Time-to-Treatment in Oral Cancer: Causes and Implications for Survival.

Antoni Mari-Roig,José López-López,Constanza Saka-Herrán,Enric Jané-Salas,Albert Estrugo-Devesa

doi:10.3390/cancers13061321

Antoni Mari-Roig, José López-López + Show 3 more

Open Access

https://doi.org/10.3390/cancers13061321

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Abstract

Simple SummaryStage of the disease at diagnosis has been recognized as one of the most important prognostic markers for oral cancer. Unfortunately, still two thirds of patients are diagnosed at an advanced stage of disease with a 5-year survival rate of 50% or less. Although the detection of oral cancer at an early stage is the most effective means to improve survival and reduce morbidity, in the past years, there has been little change in the diagnosis of oral cancer at early stages, which is believed to be a result of delays in diagnosis and treatment of oral cancer, among other independent factors. Following the Aarhus statement, developed in effort to standardize the design, methods and reporting of studies concerning time-intervals in early diagnosis research, the review assessed the causes that influence the patient, diagnosis and pre-treatment intervals in the pathway of time-to-treatment in oral cancer and its impact on survival.The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

Highlights

In 2018 oral cancer accounted for 354,864 (2%) new cases and 177,384 (1.9%) deaths worldwide, with the highest incidence in Southern Asia and the Pacific Islands and being the eighth most common type of cancer in men [1]
Despite advances in diagnosis and oncologic treatment during the last decades, the 5-year survival rates of oral cancer still remain in the 50–60% range [2,3], with a slight increase observed in the United States (US) during the last decade (66%) [4]
Since the patient interval is the major contributor to the total time-interval, priority should be given to strategies aimed at increasing public education and awareness of early signs and/or symptoms of head and neck cancer (HNC) [13]

Summary

Introduction

In 2018 oral cancer accounted for 354,864 (2%) new cases and 177,384 (1.9%) deaths worldwide, with the highest incidence in Southern Asia and the Pacific Islands and being the eighth most common type of cancer in men [1]. Despite advances in diagnosis and oncologic treatment during the last decades, the 5-year survival rates of oral cancer still remain in the 50–60% range [2,3], with a slight increase observed in the United States (US) during the last decade (66%) [4]. Several factors have been assessed as independent prognostic factors for head and neck cancer (HNC). These factors include demographic and patient factors, lifestyle factors, treatment modality factors and tumor factors [5]. Of the prognostic factors, tumor size and increased stage, nodal involvement (extracapsular spread), distant metastasis, positive margins and, the stage of the presenting lesion at diagnosis are the most important prognostic markers for oral cancer [2,5,6]. Still two thirds of patients with oral cancer are diagnosed at an advanced stage of disease (stage III and IV) [3,7] with a 5-year survival rate of 50% or less [2] compared to the more than 80% survival rate in those with localized disease, which make the differences in mortality rates based on staging very marked [8]

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