Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer

Abstract

This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3–76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61–0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.

Factors related to the waiting time for scheduling an oral biopsy in Brazil: a multilevel analysis

“…An extended wait is a matter of concern particularly in a country like Brazil, which has rising mortality rates from oral cancer in most regions and where, in about 74% of cases, it takes the patient more than 60 days to start the treatment [ 1 ]. Moreover, in Brazil [ 10 , 16 ] and worldwide [ 11 , 12 ], oral cancer is still predominantly diagnosed at an advanced stage.…”

“…The relationship between PHC and ASSB is important to promote health care. The greater number of appointments in the PHC until the decision for referral to the ASSB and the degree of refinement of protocols, the worse the prognosis and outcomes for confirmed cases of oral and oropharyngeal cancer [ 11 , 12 ]. In this sense, training with PHC professionals for the detection of oral cancer is considered a relevant strategic standard of the work process, comprising a CEO evaluation indicator [ 14 ].…”

“…The present study provided information on relevant aspects of care for oral cancer in the CEO in Brazil, reinforcing the need to consider it a priority in public oral health policies [ 30 ]. In the specific case of scheduling a biopsy, the reference time interval for the ASSB [ 12 ] may represent a strategic target for intervention, and its optimization could contribute to the meeting of time limits established by the Brazilian legislation for both the diagnosis and start of the cancer treatment. Therefore, protocols are required to ensure epidemiological surveillance and immediate referral of patients with lesions suspected of oral cancer, considering the occurrence of potentially severe sequelae in relation to prognosis, in the presence of delays between the identification of the lesion and the specialists’ opinion [ 27 ].…”

“…The availability of access to health services that offer the necessary care in a timely manner is crucial for this outcome. The delay in diagnosing this disease is a matter of concern and a prevalent one – most oral neoplasms are detected at an advanced stage [ 10 – 12 ]. A study that analyzed the relative survival of oral cancer in several health institutions in South America identified that around 48% of the patients included in the study were diagnosed with tumors at the most advanced stage, i.e., stage IV.…”

Early Diagnosis and Diagnostic Delay in Oral Cancer

“…This circumstance may condition not only the referral pathways, but also the trigger consultations with each profile. The article by Varela-Centelles et al [ 19 ] investigates the impacts of the type of the first symptom of oral cancer on the time intervals to diagnosis. This study shows that, despite specific training opportunities [ 20 ], dentists generate longer primary care intervals and need a higher number of consultations than physicians before deciding to refer an oral cancer patient.…”