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Vladić MB, Andabak-Rogulj A, Gršić K, Brailo V, Brzak BL, Škrinjar I, Juras DV. Dentist Involvement in the Treatment of Radiation-Induced Oral Mucositis-A Pilot Cross-Sectional Study. Dent J (Basel) 2024; 12:134. [PMID: 38786532 PMCID: PMC11119246 DOI: 10.3390/dj12050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives: Oral mucositis (OM) occurs in more than 95% of patients irradiated in the head and neck area. This paper aims to determine the occurrence and characteristics of OM in patients with head and neck cancer (HNC), as well as the involvement of dentists/oral medicine specialists in treating such patients. Methods: This study was conducted at the Department of Otorhinolaryngology and Department of Oral Medicine, University Hospital Center Zagreb, from April to August 2022, on patients irradiated in the head and neck area. A unique OM questionnaire was created on the incidence, characteristics, oral care, and involvement of dentists in the overall care. Results: Thirty patients filled out the questionnaire. Of the 22 patients who had developed OM, 14 had grade-three OM. Ten patients were treated for OM in line with the instructions of an oral medicine specialist, eight based on the instructions of a specialist responsible for monitoring of the underlying disease, and four were not treated at all. Sixteen patients had not been referred to a dentist before the start of RT. Conclusions: These results showed insufficient care and treatment of OM, as well as insufficient involvement of dentists in the oncology team.
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Affiliation(s)
- Monika Burja Vladić
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia; (M.B.V.); (B.L.B.)
| | - Ana Andabak-Rogulj
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
| | - Krešimir Gršić
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
| | - Vlaho Brailo
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
| | - Božana Lončar Brzak
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia; (M.B.V.); (B.L.B.)
| | - Ivana Škrinjar
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
| | - Danica Vidović Juras
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
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Manikkath J, Manikkath A, Lad H, Vora LK, Mudgal J, Shenoy RR, Ashili S, Radhakrishnan R. Nanoparticle-mediated active and passive drug targeting in oral squamous cell carcinoma: current trends and advances. Nanomedicine (Lond) 2023; 18:2061-2080. [PMID: 38197397 DOI: 10.2217/nnm-2023-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) is an invasive and highly malignant cancer with significant morbidity and mortality. Existing treatments including surgery, chemotherapy and radiation have poor overall survival rates and prognosis. The intended therapeutic effects of chemotherapy are limited by drug resistance, systemic toxicity and adverse effects. This review explores advances in OSCC treatment, with a focus on lipid-based platforms (solid lipid nanoparticles, nanostructured lipid carriers, lipid-polymer hybrids, cubosomes), polymeric nanoparticles, self-assembling nucleoside nanoparticles, dendrimers, magnetic nanovectors, graphene oxide nanostructures, stimuli-responsive nanoparticles, gene therapy, folic acid receptor targeting, gastrin-releasing peptide receptor targeting, fibroblast activation protein targeting, urokinase-type plasminogen activator receptor targeting, biotin receptor targeting and transferrin receptor targeting. This review also highlights oncolytic viruses as OSCC therapy candidates.
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Affiliation(s)
- Jyothsna Manikkath
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Karnataka State, 576104, India
| | - Aparna Manikkath
- Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA 94103, USA
| | - Hitesh Lad
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Karnataka State, 576104, India
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, UK
| | - Jayesh Mudgal
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka State, 576104, India
| | - Rekha R Shenoy
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka State, 576104, India
| | | | - Raghu Radhakrishnan
- Department of Oral Pathology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka State, 576104, India
- Academic Unit of Oral & Maxillofacial Medicine & Pathology, School of Clinical Dentistry, University of Sheffield, S10 2TA, UK
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Fernández-Martínez NF, Petrova D, Špacírová Z, Barrios-Rodríguez R, Pérez-Sayáns M, Martín-delosReyes LM, Pérez-Gómez B, Rodríguez-Barranco M, Sánchez MJ. The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis. Front Public Health 2023; 11:1183244. [PMID: 37614446 PMCID: PMC10442570 DOI: 10.3389/fpubh.2023.1183244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival. Materials and methods We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist. Results Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31-73), k = 18, of the diagnosis interval 35 days (95% CI = 21-38), k = 11, and of the treatment interval 30 days (95% CI = 23-53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates. Conclusion Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.
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Affiliation(s)
- Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Zuzana Špacírová
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- ORALRES Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Miguel Martín-delosReyes
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology for Chronic Diseases, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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Costa AASD, Caldeira PC, Sousa AA, Tibúrcio JD, Belligoli LDQG, Santos VBD, Bretas PMC, Nunes LL, Prado Neto SCD, Silva GW, Soares JMA. Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors. Braz Oral Res 2023; 37:e054. [PMID: 37255074 DOI: 10.1590/1807-3107bor-2023.vol37.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/19/2022] [Indexed: 06/01/2023] Open
Abstract
The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.
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Affiliation(s)
- Adriana Aparecida Silva da Costa
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Pathology and Surgery, Belo Horizonte - MG, Brazil
| | - Patrícia Carlos Caldeira
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Pathology and Surgery, Belo Horizonte - MG, Brazil
| | - Alexandre Andrade Sousa
- Universidade Federal de Minas Gerais - UFMG, Hospital das Clínicas, Instituto Alfa de Gastroenterologia, Belo Horizonte - MG, Brazil
| | | | | | - Viviane Bigodeiro Dos Santos
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
| | | | - Louise Lanna Nunes
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
| | | | - Gustavo Waldolato Silva
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
| | - João Marcos Arantes Soares
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
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Jabbour N, Mur T, Tracy JC, Tracy LF. Seasonality of head and neck cancers. Am J Otolaryngol 2023; 44:103745. [PMID: 36586316 DOI: 10.1016/j.amjoto.2022.103745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study is to investigate if the season of diagnosis is associated with patient, tumor, and treatment characteristics within head and neck cancer. MATERIALS AND METHODS 1406 patients with a diagnosis of head and neck cancer (HNC) were identified from a HNC database (1996-2019). Patients were classified as receiving a diagnosis in the winter, spring, summer, or fall by calendar definition. Proportions and chi-squared analysis compared patient, tumor, and treatment factors for all diagnoses. Data was subdivided and analyzed based on the primary site. RESULTS From this cohort, 23 %, 27 %, 25 %, and 25 % of HNC patients were diagnosed in winter, spring, summer, and fall respectively with no statistically significant difference between seasons of diagnosis. When subdivided by primary site, oral cavity cancer was significantly more likely to be diagnosed in spring, salivary gland cancer was more likely to be diagnosed in winter and summer (p = 0.03 and p = 0.01 respectively). No other demographic, clinicopathologic, or management characteristics were associated with the season of diagnosis (p > 0.05 for all). CONCLUSIONS Diagnosis of head and neck cancer does not follow a seasonal pattern. Diagnosis of oral cavity and salivary gland cancer showed a seasonal pattern. The majority of patient, tumor and management characteristics were not associated with the.
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Affiliation(s)
- Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
| | - Taha Mur
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jeremiah C Tracy
- Tufts University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Boston, MA, United States of America
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
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Lemma F, Parrino D, Bissolotti G, Emanuelli E, DI Carlo R, Fusetti S. Impact of the SARS-CoV-2 pandemic on the diagnostic delay of oral carcinoma: a retrospective analysis. Minerva Dent Oral Sci 2022; 71:308-317. [PMID: 36760200 DOI: 10.23736/s2724-6329.22.04645-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The aim of the present study was to investigate how the organisation of healthcare activity during the first wave of the SARS-CoV-2 pandemic affected the timing of diagnosis of oral carcinoma in the Functional Head and Neck Department of Padua (Italy). This study gives an effective temporal dimension of the diagnostic delay that occurred during the pandemic, compared with data from the literature. METHODS A retrospective analysis of the diagnostic path of a patient affected by oral cancer during COVID-19 pandemic was performed. The time elapsed from the patient's awareness of the problem to the first curative surgical intervention was considered both during the blockage of elective care activities and in the period immediately following. The results were compared to a group of patients treated in the same period of the year 2019. RESULTS The territorial time was 53.9% longer in the post-lockdown period than in the lockdown period (39.6 days) while the hospital time was 56.6% shorter than in the post-lockdown period (56 days). CONCLUSIONS The response time of territorial medicine has been longer during the pandemic peak. The unintentional creation of exclusive pathways for oncological patients speeded up the diagnostic process. The organization and accessibility of operating theatres can become particularly problematic during the acute phases of a pandemic.
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Affiliation(s)
- Francesco Lemma
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy - .,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy -
| | - Daniela Parrino
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Guido Bissolotti
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Enzo Emanuelli
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Roberto DI Carlo
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Stefano Fusetti
- Department of Maxillofacial Surgery, University of Padua, Padua, Italy.,Section of Otolaryngology, Department of Neuroscience (DNS), University of Padua, Padua, Italy
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Venchiarutti RL, Pho L, Clark JR, Palme CE, Young JM. A qualitative exploration of the facilitators and barriers to early diagnosis and treatment of head and neck cancer: Perceptions of patients and carers. Eur J Cancer Care (Engl) 2022; 31:e13718. [PMID: 36178016 PMCID: PMC9788178 DOI: 10.1111/ecc.13718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study to explore experiences of patients and carers of the pathway to diagnosis and treatment of head and neck cancer (HNC), focusing on differences based on remoteness of residence. METHODS Patients ≥6 months post-treatment completion, and their carers, were recruited. Semi-structured interviews, guided by the Model of Pathways to Treatment as the theoretical framework, were conducted to examine pathways to treatment of HNC and facilitators and barriers to early diagnosis and treatment. Thematic analysis with an iterative and data-driven approach was used to identify themes. RESULTS A total of 39 patients and 17 carers participated in the interviews. Facilitators of timely diagnosis and treatment included a sense of urgency from health care professionals (HCPs), advocacy by the HCP or carers, and leveraging social capital. Distance to services, financial costs, and a perceived lack of emotional investment by HCPs arose as barriers to timely diagnosis and treatment. Participants were often able to rationalise that not all delays were negative, depending causes and expected impact on cancer management. CONCLUSION The findings highlight the complex nature of factors facilitating and impeding early HNC diagnosis and treatment that may be targeted in interventions to support patients and meet important benchmarks for high-quality cancer care.
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Affiliation(s)
- Rebecca L. Venchiarutti
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia,Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia
| | - Lily Pho
- Sydney Local Health District Nursing and Midwifery Executive UnitSydney Local Health DistrictCamperdownNew South WalesAustralia
| | - Jonathan R. Clark
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictCamperdownNew South WalesAustralia,Central Clinical School, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Carsten E. Palme
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictCamperdownNew South WalesAustralia,Central Clinical School, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Jane M. Young
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia,The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
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Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer. Cancers (Basel) 2021; 13:cancers13205163. [PMID: 34680312 PMCID: PMC8533728 DOI: 10.3390/cancers13205163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
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.
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Clohessy J, Hoffman G, Cope D. Geographic remoteness from a multidisciplinary team is associated with an increased clinical staging of head and neck cancer: a Newcastle (Australia) study. Int J Oral Maxillofac Surg 2021; 51:862-868. [PMID: 34598849 DOI: 10.1016/j.ijom.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to investigate the relationship between a patient's residential distance from a tertiary referral regional multidisciplinary team (MDT) and the clinical staging of their head and neck cancer (HNC) at presentation. A retrospective cohort study was performed of all attendees with HNC who had undergone an MDT assessment. The period of study was January 2016 to January 2017. The primary predictor variable was the patient's residential distance from the MDT. Demographic and clinicopathological factors were recorded. The primary outcome variable was the clinical staging conferred by the MDT. Descriptive and ordinal logistical regression analyses were conducted to examine the data. There were 286 observations; 230 patients were male and 56 were female. The mean age of the cohort was 66.52 years. The average residential distance from the MDT was 68.16 km. Regression analysis, while not statistically significant, indicated that those living more than 100 km (range 102-592 km) from the MDT had a 1.49 times increased risk of being diagnosed with an advanced stage of cancer when compared to those living less than 100 km away. This study provides insights into the potential adverse effect geographic remoteness has on initial staging of HNC and the need for further strategies to serve this at-risk population.
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Affiliation(s)
- J Clohessy
- Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Hunter New England Health District, Newcastle, NSW, Australia.
| | - G Hoffman
- Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Hunter New England Health District, Newcastle, NSW, Australia; Medical School, University of Newcastle, Callaghan, NSW, Australia
| | - D Cope
- Department of Otolaryngology/Head and Neck Surgery, John Hunter Hospital, Hunter New England Health District, Newcastle, NSW, Australia
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10
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Pakravan F, Abbasi F, Garshasbi MA, Isfahani MN. Relationship between oral cancer stage and elapsed time from the onset of signs and symptoms to diagnosis and treatment. Cancer Treat Res Commun 2021; 28:100428. [PMID: 34225105 DOI: 10.1016/j.ctarc.2021.100428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Oral cancer includes a variety of diagnoses of malignancies that manifest in the oral tissues. Prognosis and treatment depend on the site of involvement, the time of diagnosis, and the stage of the tumor. Early diagnosis of oral mucosal lesions facilitates the early detection of cancer, which is a key step for treatment. The purpose of this study was to investigate the relationship between delayed referral of patients with oral cancer and disease progression at the time of diagnosis. MATERIALS AND METHODS In this cross-sectional study, data were collected from 108 patients with a definitive diagnosis of oral cancer by a standardized questionnaire. Data were analyzed by descriptive statistics, including mean, standard deviation, frequency, frequency percentage, and inferential statistics, including logistic regression analysis. P<0.05 was considered to be statistically significant. RESULTS The mean time of referral to a therapist was 17.73 ± 22.80 weeks, with 53 (49.1%) patients having a delay of more than 10 weeks. Age, education level, smoking, disease stage, N class, M class, and type of cancer were not significantly associated with the incidence of delay (P>0.05). Patients whose first signs were significant bleeding and/or unrecovered ulceration showed a significant reduction in the delay time (OR = 0.024 and P = 0.038). CONCLUSION There was no significant relationship between the disease progression in oral cancer and the time elapsed from the onset of symptoms to diagnosis and treatment. Hence, it seems necessary to take appropriate measures to enhance public awareness of oral cancer and its symptoms.
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Affiliation(s)
- Fahimeh Pakravan
- Department of Oral Medicine, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Abbasi
- Department of Oral Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Amin Garshasbi
- Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nasr Isfahani
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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11
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Time-to-Treatment in Oral Cancer: Causes and Implications for Survival. Cancers (Basel) 2021; 13:cancers13061321. [PMID: 33809427 PMCID: PMC8000007 DOI: 10.3390/cancers13061321] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
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.
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Zavarez LB, Stramandinoli-Zanicotti RT, Sassi LM, Ramos GH, Schussel JL, Torres-Pereira CC. The interval since first symptoms until diagnosis of squamous cell carcinoma in the head and neck region is still a problem in southern Brazil. Med Oral Patol Oral Cir Bucal 2020; 25:e769-e774. [PMID: 33037811 PMCID: PMC7648913 DOI: 10.4317/medoral.23781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background The aim was to examine the interval since first symptoms until final diagnosis of squamous cell carcinoma (SCC) in the head and neck region in southern Brazil.
Material and Methods The individuals were prospectively selected and underwent anamnesis, physical examination and interview in the first medical consultation at a Cancer Hospital from south of Brazil.
Results From 488 patients who underwent clinical examination, 105 were included in the study with diagnosis of SCC. Patients average interval from first symptoms to final diagnosis was 152 days (median 86; max:1105; min: 1), the average professional interval was 108 days (median: 97; max:525; min: 1) , and the average total period interval was 258 days (median: 186; max:1177; min: 45). Factors statistically associated with patient and diagnosis itinerary intervals were smoking and poorly adapted dentures and distance from home to hospital, respectively.
Conclusions The identification of the itinerary characteristics of this specific population may reflect in more effective public policies, such as primary and secondary prevention programs, aiming to increase the survival of oncological patient. Furthermore, the knowledge of the variables that influence the late diagnosis minimizes patient's journey in search of care to cancer centers through health programs. Key words:Head and neck cancer, time interval, time to diagnosis, diagnosis delay, squamous cell carcinoma.
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Affiliation(s)
- L-B Zavarez
- Av Lothário Meissner 632 Curitiba - PR, Brazil. ZIP 80210-170
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13
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Thomas A, Manchella S, Koo K, Tiong A, Nastri A, Wiesenfeld D. The impact of delayed diagnosis on the outcomes of oral cancer patients: a retrospective cohort study. Int J Oral Maxillofac Surg 2020; 50:585-590. [PMID: 32917484 DOI: 10.1016/j.ijom.2020.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/21/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
The contemporary literature is discordant regarding the role of delayed diagnosis in the prognosis of patients with oral cancer. This study examined data on a previously reported cohort of 101 patients with oral squamous cell carcinoma diagnosed at a single institution between 2008 and 2010. The time interval between symptom onset and initial histological diagnosis (diagnostic delay) was recorded for each patient, as were demographic data and cancer features such as T stage, nodal status, and smoking status. The mean follow-up period was 4 years 10 months. The mean diagnostic delay was 4 months, mean overall survival was 5years 6 months, and mean disease-specific survival was 4 years 9 months. No significant correlation was found between diagnostic delay and overall survival, disease-specific survival, or recurrence rates. Patients with node-positive disease were more likely to be diagnosed earlier, whereas women and non-smokers were more likely to have a delayed diagnosis. Inherent tumour biology is likely an important prognostic factor separate to diagnostic delay. Public education efforts should focus on symptom recognition and encourage early presentation for investigation of oral lesions, particularly for females and non-smokers, so that more aggressive tumours can be treated sooner to give the best chance at survival.
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Affiliation(s)
- A Thomas
- Head and Neck Tumour Stream, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - S Manchella
- Head and Neck Tumour Stream, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - K Koo
- Head and Neck Tumour Stream, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - A Tiong
- Head and Neck Tumour Stream, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - A Nastri
- Head and Neck Tumour Stream, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D Wiesenfeld
- Head and Neck Tumour Stream, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, the University of Melbourne, Parkville, Victoria, Australia
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14
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Langton S, Cousin GCS, Plüddemann A, Bankhead CR. Comparison of primary care doctors and dentists in the referral of oral cancer: a systematic review. Br J Oral Maxillofac Surg 2020; 58:898-917. [PMID: 32591210 DOI: 10.1016/j.bjoms.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/09/2020] [Indexed: 12/25/2022]
Abstract
Oral cancer is referred to specialists by both general practitioners (GPs) and dentists, with varying proportions reported in different studies. However, some have noted that dentists more commonly refer oral cancer in the absence of patient-perceived symptoms and may refer at an earlier stage. Unfortunately, approximately half the UK adult population do not receive regular dental care. We have conducted a systematic review of studies that compare GPs and dentists in the referral of oral cancer and have focused on three aspects: the proportion of diagnosed oral cancers, stage on presentation, and delay. Searches of the databases Medline, Embase, Scopus, Google Scholar, Web of Science, and CINAHL, together with additional searches of reference lists, authors, and conference proceedings, found 22 studies from 10 countries, which included a total of 4953 oral cancers. The percentage of medical referrals ranged from 13% to 86%; dental referrals ranged from 15% to 80%. Random-effects meta-analysis indicated a combined relative risk of medical referral to dental referral of 1.36 (95% CI: 0.99 to 1.86). For UK-based studies, the relative risk was also 1.36 (95% CI: 1.05 to 1.76). There was considerable heterogeneity for all studies and for a subgroup of UK studies: I296.4% (95% CI 95.4 to 97.1) and 81.0% (95% CI 63.3 to 90.1), respectively. Several studies showed a lower stage for dentally-referred cancers; the combined risk for dentists and GPs referring early (stages 1 and 2) disease was 1.37 (95% CI: 1.17 to 1.60), and one cause may be the much higher number of cases referred by dentists in the absence of symptoms. No studies showed a significant difference in delay. Oral cancer is referred by both GPs and dentists, typically about 50% and 40%, respectively, although there is a wide range, probably depending on local circumstances. Both groups require skills in oral examination, recognition of lesions, and knowledge of the risk factors. Effectively, regular dental attenders are a select group that is regularly screened for oral cancer, and it is likely that screening is not delivered to those with the highest risk. We suggest that further work is required on how to access high-risk individuals both for possible screening and preventive interventions.
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Affiliation(s)
| | | | - A Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - C R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
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Overall time interval ("Total diagnostic delay") and mortality in symptomatic oral cancer: A U-shaped association. Oral Oncol 2020; 104:104626. [PMID: 32146387 DOI: 10.1016/j.oraloncology.2020.104626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/14/2020] [Accepted: 02/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess the impact on survival of the total time interval since the first bodily change (sign/symptom) until the start of treatment in symptomatic oral cancer patients. METHODS Retrospective, hospital-based study designed within the "Aarhus Statement" conceptual framework, using the overall interval to treatment of 183 oral cancer patients to analyse their survival rates. RESULTS Overall time interval (T5): 107.1 ± 85.2 days. Overall survival rate: 58.4 (CI: 51.3-66.4%). Recurrence time (median): 724 days (IQR, 223-2963.5). Median survival time: 1744 days (IQR, 479.5-3438). Overall delay (T5) and mortality showed a U-shaped association, where patients with short (24.0-55.5 days) and long T5 intervals (127.5-420 days) had higher mortality than those with medium T5 intervals (55.5-127.5 days). CONCLUSION There is a non-monotonic association between time interval and mortality. Higher mortality rates are linked to shorter and longer time intervals. This may induce underestimation of the association when time intervals are considered dichotomously.
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Papadiochou S, Papadiochos I, Perisanidis C, Papadogeorgakis N. Medical practitioners' educational competence about oral and oropharyngeal carcinoma: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2019; 58:3-24. [PMID: 31785865 DOI: 10.1016/j.bjoms.2019.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
Medical practitioners' (MP) role is pivotal in primary prevention, early diagnosis, prompt referral and effective management of oral and oropharyngeal carcinomas (OC/OPC), which raises the importance of their effective OC/OPC education at all levels of medical education. The purpose of this systematic review was to summarise the available scientific evidence about their educational competence in dealing with OC/OPC. We made a systematic search of papers in the English language in MEDLINE, Scopus, Cochrane Library CENTRAL and CINAHL databases from their inception until December 2018. Overall, 23 cross-sectional and three interventional studies have been selected for the systematic review and 18 of these were included in the meta-analyses. Excluding tobacco use (synthesised estimate of 95% of respondents identified tobacco as an OC/OPC risk factor, 95% CI of synthesised estimate 92% to 97%) and alcohol consumption (65%, 95%CI 52% to 77%), less than half of MP (approximately) were knowledgeable about important OC/OPC risk factors including human papilloma virus (42%, 95% CI 30% to 54%), poor diet (34%, 95% CI 17% to 54%), and advancing age (45%, 95% CI 21% to 70%). There was a low to moderate level of awareness among MP regarding common precancerous oral lesions involving leukoplakia (56%, 95% CI 32% to 79%), erythroplakia (30%, 95% CI 8% to 58%), and oral lichen planus (13%, 95% CI 0 to 41%). Moderate knowledge was also recorded about frequent sites of OC development involving the tongue (48%, 95% CI 33% to 64%) and floor of the mouth (37%, 95% CI 19% to 57%). Most MP enquired about tobacco use (86%, 95% CI 74% to 96%), and alcohol consumption (73%, 95% CI 47% to 94%) during history taking, and expressed willingness to be given supplementary OC/OPC education (78%, 95% CI 54% to 96%), as well. With regard to the incidence of intraoral screening, 27% of MP (95% CI 12% to 46%) make an intraoral examination as a routine. Interestingly, studies from each continent yielded significantly different outcomes to some research questions in the review. From the MP's perspective, clinical time restrictions and deficiencies in organised training were recognised as the main barriers towards their OC/OPC educational competence. The findings of this systematic review indicated the existence of deficiencies in knowledge and misconceptions, neglected preventive responsibilities, and associated barriers towards OC/OPC. A need for improved OC/OPC training at all levels of medical education is required to increase competence worldwide.
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Affiliation(s)
- S Papadiochou
- Health Center of Spata, Spata Attikis 19004, Greece.
| | - I Papadiochos
- Eacmfs Clinical Fellow, Chirurgie Maxillo-faciale et Stomatologie, CHU Amiens-Picardie, 1 Rue du Professeur Christian Cabrol, 80000 Amiens, France.
| | - C Perisanidis
- Oral & Maxillofacial Surgery Department, Evaggelismos General Hospital of Athens, National and Kapodistrian University of Athens, Greece.
| | - N Papadogeorgakis
- Oral and Maxillofacial Surgery, National and Kapodistrian University of Athens, Greece.
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Sujir N, Ahmed J, Pai K, Denny C, Shenoy N. Challenges in Early Diagnosis of Oral Cancer: Cases Series. Acta Stomatol Croat 2019; 53:174-180. [PMID: 31341326 PMCID: PMC6604559 DOI: 10.15644/asc53/2/10] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Oral cancer has an overall survival rate of only 50%. This prognosis is significantly improved when this disease is diagnosed and treated in its early stages. Oral cancer is usually associated with classical clinical features associated with malignancy resulting in accurate diagnosis. However, certain cases of oral cancer, especially in its early stages, can be clinically deceptive and can be misdiagnosed. There is a recent trend of changing demographics and etiology associated with oral cancer adding to the diagnostic challenges faced by the clinician. The awareness of these changing trends is needed to aid in early diagnosis of oral cancer. In this case series, we have presented three cases of patients with challenging aspects.
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Affiliation(s)
- Nanditha Sujir
- Department of Oral Medicine and Radiology, Manipal College Of Dental Sciences, Mangalore
| | - Junaid Ahmed
- Department of Oral Medicine and Radiology, Manipal College Of Dental Sciences, Mangalore
| | - Keerthilatha Pai
- Department of Oral Medicine and Radiology, Manipal College Of Dental Sciences, Mangalore
| | - Ceena Denny
- Department of Oral Medicine and Radiology, Manipal College Of Dental Sciences, Mangalore
| | - Nandita Shenoy
- Department of Oral Medicine and Radiology, Manipal College Of Dental Sciences, Mangalore
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Friesen R, McGaw T, Peters E, Lai H. A retrospective analysis of referral patterns to a university oral medicine clinic. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:381-385. [PMID: 31103528 DOI: 10.1016/j.oooo.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to analyze referral patterns to a university-based oral medicine (OM) clinic and to identify access issues to OM care. STUDY DESIGN A retrospective patient chart review on all OM specialists at the University of Alberta (Edmonton, Alberta, Canada) over a 1-year period was performed. Data collected included patient age and gender, referring clinician training and experience, reason and urgency of referral, provisional and final diagnosis, and the referral times. Proportions for data points were collected by using a 95% Wilson Score confidence interval. Two-sided Fisher's exact tests were performed for significant differences. RESULTS In total, 924 patients were included. Dentists referred 81.4% of the cases, with the remaining cases referred by physicians. Patients traveled, on average, 55.44 km to the OM clinic, with a mean wait time of 105.5 days. White/red lesions were the most common referral reason (38%), with the tongue (21.8%) being the most common site of concern. There was no significant difference in the accuracy of provisional diagnoses between clinician types. Immune-mediated conditions were the most common final diagnosis. CONCLUSIONS The referral patterns of dental and medical practitioners are similar, with mucosal lesions being the most common referral reason. In our study population, access to care was compromised by wait times and travel distances.
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Affiliation(s)
- Reid Friesen
- Division of Oral Medicine, Oral Pathology and Oral Radiology, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Tim McGaw
- Division of Oral Medicine, Oral Pathology and Oral Radiology, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Edmund Peters
- Division of Oral Medicine, Oral Pathology and Oral Radiology, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hollis Lai
- Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Diagnosis and referral delays in primary care for oral squamous cell cancer: a systematic review. Br J Gen Pract 2018; 69:e112-e126. [PMID: 30455220 DOI: 10.3399/bjgp18x700205] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/28/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The incidence of oral cancer is increasing. Guidance for oral cancer from the National Institute for Health and Care Excellence (NICE) is unique in recommending cross-primary care referral from GPs to dentists. AIM This review investigates knowledge about delays in the diagnosis of symptomatic oral squamous cell carcinoma (OSCC) in primary care. DESIGN AND SETTING An independent multi-investigator literature search strategy and an analysis of study methodologies using a modified data extraction tool based on Aarhus checklist criteria relevant to primary care. METHOD The authors conducted a focused systematic review involving document retrieval from five databases up to March 2018. Included were studies looking at OSCC diagnosis from when patients first accessed primary care up to referral, including length of delay and stage of disease at time of definitive diagnosis. RESULTS From 538 records, 16 articles were eligible for full-text review. In the UK, more than 55% of patients with OSCC were referred by their GP, and 44% by their dentist. Rates of prescribing between dentists and GPs were similar, and both had similar delays in referral, though one study found greater delays attributed to dentists as they had undertaken dental procedures. On average, patients had two to three consultations before referral. Less than 50% of studies described the primary care aspect of referral in detail. There was no information on inter-GP-dentist referrals. CONCLUSION There is a need for primary care studies on OSCC diagnosis. There was no evidence that GPs performed less well than dentists, which calls into question the NICE cancer option to refer to dentists, particularly in the absence of robust auditable pathways.
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