott, S, Emery, J. (2012). The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Serv Res Policy. 17. 110
  • Lyratzopoulos, G, Saunders, CL, Abel, GA, McPhail, S, Neal, RD, Wardle, J. (2015). The relative length of the patient and the primary care interval in patients with 28 common and rarer cancers. Br J Cancer. 1121. 35-40
  • Neal, RD, Tharmanathan, P, France, B, Din, NU, Cotton, S, Fallon-Ferguson, J. (2015). Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 1121. 92-107
  • Kantola, S, Jokinen, K, Hyrynkangas, K, Mäntyselkä, P, Alho, OP. (2001). Detection of tongue cancer in primary care. Br J Gen Pract. 51. 106
  • Teppo, H, Alho, OP. (2008). Relative importance of diagnostic delays in different head and neck cancers. Clin Otolaryngol. 33. 325
  • Sargeran, K, Murtomaa, H, Safavi, SM, Teronen, O. (2009). Delayed diagnosis of oral cancer in Iran: challenge for prevention. Oral Health Prev Dent. 7. 69-76
  • van der Waal, I, de Bree, R, Brakenhoff, R, Coebergh, JW. (2011). Early diagnosis in primary oral cancer: is it possible?. Med Oral Patol Oral Cir Bucal. 16. 300
  • Llewellyn, CD, Johnson, NW, Warnakulasuriya, KA. (2004). Risk factors for oral in newly diagnosed patients aged 45 years and younger: a case-control study in Southern England. J Oral Pathol Med. 33. 525
  • Lyratzopoulos, G, Abel, GA, McPhail, S, Neal, RD, Rubin, GP. (2013). Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers. Br J Cancer. 108. 686
  • Onizawa, K, Nishihara, K, Yamagata, K, Yusa, H, Yanagawa, T, Yoshida, H. (2003). Factors associated with diagnostic delay of oral squamous cell carcinoma. Oral Oncol. 39. 781
  • Peacock, ZS, Pogrel, MA, Schmidt, BL. (2008). Exploring the reasons for delay in treatment of oral cancer. J Am Dent Assoc. 139. 1346
  • Joshi, P, Nair, S, Chaturvedi, P, Nair, D, Agarwal, JP, D'Cruz, AK. (2014). Delay in seeking specialized care for oral cancers: experience from a tertiary cancer center. Indian J Cancer. 51. 95
  • Seoane-Lestón, J, Velo-Noya, J, Warnakulasuriya, S, Varela-Centelles, P, Gonzalez-Mosquera, A, Villa-Vigil, MA. (2010). Knowledge of oral cancer and preventive attitudes of Spanish dentists. Primary effects of a pilot educational intervention. Med Oral Patol Oral Cir Bucal. 15. 422
  • Papas, RK, Logan, HL, Tomar, SL. (2004). Effectiveness of a community-based oral cancer awareness campaign (United States). Cancer Causes Control. 15. 121
  • Neal, RD, Din, NU, Hamilton, W, Ukoumunne, OC, Carter, B, Stapley, S. (2014). Comparison of cancer diagnostic intervals before and after implementation of NICE guidelines: analysis of data from the UK General Practice Research Database. Br J Cancer. 110. 584
  • Toustrup, K, Lambertsen, K, Birke-Sørensen, H, Ulhøi, B, Sørensen, L, Grau, C. (2011). Reduction in waiting time for diagnosis and treatment of head and neck cancer - a fast track study. Acta Oncol. 50. 636