Impact of Delay in Treatment on Survival of 6353 Oral Cancers: Results of a Nationwide Screening Program in Taiwan

Abstract

Background: Previous studies have indicated the issue of delay treatment in patients diagnosed as oral cancer in population-based screening because oral cancer patients often lack the knowledge to understand rapid progress of oral cancer. Aim: To evaluate the impact of delay in treatment on the survival of oral cancer detected by screening. Methods: We enrolled residences aged 18 years or older with cigarette smoking and/or betel quid chewing who attended Nationwide Oral Cancer Screening program between 2004 and 2009. Cases with prior history of oral cancer were excluded. Demographic characteristics, oral habits, time of delay in treatment after screening and cancer stage were collected. The survival status of oral cancer was ascertained by following up this cohort until the end of 2012. Results: A total of 6353 oral cancers were detected by screening with a median of 19 (interquartile range 12 to 29) days for treatment. Oral cancer with earlier clinical stage had less delay in treatment ( P < 0.01) while gender, age, and diagnostic year had no difference in delay. In univariate analysis, older age (hazard ratio, HR = 1.01), clinical stage (HR = 1.96 for stage II, 3.13 for stage III, 6.42 for stage IV as compared with stage I), and delay in treatment after screening longer than 3 weeks (HR = 1.11) or 6 weeks (HR = 1.64) were highly associated with worse prognosis. In multivariate analysis, delay in treatment more than 6 weeks (HR = 1.34, 95% CI 1.21-1.48) led to poor survival of oral cancer. Conclusion: Subjects with cigarette smoking and/or betel quid chewing who attended oral cancer screening and were detected as oral cancer patients should be advised to undergo treatment no more than 6 weeks.