Patient factors associated with oral and pharyngeal cancer diagnosis via dental practice compared to medical practice

Abstract

Background. Early diagnosis of oral and pharyngeal cancer is influenced by providers' knowledge, attitudes, and practices, and by patients' awareness of the importance of symptoms and providers' ability to diagnose and treat them. Objectives. The purpose of this study was to investigate sociodemographic, behavioral, and clinical factors of newly diagnosed oral and pharyngeal cancer patients that were associated with the initial healthcare contact leading to diagnosis having been dental practice versus medical practice. Study design. Interview questionnaires and medical record reviews were conducted among a convenience sample of newly diagnosed oral and pharyngeal cancer patients undergoing staging evaluation/treatment at the University of North Carolina Hospitals. Data were entered in EPIINFO 2002 and analyzed in SAS version 8.2 with chi-squared, Fisher exact test, and Cochran-Mantel-Haenszel test of association. The outcome variable was patients diagnosed via dental practice (n = 13) compared to those diagnosed via medical practice (n = 33). Results. Characteristics of the initial 46 patients include: 65% male; 67% white; age range 21-83 years, median 56; 67% high school education or less; 35% income under $20,000/year; 83% current or past smokers, median 44 pack-year; 24% reported having a drinking problem. Most (87%) had medical insurance and 48% had dental insurance. Most were diagnosed late (83% stage III or IV) and had squamous cell carcinoma (85%). The most common sites were tongue (n = 13) and tonsil (n = 11). Dental practice was significantly more likely to be the route of diagnosis for full and partial denture wearers (P = .018) and those with local stage I or II disease at diagnosis (P = .004). Medical practice was the more likely route to diagnosis for those who felt they had good general health (P = .008) and good health of teeth and gums (P = .036). There was no difference in gender, race, age, tobacco or alcohol use, education, medical and dental attendance patterns, income, or medical/dental insurance coverage between groups. Most (91%) had 1 or more warning symptoms, including 49% with oropharyngeal pain or soreness at diagnosis. Of all symptoms, only patients with voice change (P = .049) were more likely to seek medical practice assessment. Specific tumor site was associated with type of provider sought for help (P = .009). Conclusions. Of this small convenience sample of newly diagnosed oral and pharyngeal cancer patients seen for staging/treatment at an academic medical center, those who were diagnosed via dental practice are more likely to wear dentures and to have early stage I and II disease than those diagnosed via medical practice.