Exploring the Reasons for Delay in Treatment of Oral Cancer

doi:10.14219/jada.archive.2008.0046

The Journal of the American Dental Association

Volume 139, Issue 10, October 2008, Pages 1346-1352

https://doi.org/10.14219/jada.archive.2008.0046 Get rights and content

ABSTRACT

Background

Oral cancer continues to be diagnosed and treated at a late stage, which has a negative effect on outcomes. This study identified and quantified delays in diagnosis and treatment.

Methods

The authors conducted a study that included all new patients seen in the Department of Oral and Maxillofacial Surgery, University of California, San Francisco, between 2003 and 2007 who had a diagnosis of squamous cell carcinoma of the oral cavity. They identified the time intervals for six stages, beginning with the time at which patients first became aware of symptoms and ending with the time at which definitive treatment began.

Results

The total time from patients' first sign or symptoms to commencement of treatment was a mean of 205.9 days (range, 52–786 days). The longest delay was from the time symptoms first appeared to the initial visit to a health care professional (mean time, 104.7 days; range, 0–730 days).

Conclusions

Health care professionals need to place greater emphasis on patient education to encourage early self-referrals.

Clinical Implications

Patients should be encouraged to visit a health care professional when signs or symptoms of oral cancer first develop.

Section snippets

SUBJECTS, MATERIALS AND METHODS

This study includes all patients seen in the Oral and Maxillofacial Surgery Clinic, University of California, San Francisco, between Jan. 1, 2003, and Dec. 31, 2007 (60 months), with a new diagnosis of squamous cell carcinoma of the oral cavity. Exclusion criteria included other malignancies, recurrences, long-standing dysplasia, proliferative verrucous leukoplakia and other premalignant conditions. We chose these criteria because many of these patients were being seen on a regular basis by a

RESULTS

During the five-year study period, we identified 50 new patients with biopsy-proven squamous cell carcinoma of the oral cavity who did not meet the exclusion criteria. Below are the time interval findings:

T1: mean time from the patient's first becoming aware of the problem to visiting a primary care clinician, 104.7 days (range, 0–730 days);
T2: mean time from the patient's visiting a primary care clinician to undergoing a biopsy or being referred, 35.9 days (range, 0–280 days);
T3: mean time

DISCUSSION

Oral cancer remains a public health problem, with approximately 8,500 people dying of the disease each year in the United States.¹ In our study, the longest single delay in receiving treatment was from the time the patient became aware of a possible problem to his or her first visit to a primary care clinician. Other studies have confirmed this delay.18, 19, 20, 21, 22 The shortest time for a symptomatic patient to visit a clinician in this study was the same day that symptoms appeared, and the

CONCLUSION

Delays in the diagnosis and treatment of oral cancer occur in a number of stages in the referral and treatment process. The longest single delay in our study occurred between the patient's first becoming aware of symptoms and visiting a primary care clinician. Health care professionals need to place more emphasis on early self-referrals, as well as accelerate other portions of the referral process, particularly in referrals from a primary care clinician to a specialist. Screening and

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: Disclosure. None of the authors reported any disclosures.

¹: Dr. Peacock is a resident, Department of Oral and Maxillofacial Surgery, University of California, San Francisco.

²: Dr. Pogrel is a professor and the chairman, Department of Oral and Maxillofacial Surgery, University of California, San Francisco, P.O. Box 0440, 521 Parnassus Ave., Room C-522, San Francisco, Calif., 94143-0440.

³: Dr. Schmidt is an associate professor and director, Residency Training Program, Department of Oral and Maxillofacial Surgery, University of California, San Francisco.

View full text

Exploring the Reasons for Delay in Treatment of Oral Cancer

ABSTRACT

Background

Methods

Results

Conclusions

Clinical Implications

Section snippets

SUBJECTS, MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

Br J Oral Maxillofac Surg

Oral Oncol

Otolaryngol Head Neck Surg

Oral Oncol

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Oncol

Int J Oral Maxillofac Surg

Lancet

Oral Oncol

Int J Oral Maxillofac Surg

Oral Oncol

JADA

JADA

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

J Oral Maxillofac Surg

JADA

JADA

JADA

Tongue and tonsil carcinoma: increasing trends in the U.S. population ages 20–44 years

Cancer

Skin cancer is on the increase but incidence of lung cancer is falling

BMJ

Cancer facts and figures

Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival

Cancer

The role of the general dental practitioner in detection and prevention of oral cancer: a review of the literature

Dent Update

Estimates of the worldwide mortality from 25 cancers in 1990

Int J Cancer

Cancer statistics, 1997

CA Cancer J Clin

Squamous cancer of the tongue

CA Cancer J Clin

Prognostic significance of STNMP and velocity of tumor growth in oral cancer

Cancer

Early detection, diagnosis, and management of oral and oropharyngeal cancer

CA Cancer J Clin

The early diagnosis of carcinoma of the mouth

Ann R Coll Surg Engl