Abstract
Simple SummaryInformation about the relative length of patient stays, primary care, and prereferral intervals (from symptom onset to specialist referral) is very scarce, and how the presenting symptoms influence these intervals and referral routes remains unknown. This study assesses the impact of presenting symptoms on time intervals, number of visits at the primary care level, and referral pattern of patients with symptomatic oral cancer. This approach will allow targets to be identified for future interventions and the optimization of the treatment pathway for symptomatic oral cancer patients.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.
Highlights
Oral and pharyngeal neoplasms combined are the seventh most frequent cancer and the ninth-leading cause of cancer deaths worldwide [1,2]
The study included a sample of 181 patients (63.9% males; mean age 65.8 ± 12.7 years-old), with carcinomas located on the tongue (C02: 45.2%) and less frequently on the palate (C05: 9.6%), floor of the mouth (C04: 8.3%), gums (C03: 7.6%), base of the tongue (C01: 3.1%), and other sites within the oral cavity (C06: 26.1%)
The majority of patients were diagnosed at advanced disease stages (TNM III-IV: 56.7%), and total time interval from initial symptom to start of treatment was x = 159.8 days
Summary
Oral and pharyngeal neoplasms combined are the seventh most frequent cancer and the ninth-leading cause of cancer deaths worldwide [1,2]. In order to improve the quality of research on this topic, methodological protocols have been developed in the last decade to study the journeys of symptomatic cancer patients within the model of pathways to treatment (from symptom onset to the start of treatment) framework, which allows time intervals and their prognostic implications to be identified, together with allowing intervention strategies to be designed and to minimize bias [12,13,14,15] One result of these strategies is the finding that the longer the diagnostic-to-treatment interval, the poorer the overall survival for patients with oral squamous cell carcinomas [16]. The aims of this investigation were to determine the time intervals from the first symptom (presenting symptom) until the beginning of treatment of oral cancer patients and their relative importance and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes
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