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Patel R, Sainuddin S. Assessing the information provided regarding oral cancer by dental practice websites within the Greater Manchester area. Prim Dent J 2024; 13:26-28. [PMID: 38888070 DOI: 10.1177/20501684241230190] [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: 06/20/2024]
Abstract
INTRODUCTION With increasing numbers of oral cancer diagnoses and guidance recommending that patients approach their doctors or dentists for assessments, when searching for information regarding mouth cancer, patients may first look to their dental practice website. This study aimed to evaluate the variance of patient information provided regarding oral cancer on dental practice websites. MATERIALS AND METHODS Dental practices within the Manchester area with an active website were included with assessment of whether there was any information provided regarding reducing oral cancer risk factors, signs to look out for and if oral cancer screening was included as part of the general check-up, using a three-point score based on the joint statement from the British and Irish Society for Oral Medicine (BISOM) and Cancer Research UK (CRUK) regarding oral cancer diagnosis and prevention. RESULTS In total, 66.6% (n=60) of practices provided no accessible information regarding oral cancer screening and prevention on their websites. Only 12.2% (n=11) discussed all three factors of oral screening, symptoms and reducing risk factors. Screening as part of routine examination was most frequently mentioned at 27% (n=24), risk factors were discussed by 23% (n=21) of practices and symptoms to be aware of by 13% (n=12). DISCUSSION There is a lack of information available to patients on dental practice websites regarding oral cancer. To overcome lack of quality assurance on the internet, dentists can provide factual information via their dental practice websites. This could help with improving patient awareness and therefore aiding in early detection, improving patient outcomes.
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Affiliation(s)
- Roshni Patel
- Roshni Patel BDS (Hons), MFDS, RCS Edinburgh STR in Oral Surgery, Newcastle Dental Hospital, Newcastle, UK
- Sajid Sainuddin BDS, MDS (OMFS), MFDSRCS (Eng), MBBCh FRCS (Ed) Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Sajid Sainuddin
- Roshni Patel BDS (Hons), MFDS, RCS Edinburgh STR in Oral Surgery, Newcastle Dental Hospital, Newcastle, UK
- Sajid Sainuddin BDS, MDS (OMFS), MFDSRCS (Eng), MBBCh FRCS (Ed) Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Manchester Royal Infirmary, Manchester, UK
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Dang RR, Lin JAJ, Hung SY, Wei FC. Quality-of-Life Outcomes in Oral Cancer Patients Reconstructed With Double Free Flaps: A Preoperative and Postoperative Assessment. Ann Plast Surg 2024; 92:658-662. [PMID: 38718341 DOI: 10.1097/sap.0000000000003915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
PURPOSE This study aimed to evaluate quality of life (QOL) in patients with locally advanced oral cancer who underwent surgical resection followed by simultaneous double free flap reconstruction. METHODS Institutional database was reviewed from 2015 to 2021 and prospectively collected University of Washington Quality of Life data that were extracted for patients who met the inclusion criteria. Mean, composite, and best percentage scores were computed. Wilcoxon signed rank test was used to analyze differences between groups. RESULTS Thirteen patients completed the assessment, all of them being male with a mean follow-up of 2.2 ± 1.2 years. Most common double free flap combination was fibula osteoseptocutaneous flap and anterolateral thigh flap (n = 11). Improvement in pain ( P = 0.01) domain score with decline in speech ( P = 0.01) and taste ( P = 0.02) was noted along with an overall decline in QOL ( P = 0.001) after cancer diagnosis. A decrease in physical function was seen postoperatively. Chewing and saliva were the most cited postoperative patient-reported domain affecting QOL. CONCLUSIONS In double free flap reconstructed patients, in the postoperative phase, pain scores improved, whereas speech and taste scores declined. The overall health-related QOL declined compared with before cancer diagnosis.
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Affiliation(s)
| | - Jennifer An-Jou Lin
- From the Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shao-Yu Hung
- From the Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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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: 0] [Impact Index Per Article: 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: 0] [Impact Index Per Article: 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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Fanourakis G, Kyrodimos E, Papanikolaou V, Chrysovergis A, Kafiri G, Papanikolaou N, Verykokakis M, Tosios K, Vastardis H. APOBEC3B Is Co-Expressed with PKCα/NF-κB in Oral and Oropharyngeal Squamous Cell Carcinomas. Diagnostics (Basel) 2023; 13:diagnostics13030569. [PMID: 36766673 PMCID: PMC9914863 DOI: 10.3390/diagnostics13030569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
The enzymatic activity of APOBEC3B (A3B) has been implicated as a prime source of mutagenesis in head and neck squamous cell carcinoma (HNSCC). The expression of Protein Kinase C α (PKCα) and Nuclear Factor-κΒ p65 (NF-κΒ p65) has been linked to the activation of the classical and the non-canonical NF-κB signaling pathways, respectively, both of which have been shown to lead to the upregulation of A3B. Accordingly, the aim of the present study was to evaluate the expression of PKCα, NF-κΒ p65 and A3B in non-HPV related oral and oropharyngeal squamous cell carcinomas (SCC), by means of immunohistochemistry and in silico methods. PKCα was expressed in 29/36 (80%) cases of oral and oropharyngeal SCCs, with 25 (69%) cases showing a PKCα+/A3B+ phenotype and only 6/36 (17%) cases showing a PKCα-/A3B+ phenotype. Εxpression of NF-κB p65 was seen in 33/35 (94%) cases of oral and oropharyngeal SCCs, with 30/35 (86%) cases showing an NF-κB p65+/A3B+ phenotype and only 2/35 (6%) cases showing an NF-κB p65-/A3B+ phenotype. In addition, mRNA expression analysis, using the UALCAN database, revealed strong expression of all three genes. These findings indicate that the expression of A3B is associated with PKCα/NF-κB p65 expression and suggest a potential role for the PKC/NF-κB signaling pathway in the development of oral and oropharyngeal cancer.
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Affiliation(s)
- Galinos Fanourakis
- Department of Oral Biology, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece
- Correspondence:
| | - Efthymios Kyrodimos
- 1st ENT Department, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, 114 Vasilissis Sophias Ave., 11527 Athens, Greece
| | - Vasileios Papanikolaou
- 1st ENT Department, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, 114 Vasilissis Sophias Ave., 11527 Athens, Greece
| | - Aristeidis Chrysovergis
- 1st ENT Department, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, 114 Vasilissis Sophias Ave., 11527 Athens, Greece
| | - Georgia Kafiri
- Department of Pathology, Hippokration Hospital, 114 Vasilissis Sophias Ave., 11527 Athens, Greece
| | - Nikolaos Papanikolaou
- EnzyQuest PC, Science and Technology Park of Crete, 100 Nikolaou Plastira Str., Vassilika Vouton, 70013 Heraklion, Greece
| | - Mihalis Verykokakis
- Institute for Fundamental Biomedical Research, BSRC Alexander Fleming, 34 Fleming Str., 16672 Vari, Greece
| | - Konstantinos Tosios
- Department of Oral Pathology, Medicine and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece
| | - Heleni Vastardis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece
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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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Time-to-Treatment of Oral Cancer and Potentially Malignant Oral Disorders: Findings in Malaysian Public Healthcare. Dent J (Basel) 2022; 10:dj10110199. [PMID: 36354644 PMCID: PMC9689072 DOI: 10.3390/dj10110199] [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: 10/08/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to evaluate the time-to-treatment of oral cancer and potentially malignant oral disorders (PMOD) in a Malaysian public healthcare setting while exploring its contributing factors. It consists of (1) a cross-sectional patient survey to quantify time to seek care and barriers faced, and (2) a retrospective medical record abstraction to determine treatment and management intervals. Time intervals were aggregated and analyzed by their primary contributor—patient, professional, or healthcare system. The average total time-to-treatment of the 104 patients investigated was 167 days (SD = 158). This was predominantly contributed by the patient interval of 120 days (SD = 152). In total, 67.0% of patients delayed their visit to primary healthcare centers because they assumed the lesions were not dangerous or of concern. Additionally, there was a significant difference between patients ‘facing’ and ‘not facing’ difficulties to seek care, at 157 vs. 103 days (p = 0.028). System and professional delays were comparably shorter, at 33 days (SD = 20) and 10 days (SD = 15) respectively. Both demonstrated a significant difference between oral cancer and PMOD, at 43 vs. 29 days (p < 0.001) and 5 vs. 17 days (p < 0.001). The findings reiterate the need to reform current initiatives to better promote early lesion recognition by patients and implement strategies for the elimination of their access barriers.
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Affonso MVDG, Souza IG, de Rocha ES, Goloni-Bertollo EM, Gomes FDC, do Nascimento LS, de Melo-Neto JS. Association between Sociodemographic Factors, Coverage and Offer of Health Services with Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-Year Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13208. [PMID: 36293789 PMCID: PMC9603184 DOI: 10.3390/ijerph192013208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 06/16/2023]
Abstract
To investigate the association between sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil, between 2000 and 2019. This study had an ecological design. Standardized mortality rates were compared between age group, sex, and regions. Age-Period-Cohort analysis was applied. Oral health services variables were analyzed in correlation tests. Survival analysis included Kaplan-Meier estimators, log-rank tests, and Cox regression. The mortality rate increased with age and was higher in men. Southeast and south regions had the highest rates for men, and the northeast and southeast had it for women. Age-Period-Cohort analysis showed a slight increase in female deaths and an increasing trend in the annual percent change in mortality for men over age 55. In survival analysis, males, Black individuals and southern residents were more strongly associated with death. The correlation between oral health teams' coverage was high and negative, while the number of dental specialty centers and soft tissue biopsies had a high and positive correlation. Mortality and survival patterns were dependent on sex, age, geographic region and race/ethnicity. It was observed that preventive and diagnostic procedures were not being performed, which may be related to the increase in mortality.
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Affiliation(s)
| | - Igor Gonçalves Souza
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
| | - Emerson Souza de Rocha
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
| | | | - Fabiana de Campos Gomes
- Faculty of Medicine of São José do Rio Preto (FAMERP), Sao Jose do Rio Preto 15090-000, Brazil
| | | | - João Simão de Melo-Neto
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
- School of Physiotherapy and Occupational Therapy, Federal University of Pará (UFPA), Street Augusto Corrêa, 01, Belem 66075-110, Brazil
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Challenges in the Early Diagnosis of Oral Cancer, Evidence Gaps and Strategies for Improvement: A Scoping Review of Systematic Reviews. Cancers (Basel) 2022; 14:cancers14194967. [PMID: 36230890 PMCID: PMC9562013 DOI: 10.3390/cancers14194967] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Oral cancer presents a worldwide incidence of 377,713 new cases and 177,757 deaths per year (GLOBOCAN, IARC, WHO). Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of oral malignancies and has a 5-year mortality rate close to 50%. We aim to better understand, based on the evidence, and to discuss in depth, the reasons for the diagnostic delay of oral cancer by reviewing systematic reviews and meta-analyses. We also aim to, identify gaps in evidence, recommend future lines of research that should be implemented, and formulate strategies for improvement. Abstract Oral cancer is a growing problem, accounting for 377,713 worldwide new cases per year, and 177,757 deaths annually and representing a 5-year mortality rate close to 50%, which is a considerable mortality that has not decreased substantially in the last 40 years. The main cause of this high mortality is related to the diagnosis of a high percentage of oral cancers in advanced stages (stages III and IV) in which treatment is complex, mutilating or disabling, and ineffective. The essential cause of a cancer diagnosis at a late stage is the delay in diagnosis, therefore, the achievement of the objective of improving the prognosis of oral cancer involves reducing the delay in its diagnosis. The reasons for the delay in the diagnosis of oral cancer are complex and involve several actors and circumstances—patients, health care providers, and health services. In this paper, we present the results of a scoping review of systematic reviews on the diagnostic delay in oral cancer with the aim to better understand, based on the evidence, and discuss in depth, the reasons for this fact, and to identify evidence gaps and formulate strategies for improvement.
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Kanmodi KK, Salami AA, Nwafor JN, Olomo CA, Nnyanzi LA. Trend Analysis of Global Web Searches (2004–2022) on Oral Cancer and Its Major Risk Factors. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1756479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background Oral cancer is the 15th leading cause of mortality globally. The Internet is an online source of information pertaining to oral cancer and its major risk factors. This study aims to analyze the trend of global online interest on oral cancer and its major risk factors through an analysis of web searches of oral cancer.
Materials and Methods This study analyzed the web searches conducted, from 2004 to January 2022, on oral cancer and its major risk factors (tobacco use, harmful alcohol use, and human papillomavirus [HPV] infection) using data obtained from Google Trends.
Results Within the time frame under study, oral cancer had multiple peak search periods, with the highest relative search volume index (SVI) for a period being 1; the peak search period for alcohol was March 2020 (SVI = 100); the peak search periods for tobacco were March to April 2004 (SVI = 17); and the peak search period of HPV was April 2004 (SVI = 1). Globally, alcohol was the most common searched term among these four terms (oral cancer, alcohol, tobacco, and HPV) except in Turkey where tobacco was the most common (55%) searched term. The top 25 search queries for oral cancer, HPV, tobacco, and alcohol had SVI ranges of 22 to 100, 12 to 100, 28 to 100, and 18 to 100, respectively. From these search queries, it was observed that people have interest in oral cancer symptomatology, and the adverse effects of tobacco, alcohol, and HPV.
Conclusion This study revealed an overall decline in the online interest on oral cancer and its major risk factors on a global scale.
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Affiliation(s)
- Kehinde Kazeem Kanmodi
- Oral Health Working Group (Health Students Research Network), School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria
| | - Afeez Abolarinwa Salami
- Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Jacob Njideka Nwafor
- Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria
- Department of Medicine, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Charles Adetokunbo Olomo
- Campaign for Head and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative Inc, Ibadan, Nigeria
- Department of Oral Pathology/Oral Medicine, University College Hospital, Ibadan, Nigeria
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lawrence Achilles Nnyanzi
- Oral Health Working Group (Health Students Research Network), School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
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Motlokwa PK, Tsima BM, Martei YM, Ralefala T, Galebole F, Stephens-Shields AJ, Grover S, Gross R. Disparities in Oral Cancer Stage at Presentation in a High HIV Prevalence Setting In Sub-Saharan Africa. JCO Glob Oncol 2022; 8:e2100439. [PMID: 35981280 PMCID: PMC9812499 DOI: 10.1200/go.21.00439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Oral cancer is the sixth most common cancer worldwide and is the seventh most common in Botswana. Lack of improvement in oral cancer survival despite the availability of multiple treatment options may be due to the high prevalence of advanced stage at presentation. We identified risk factors for presenting with oral cancer at an advanced stage to facilitate interventions to reduce mortality from oral cancers. METHODS A retrospective cohort analysis was conducted among individuals with biopsy-confirmed oral cancer at Princess Marina Hospital in Gaborone, Botswana, between 2010 and 2020. Data collected included age at diagnosis, sex, place of residence, HIV status, oral cancer stage, and oral subsite. Multivariable analyses were controlled for age, sex, district of residence, and oral subsite. RESULTS Of the 218 records analyzed, 79% were male, 58% were HIV-positive, the median age was 56 years (interquartile range: 47-63), and 67% presented with advanced-stage disease. Cancers from hidden oral sites were more likely to present at an advanced stage with an adjusted odds ratio (OR) of 2.98 (95% CI, 1.29 to 6.89; P = .01). Residence in socioeconomically disadvantaged districts was associated with higher likelihood (OR, 2.36; 95% CI, 1.28 to 4.39; P = .01) of advanced stage presentation compared with other districts. HIV infection was not associated with risk of advanced lesion presentation (OR, 1; 95% CI, 0.61 to 1.61; P = .97). CONCLUSION Hidden oral cancer sites and residence in districts with limited access to care were risk factors for advanced oral cancer at the time of diagnosis in Botswana. These findings support a need to increase efforts to improve access to care and increase oral cancer awareness to decrease the burden of advanced oral cancer.
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Affiliation(s)
- Precious K. Motlokwa
- University of Pennsylvania, Philadelphia, PA,Princess Marina Hospital, Gaborone, Botswana,Precious K. Motlokwa, BchD, MSCE, Princess Marina Hospital, PO Box 71855881, Virtal post box, Squaremart, Gaborone 00267, Botswana; e-mail:
| | - Billy M. Tsima
- University of Pennsylvania, Philadelphia, PA,University of Botswana, Gaborone, Botswana
| | - Yehoda M. Martei
- University of Pennsylvania, Philadelphia, PA,University of Botswana, Gaborone, Botswana
| | | | | | | | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA,University of Botswana, Gaborone, Botswana
| | - Robert Gross
- University of Pennsylvania, Philadelphia, PA,University of Botswana, Gaborone, Botswana
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Kim JS, Kim BG, Hwang SH. Efficacy of Artificial Intelligence-Assisted Discrimination of Oral Cancerous Lesions from Normal Mucosa Based on the Oral Mucosal Image: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14143499. [PMID: 35884560 PMCID: PMC9320189 DOI: 10.3390/cancers14143499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Early detection of oral cancer is important to increase the survival rate and reduce morbidity. For the past few years, the early detection of oral cancer using artificial intelligence (AI) technology based on autofluorescence imaging, photographic imaging, and optical coherence tomography imaging has been an important research area. In this study, diagnostic values including sensitivity and specificity data were comprehensively confirmed in various studies that performed AI analysis of images. The diagnostic sensitivity of AI-assisted screening was 0.92. In subgroup analysis, there was no statistically significant difference in the diagnostic rate according to each image tool. AI shows good diagnostic performance with high sensitivity for oral cancer. Image analysis using AI is expected to be used as a clinical tool for early detection and evaluation of treatment efficacy for oral cancer. Abstract The accuracy of artificial intelligence (AI)-assisted discrimination of oral cancerous lesions from normal mucosa based on mucosal images was evaluated. Two authors independently reviewed the database until June 2022. Oral mucosal disorder, as recorded by photographic images, autofluorescence, and optical coherence tomography (OCT), was compared with the reference results by histology findings. True-positive, true-negative, false-positive, and false-negative data were extracted. Seven studies were included for discriminating oral cancerous lesions from normal mucosa. The diagnostic odds ratio (DOR) of AI-assisted screening was 121.66 (95% confidence interval [CI], 29.60; 500.05). Twelve studies were included for discriminating all oral precancerous lesions from normal mucosa. The DOR of screening was 63.02 (95% CI, 40.32; 98.49). Subgroup analysis showed that OCT was more diagnostically accurate (324.33 vs. 66.81 and 27.63) and more negatively predictive (0.94 vs. 0.93 and 0.84) than photographic images and autofluorescence on the screening for all oral precancerous lesions from normal mucosa. Automated detection of oral cancerous lesions by AI would be a rapid, non-invasive diagnostic tool that could provide immediate results on the diagnostic work-up of oral cancer. This method has the potential to be used as a clinical tool for the early diagnosis of pathological lesions.
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Affiliation(s)
- Ji-Sun Kim
- Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, Korea; (J.-S.K.); (B.G.K.)
| | - Byung Guk Kim
- Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, Korea; (J.-S.K.); (B.G.K.)
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Bucheon 14647, Korea
- Correspondence: ; Tel.: +82-32-340-7044
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13
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Khadka S, Shrestha O, Koirala G, Acharya U, Adhikari G. Health seeking behavior and self-medication practice among undergraduate medical students of a teaching hospital: A cross-sectional study. Ann Med Surg (Lond) 2022; 78:103776. [PMID: 35600203 PMCID: PMC9117532 DOI: 10.1016/j.amsu.2022.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/08/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Health seeking behavior is any activity undertaken by individuals who find themselves with a health-related problem with the aim of seeking an appropriate remedy. It includes decision making that is not homogenous among all as it is determined by different demographic factors. Self-medication and alternative medicine are also choices made by an individual that comes under health care seeking behavior. This study aimed to put light on the health seeking behavior of undergraduate medical students and to assess how they deal with their illnesses, including the practise of self-medication. Methods In this web-based cross-sectional study, conducted among undergraduate medical students, a total of 210 students were selected through a systematic sampling method. The data were analyzed using SPSS version 20. Frequency was calculated for all the variables. The Mann-Whitney U or Kruskal-Wallis H test was used to see if any difference existed in the response. A significant association was declared at a p-value less than 0.05. Results Response from 208 respondents was received and among those 88.9% of the respondents were aware of physical, mental and social aspects of health; about 40.8% of the respondents sought help only when their symptoms got worse; while 27.4% of them sought the help of alternative medicine. Around 74.2% of the respondents took medicines without a proper prescription and the commonly self-medicated drug group was NSAIDs. Conclusions The knowledge of medical science has not satisfactorily ensured better health-seeking behavior and good practices. Also, there is high prevalence of self-medication practice among medical students.
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Affiliation(s)
- Sitaram Khadka
- Department of Pharmacy, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal
| | - Oshan Shrestha
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal
| | - Gaurab Koirala
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal
| | - Utshab Acharya
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal
| | - Gopal Adhikari
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, 44600, Nepal
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14
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Ahuja NA, Kedia SK, Ward KD, Pichon LC, Chen W, Dillon PJ, Navaparia H. Effectiveness of Interventions to Improve Oral Cancer Knowledge: a Systematic Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:479-498. [PMID: 33506408 DOI: 10.1007/s13187-021-01963-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Oral cancer is prone to late-stage diagnosis, and subsequent low five-year survival rates. A small number of interventions or campaigns designed to enhance knowledge of risk factors and symptoms associated with oral cancer have been attempted in the UK, US, and some other countries. The purpose of this systematic review is to assess the effectiveness of interventions designed to improve oral cancer knowledge. We searched five databases to identify randomized controlled trials (RCTs) and non-randomized/quasi-experimental (NR/QE) studies targeting the general population or high-risk groups (tobacco users or alcohol consumers), aged ≥15 years, and reporting the outcomes of individual and/or community level interventions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. Adhering to PRISMA guidelines, 27 (eight RCTs and 19 NR/QE studies) of the 551 studies identified from the five databases met the inclusion criteria. All RCTs and nine NR/QE studies used either printed materials, health education sessions, multimedia aids, or some combinations of these tools. The other ten NR/QE studies were community-based and used mass media campaigns to increase oral cancer awareness. Overall, the majority of studies significantly improved oral cancer knowledge; however, heterogeneity in study design and variation in measurement tools made it difficult to compare outcomes. Findings suggest that individual and/or community level interventions are generally effective in increasing knowledge of oral cancer risk factors, signs and symptoms, and/or its early diagnosis and prevention strategies among the general population or high-risk groups. However, the long-term benefits of these interventions are understudied.
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Affiliation(s)
- Nikhil A Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA.
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Weiyu Chen
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Hitesh Navaparia
- Department of Oral and Maxillofacial Surgery, Vaidik Dental College and Research Center, Daman, India
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15
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Morelatto RA, Moretti C, Bolesina NJ, Zapata MJ, Liandro MF, Warnakulasuriya S, de Blanc SL. Reexamination of delays in diagnosis of oral cancer following an intervention program in Cordoba, Argentina. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:301-307. [PMID: 34996734 DOI: 10.1016/j.oooo.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We compare the results of delay in oral cancer diagnosis before and after a campaign directed toward dentists and raising awareness of the population to achieve early diagnosis of oral cancer in Córdoba, Argentina. The campaign included training dentists in diagnostic skills and a public awareness program through media and networks. STUDY DESIGN Clinical records (period 1: before intervention program, n = 70; period 2: after intervention program, n = 60) of patients presenting with oral squamous cell carcinoma treated in 2 referral centers were analyzed. Records included first symptoms, first consultation with a health professional, and the time when treatment was formulated. RESULTS Oral cancer diagnosis at early stages increased from 27% (period 1) to 40% (period 2). Biopsy at first consultation was indicated in 6% of patients in period 1 and in 23.3% in period 2 (odds ratio = 4.68; 95% confidence interval, 1.87-11.73; P < .05). Professional delay at early stage decreased from 72% in period 1 to 36.8% in period 2. During period 1, for initial stage cancer, the average patient and professional delays were 2.7 and 2.9 months, respectively (P = .06); in period 2, patient delay was 2.67 months and professional delay was 1.34 months (P = .005). CONCLUSION The intervention program helped to improve early-stage diagnosis from 27% to 40% by reducing professional delays.
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Affiliation(s)
- Rosana Andrea Morelatto
- Associate Professor, Department of Oral Pathology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Caterina Moretti
- Department of Oral Pathology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Nicolás Jorge Bolesina
- Assistant Professor, Department of Oral Pathology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marcelo Javier Zapata
- Assistant Professor, Department of Oral Pathology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - María Fernanda Liandro
- Assistant Professor, Department of Oral Pathology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, UK; WHO Collaborating Centre for Oral Cancer, London, UK
| | - Silvia López de Blanc
- Head Professor, Department of Oral Pathology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba, Argentina
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Xu Y, Deng X, Sun Y, Wang X, Xiao Y, Li Y, Chen Q, Jiang L. Optical Imaging in the Diagnosis of OPMDs Malignant Transformation. J Dent Res 2022; 101:749-758. [PMID: 35114846 DOI: 10.1177/00220345211072477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Oral potentially malignant disorders (OPMDs) are a heterogeneous group of oral lesions with a variable risk of malignant transformation to oral squamous cell carcinoma. The current OPMDs malignant transformation screening depends on conventional oral examination (COE) and is confirmed by biopsy and histologic examination. However, early malignant lesions with subtle mucosal changes are easily unnoticed by COE based on visual inspection and palpation. Optical techniques have been used to determine the biological structure, composition, and function of cells and tissues noninvasively by analyzing the changes in their optical properties. The oral epithelium and stroma undergo persistent structural, functional, and biochemical alterations during malignant transformation, leading to variations in optical tissue properties; optical techniques are thus powerful tools for detecting OPMDs malignant transformation. The optical imaging methods already used to detect OPMDs malignant transformation in vivo include autofluorescence imaging, narrowband imaging, confocal reflectance microscopy, and optical coherence tomography. They exhibit advantages over COE in detecting biochemical or morphologic changes at the molecular or cellular level in vivo; however, limitations also exist. This article comprehensively reviews the various real-time in vivo optical imaging methods used in the adjunctive diagnosis of OPMDs malignant transformation. We focus on the principles of these techniques, review their clinical application, and compare and summarize their advantages and disadvantages. Finally, we conclude with a discussion of current challenges and future directions of this field.
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Affiliation(s)
- Y Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Xiao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Q Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - L Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Imaduddin M, Sultania M, Vigneshwaran B, Muduly DK, Kar M. Psychosocial Factors in an Oral Cancer Survivor Leading to Delay in Seeking Help. Oral Oncol 2021; 124:105438. [PMID: 34238664 DOI: 10.1016/j.oraloncology.2021.105438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - B Vigneshwaran
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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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: 1] [Impact Index Per Article: 0.3] [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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20
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Deutsch FT, Khoury SJ, Sunwoo JB, Elliott MS, Tran NT. Application of salivary noncoding microRNAs for the diagnosis of oral cancers. Head Neck 2020; 42:3072-3083. [PMID: 32686879 DOI: 10.1002/hed.26348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/16/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
Oral cancer is on the rise globally and survival rates, despite improvements in clinical care, have not significantly improved. Early detection followed by immediate intervention is key to improving patient outcomes. The use of biomarkers has changed the diagnostic landscape for many cancers. For oral cancers, visual inspection followed by a tissue biopsy is standard practice. The discovery of microRNAs as potential biomarkers has attracted clinical interest but several challenges remain. These microRNAs can be found in bodily fluids such as blood and saliva which have been investigated as potential sources of biomarker discovery. As oral cancer is localized within the oral cavity, saliva may contain clinically relevant molecular markers for disease detection. Our review provides an outline of the current advances for the application of salivary microRNAs in oral cancer. We also provide a technical guide for the processing of salivary RNAs to ensure accurate clinical measurement and validation.
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Affiliation(s)
- Fiona T Deutsch
- School Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Samantha J Khoury
- Office of the Deputy Vice Chancellor Innovation and Enterprise, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - John B Sunwoo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nham T Tran
- School Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, New South Wales, Australia.,The Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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21
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Gobbo M, Ottaviani G, Rupel K, Zoi V, Di Lenarda R, Biasotto M, Poropat A. Self-perception and physician's awareness on early detection of tongue cancer: experience of the Oral Medicine Unit of Trieste. ACTA ACUST UNITED AC 2020; 69:95-99. [PMID: 32489088 DOI: 10.23736/s0026-4970.19.04212-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this retrospective study was to characterize the outpatient oral medicine referral pattern for tongue lesions with particular emphasis on cancer. METHODS Records of patients referred to the Oral Medicine department for any tongue lesions needing biopsy between 2009 and 2016 were retrospectively analyzed. All cases diagnosed as tongue cancer were screened for medical history, referral pattern, treatment/diagnosis/follow-up. RESULTS Among 266 patients, 39 were diagnosed with cancer, 43.6% were smokers and 10.3% alcohol consumers, 38.5% felt pain, 53.8% noticed the lesion or felt its presence, 46.2% were referred from another specialist. For people aware or informed of the lesion. the mean time waited before consultation was 7.9 months. In 53.8% of cases, narrow-band-imaging guided the biopsy. In 29 patients, biopsy was performed the day of the visit. Patients were referred from dentists (42.1%), Primary-care-Physician (10.5%), Emergency-Dental-Unit (7.9%), Radiotherapist (7.9%), Otolaryngologist (7.9%), Dermatologist (26%), infectious diseases unit (2.6%), auto-referral in 18.4%. Lesion was defined by referring doctor as "suspicious" (13.1%), white (10.5%), vegentans (5.3%), Lichen-like (5.3%), ulcerative (2.6%), Tumoral (26.3%), Bollous (2.6%). An unweighted Kappa Value of 0.024, assessed low concordance between referral diagnosis and diagnosis performed by the Oral Medicine specialist before the biopsy. CONCLUSIONS Patients are not always aware of the risk of oral cancer. Accurate information should be provided to patients as well as to specialists rather than just dentists as regard as the risk factors for oral cancer, the importance of referral to specialized departments and timing. The use of new technologies should be widespread.
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Affiliation(s)
- Margherita Gobbo
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy -
| | - Giulia Ottaviani
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Katia Rupel
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Valentina Zoi
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Di Lenarda
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Biasotto
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Augusto Poropat
- Unit of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Ganesan S, Sivagnanganesan S, Thulasingam M, Karunanithi G, R K, Ravichandran S, Saxena SK, Ramasamy K. Diagnostic delay for head and neck cancer in South India: A Mixed-methods Study. Asian Pac J Cancer Prev 2020; 21:1673-1678. [PMID: 32592363 PMCID: PMC7568875 DOI: 10.31557/apjcp.2020.21.6.1673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Early diagnosis is an important aspect of quality of cancer care.Analysis of the diagnostic delays and the reasons for delay helps to plan strategies to improve cancer care. Objectives: To determine the primary, secondary, and total diagnostic delay of patients diagnosed with head and neck cancer and to explore the reasons for the delay from the patient perspective. Methods: Explanatory mixed method design was used. Two hundred persons with a confirmed diagnosis of head and neck cancer attending the ENT (ear, nose, throat) cancer clinic in a teaching hospital before the initiation of treatment were included in the study. The median delay and the association of the delay with the various factors were analyzed. Sixteen one-to-one interviews of patients were done to identify the reasons for the delays from the patient perspective. Results: Median primary, secondary, and total diagnostic delays were 30 days, 30 days, and 73 days, respectively. Statistically, primary delay was found significantly longer among ever users of smokeless tobacco and significantly longer secondary delay was found among those with age less than 60 years. The reasons for the delay were grouped in the categories (i) Symptom appraisal delay due to low perceived seriousness and (ii) health-seeking behavior delay. Conclusions: The diagnostic delay was considerable. Measures to enhance symptom appraisal by improving health literacy, opportunistic screening, and strengthening the referral system would decrease diagnostic delay.
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Affiliation(s)
- Sivaraman Ganesan
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sivanesan Sivagnanganesan
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mahalakshmy Thulasingam
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gunaseelan Karunanithi
- Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kalaiarasi R
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Surya Ravichandran
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sunil Kumar Saxena
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Karthikeyan Ramasamy
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Zhang Q, Feng S, Wong IOL, Ip DKM, Cowling BJ, Lau EHY. A population-based study on healthcare-seeking behaviour of persons with symptoms of respiratory and gastrointestinal-related infections in Hong Kong. BMC Public Health 2020; 20:402. [PMID: 32220247 PMCID: PMC7099823 DOI: 10.1186/s12889-020-08555-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Abstract
Background Studies on healthcare-seeking behaviour usually adopted a patient care perspective, or restricted to specific disease conditions. However, pre-diagnosis symptoms may be more relevant to healthcare-seeking behaviour from a patient perspective. We described healthcare-seeking behaviours by specific symptoms related to respiratory and gastrointestinal-related infections. Methods We conducted a longitudinal population-based telephone survey in Hong Kong. We collected data on healthcare-seeking behaviour specific to symptoms of respiratory and gastrointestinal-related infections and also associated demographic factors. We performed descriptive analyses and estimated the proportion of participants who sought medical consultation, types of services utilized and duration from symptom onset to healthcare seeking, by different age groups. Post-stratification was used to compensate non-response and multiple imputation to handle missing and right-censored data. Results We recruited 2564 participants who reported a total of 4370 illness episodes and 7914 symptoms. Fatigue was the most frequently reported symptom, followed by headache and runny nose, with 30-day incidence rate of 9.1, 7.7, and 7.7% respectively. 78% of the participants who had fever sought medical consultation, followed by those with rash (60%) and shortness of breath (58%). Older adults (aged ≥55y) who had symptoms including fever, sore throat, and headache had a significantly higher consultation rate comparing to the other age groups. The 30-day incidence rates of influenza-like illness (ILI) and acute respiratory illness (ARI) were 0.8 and 7.2% respectively, and the consultation rates among these participants were 91 and 64%. Private general practitioner clinics was the main service utilized by participants for most of the symptoms considered, especially those related to acute illness such as fever, diarrhoea and vomiting. Chinese medicine clinics were mostly likely to be visited by participants with low back pain, myalgia and fatigue. Among participants who have sought medical services, most were within 3 days of symptom onset. Conclusions Healthcare-seeking behaviour were different by symptoms and age. Characterization of these patterns provides crucial parameters for estimating the full burden of common infectious diseases from facility-based surveillance system, for planning and allocation of healthcare resources.
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Affiliation(s)
- Qiqi Zhang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Irene O L Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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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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Zhang X, Liu D, Dong H, Li Y, Zhang Y, Wang X, Zhang B, Bian L. Factors associated with delay in presentation among patients for oral cancer. J Comp Eff Res 2019; 8:1003-1071. [PMID: 31290337 DOI: 10.2217/cer-2019-0067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to determine factors that influence delay in presentation among oral cancer patients. Materials & methods: A cross-sectional study with 128 Oral cancer patients receiving treatment from the Hospital of Stomatology, at Jilin University, in China, was conducted. Results: A total of 78 patients delayed seeking treatment for more than 3 weeks after noticing symptoms of oral anomaly. Patients who were male, farmers (Odds ratio [OR] = 2.617; 95% CI: 1.90–3.64), or currently smoking (OR = 4.651; 95% CI: 1.21–9.46), were more likely to delay. Patients alerted to the problem at a physical exam had much lower risk of delay than patients who discovered the disease independently (OR = 0.029; 95% CI: 0.01–0.30). Higher coping style scores (OR = 0.747; 95% CI: 0.47–1.18) and oral cancer knowledge scores (OR = 0.886; 95% CI: 0.60–2.01) were significantly correlated with shorter delays. Conclusion: Delay in presentation may be achieved through regular oral health screening and improved public education about factors influencing delay.
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Affiliation(s)
- Xinyan Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Dongling Liu
- School of Nursing, Jilin University, Changchun, Jilin, China
- Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Hongmei Dong
- Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yuxiang Li
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ye Zhang
- Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Xiuli Wang
- Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Bingyan Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Lijuan Bian
- Department of Cataract, Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
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Keat RM, Makwana M, Powell HE, Poveda A, Albuquerque R. Assessing confidence in the understanding and management of oral cancer among medical and dental undergraduates at a UK university. Br Dent J 2019; 227:153-157. [DOI: 10.1038/s41415-019-0523-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Allgar VL, Oliver SE, Chen H, Oviasu O, Johnson MJ, Macleod U. Time intervals from first symptom to diagnosis for head and neck cancers: An analysis of linked patient reports and medical records from the UK. Cancer Epidemiol 2019; 59:37-45. [DOI: 10.1016/j.canep.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
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Gigliotti J, Madathil S, Makhoul N. Delays in oral cavity cancer. Int J Oral Maxillofac Surg 2019; 48:1131-1137. [PMID: 30878273 DOI: 10.1016/j.ijom.2019.02.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/23/2019] [Indexed: 01/27/2023]
Abstract
While the prognosis for early-stage oral cavity cancer is relatively good; the majority of patients are still diagnosed with advanced-stage disease on presentation with an associated poorer prognosis. The aims of this review are to summarize our current understanding of delays in oral cavity cancer and their impact on stage at diagnosis and survival. The delays pathway can be subdivided into three components: patient, professional, and treatment delays. Patient delay represents the longest interval in the delays pathway usually lasting between 2 and 5 months and being most influenced by cognitive and psychosocial factors. Professional and treatment delays are shorter in most studies, but highly variable depending on the respective healthcare system. Most studies indicate that advanced stage at diagnosis, primary treatment with radiotherapy, treatment at an academic center, and transitions in care are associated with an increased treatment delay. Based on our current understanding, a delay between definitive diagnosis and treatment of 4-6 weeks seems acceptable from an oncologic perspective. Further studies are needed to better define what a 'safe' waiting time is and to understand the psychological impact of delays for patients.
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Affiliation(s)
- J Gigliotti
- Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Madathil
- Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - N Makhoul
- Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, 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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Azhar N, Doss JG. Health-Seeking Behaviour and Delayed Presentation of Oral Cancer Patients in a Developing Country: A Qualitative Study based on the Self-Regulatory Model. Asian Pac J Cancer Prev 2018; 19:2935-2941. [PMID: 30362327 PMCID: PMC6291039 DOI: 10.22034/apjcp.2018.19.10.2935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
Background: The aim of this study was to explore reasons for delayed health-seeking for late stage oral cancer patients. Methods: Semi-structured in-depth interviews were conducted with 35 oral cancer patients with TNM stage III to IV disease, who were treated at six tertiary regional centres managing oral cancer throughout Malaysia. Interviews were audio-recorded, transcribed verbatim, coded using NVivo (version 10.0) qualitative software and analysed using framework analysis. Results: Participants interpreted their early symptoms as a minor condition and did not consider it as requiring immediate attention. Four types of coping strategies causing delayed help-seeking emerged: 1) self-remedy 2) self-medication 3) seeking traditional healers and 4) consulting general medical practitioners (GPs) instead of dentists. Socio-economic factors, cultural beliefs and religious practices have some influence on diagnostic delay. Conclusion: Low levels of public knowledge and awareness regarding early signs and symptoms of oral cancer as well as GPs’ misdiagnosis of early lesions results in delayed diagnosis.
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Affiliation(s)
- Nurizyani Azhar
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
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Adoga AA, Kokong DD, Ma'an ND, Mugu JG, Mgbachi CJ, Dauda AM. The predictive factors of primary head and neck cancer stage at presentation and survival in a developing nation's tertiary hospital. SAGE Open Med 2018; 6:2050312118792416. [PMID: 30140440 PMCID: PMC6096671 DOI: 10.1177/2050312118792416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/09/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Stage of head and neck cancers at presentation is a strong determinant of
outcomes. Objective: To evaluate predictors of stage of head and neck cancers at presentation and
survival in a Nigerian tertiary hospital. Patients and methods: Health records that met the inclusion criteria for head and neck cancers were
retrieved using the International Classification of Diseases, 10th revision
and analyzed with associations between variables modeled using logistic
regression analysis. Results: From a record of 487 head and neck neoplasms, 129 (26.5%) were malignant of
which 122 health records met the criteria for analysis consisting of 83
(68.0%) males and 39 (32.0%) females aged 13–85 years (mean = 51 years;
standard deviation = ±16 years). Alcohol (odds ratio = 1.99; 95% confidence
interval = 1.08–3.69; p = 0.02) and tobacco exposure (odds ratio = 3.07; 95%
confidence interval = 1.32–7.16; p = 0.01) were associated with increased
odds for advanced tumor stage at presentation. Stage IV cancer (hazard
ratio = 1.44; 95% confidence interval = 1.80–2.59), alcohol (hazard
ratio = 2.19; 95% confidence interval = 1.18–4.10) and tobacco use (hazard
ratio = 3.40; 95% confidence interval = 1.22–8.74) were associated with
increased hazards for death. Conclusion: Alcohol, tobacco use and smoke from cooking wood are predictive factors for
advanced HNC stage at presentation. Stage IV cancer, alcohol and tobacco use
were associated with an increased hazard for death.
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Affiliation(s)
- Adeyi A Adoga
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Daniel D Kokong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Nuhu D Ma'an
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Joyce G Mugu
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Chukwunonso J Mgbachi
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences, Jos University Teaching Hospital/University of Jos, Jos, Nigeria
| | - Ayuba M Dauda
- Department of Pathology, Faculty of Medical Sciences, University of Jos, Jos, Nigeria
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Hassona Y, Sawair F, Matarweh D, Abdalhamid A, Thweib D, Scully C. Oral Cancer Early Detection: What Do Patients Need To Know? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:865-869. [PMID: 28220285 DOI: 10.1007/s13187-017-1191-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of the present study was to examine the educational needs of patients regarding early detection of oral cancer. A total of 790 patients without cancer were interviewed and shown a set of validated clinical images of various oral lesions including early oral cancer. Participants were asked about their perception of cancer and the action that they would take if they notice a similar lesion. Lower risk lesions (e.g., lumps) were more likely to be perceived as cancer (52.4%), while higher risk lesions (e.g., red patches) were least likely to be perceived as cancer (8.8%). The perceived appearance of the lesions was correlated with patients' perceived need for medical advice. Higher risk lesions were less likely to make patients feel the need to seek professional advice. High-risk patients were less aware about oral cancer appearance and were less likely to take action if they notice an oral lesion. Patients are not aware of the various presentations of early oral cancers, especially higher risk lesions. Patients need to know more about the clinical appearance of early oral cancer. The use of representative clinical images of early oral cancer and educational videos on self-inspection of oral mucosa is important.
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Affiliation(s)
- Yazan Hassona
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Po-Box: 11942, Amman, Jordan.
| | - F Sawair
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Po-Box: 11942, Amman, Jordan
| | - D Matarweh
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Po-Box: 11942, Amman, Jordan
| | - A Abdalhamid
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Po-Box: 11942, Amman, Jordan
| | - D Thweib
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Po-Box: 11942, Amman, Jordan
| | - C Scully
- University College London, London, UK
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Shimpi N, Jethwani M, Bharatkumar A, Chyou PH, Glurich I, Acharya A. Patient awareness/knowledge towards oral cancer: a cross-sectional survey. BMC Oral Health 2018; 18:86. [PMID: 29764414 PMCID: PMC5952627 DOI: 10.1186/s12903-018-0539-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/26/2018] [Indexed: 11/30/2022] Open
Abstract
Background Oral cancer (OC) is associated with multiple risk factors and high mortality rates and substantially contributes to the global cancer burden despite being highly preventable. This cross-sectional study sought to assess current knowledge, awareness, and behaviors of patients in rural communities surrounding OC risk. Methods An anonymous 21-question survey was distributed to patients in waiting rooms of a large integrated medical-dental health system serving north-central Wisconsin. Survey results were summarized via descriptive statistics. Odds ratios surrounding health literacy on OC risk factors were obtained using unconditional univariate logistic regression analysis. Results Of 504 dental and 306 medical patients completing the survey, 62.2% were female, Caucasian/White (92%) with 41% having a ≤ high school diploma/equivalent. Current smoker/smokeless tobacco use was reported by 34%, while 39% reported former tobacco exposure. Alcohol use was reported by 54% of respondents at the following frequencies: < once/week, (35%); 1–2 times/week, (16%); 3–4 times/week, (6%); 5–6 times/week, (2%); and daily, (23%). Knowledge about tobacco and alcohol use and increased OC risk was reported by 94 and 40%, respectively. About 50% reported knowledgeability regarding cancer-associated symptomology. Tobacco cessation was reported by 20% of responders. Receipt of education on OC from healthcare providers and human papilloma virus links to OC causation was reported by 38 and 21%, respectively. Conclusion Patients who smoked > 20+ cigarettes per day were more knowledgeable about tobacco and OC risk compared to non-smokers and those who smoked ≤ 19 cigarettes/day (p = 0.0647). Patients who were alcohol consumers exhibited higher knowledgeability surrounding increased OC risk with alcohol and tobacco exposures compared to alcohol abstainers (p = 0.06). We concluded that patients recognized links between tobacco and OC risk but demonstrated lower knowledge of other causal factors. Strategic patient education by providers could increase awareness of OC risk. Electronic supplementary material The online version of this article (10.1186/s12903-018-0539-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neel Shimpi
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, 54449, WI, United States of America
| | - Monica Jethwani
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, 54449, WI, United States of America.,Family Health Center of Marshfield Inc., 1307 N St Joseph Ave, Marshfield, 54449, WI, United States of America
| | - Aditi Bharatkumar
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, 54449, WI, United States of America.,Family Health Center of Marshfield Inc., 1307 N St Joseph Ave, Marshfield, 54449, WI, United States of America
| | - Po-Huang Chyou
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, 54449, WI, United States of America
| | - Ingrid Glurich
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, 54449, WI, United States of America
| | - Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, 54449, WI, United States of America. .,Family Health Center of Marshfield Inc., 1307 N St Joseph Ave, Marshfield, 54449, WI, United States of America. .,Office of Research Computing and Analytics, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, 54449, WI, United States of America.
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Exploring determinants of care-seeking behaviour of oral cancer patients in India: A qualitative content analysis. Cancer Epidemiol 2018; 53:141-148. [DOI: 10.1016/j.canep.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/16/2018] [Accepted: 01/27/2018] [Indexed: 11/22/2022]
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Joseph BK, Ali MA, Sundaram DB. Awareness of Mouth Cancer Among Adult Dental Patients Attending the Kuwait University Dental School Clinic. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:340-345. [PMID: 27631717 DOI: 10.1007/s13187-016-1110-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In Kuwait, the age-standardized incidence rate (per 100,000) for oral cancer is 1.5 and the mortality rate is 0.4. Early detection of oral cancer combined with appropriate treatment greatly improves the chances of cure and the quality of life. However, little is known about patient awareness of this disease and the ability to identify early signs, particularly among high-risk groups. Hence, the aim of this study is to assess dental patients' awareness and knowledge of mouth cancer and beliefs and perceptions about risk factors. A self-administered questionnaire was used to collect information from a convenience sample of outpatients attending the dental admission clinic. The questionnaire included questions to ascertain information on socio-demographic characteristics, knowledge of risk factors, and signs of oral cancer as well as sources of information regarding the same. Data were analyzed using the Statistical Package for the Social Sciences for Windows 19.0. A total of 160 questionnaires were distributed out of which 136 completed questionnaires were returned and used for the study. The mean knowledge score for oral cancer risk factors was found to be 5.2 ± 2.7 out of ten while that of signs and symptoms was 3.4 ± 2.7 out of eight. When the knowledge of risk factors of oral cancer was taken into consideration along with variables, significant difference was seen only in sex with women having better knowledge (p = 0.03). Knowledge about signs and symptoms of oral cancer revealed a highly significant difference with the level of education (p = 0.03). Family, friends, and colleagues were mentioned as the main source of information regarding oral cancer. Our findings suggest that knowledge regarding oral cancer risk factors, signs, and symptoms was found to be lacking among the dental patients which emphasizes the need for patient education at the dental centers as well as public awareness programs.
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Affiliation(s)
- Bobby K Joseph
- Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University, P.O. Box: 24923, 13110, Safat, Kuwait.
| | - Mohammad A Ali
- Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University, P.O. Box: 24923, 13110, Safat, Kuwait
| | - Devipriya B Sundaram
- Department of Diagnostic Sciences, Faculty of Dentistry, Kuwait University, P.O. Box: 24923, 13110, Safat, Kuwait
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Leuci S, Amato M, Calabria E, Spagnuolo G, Masucci M, Davide MM. Screening Projects for Oral Carcinoma in Relation to Health Education and Patients' Compliance: Study on 600 Participants. J Int Soc Prev Community Dent 2017; 7:S163-S169. [PMID: 29285472 PMCID: PMC5730979 DOI: 10.4103/jispcd.jispcd_370_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022] Open
Abstract
Aims and Objectives: The lack of information among the population regarding the existence of oral squamous cell carcinoma (OSCC) and the lack of attention and expertise in examining the oral cavity of dentists and clinicians still remain very worrying and could explain the high incidence of OSCC. The aim of this study is to evaluate the level of awareness of OSCC among 600 participants from Southern Italy. Materials and Methods: A 13-question survey was prepared and distributed to 600 participants divided into two subgroups, the first one of 300 patients referring to the Department of Neuroscience, Reproductive, and Odontostomatological Sciences, University Federico II of Naples, for the treatment of dental pathologies, and the second one of 300 patients referring to the Department of Internal Medicine of the Second University of Naples for the diagnosis and treatment of cardiovascular diseases. Statistical analysis consisted in the calculation of percentages related to the answers given by patients. Comparison of percentages was after performed between the two subgroups. Result: Only 175 participants (29.1%) knew about the existence of pathologies which can affect the oral mucosa, and only 46 (7.6%) were aware that carcinoma can arise in the oral cavity; 345 (57,5%) stated that they had periodical dental visits, at least once a year but none of them stated they had a visit for the identification of oral carcinomas. Conclusion: The data acquired must be taken into consideration to outline essential socio-healthcare educational projects on carcinoma and its risk factors, training programs to increase dentists and clinicians’ competences, and to evaluate the feasibility and effectiveness of oral carcinoma screening programs.
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Affiliation(s)
- Stefania Leuci
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - Oral Medicine Complex Unit - University "Federico II" of Naples, Napoli, Italy
| | - Massimo Amato
- Department of Medicine, Dentistry Unit, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Elena Calabria
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - Oral Medicine Complex Unit - University "Federico II" of Naples, Napoli, Italy
| | - Gianrico Spagnuolo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - Oral Medicine Complex Unit - University "Federico II" of Naples, Napoli, Italy
| | - Michele Masucci
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - Oral Medicine Complex Unit - University "Federico II" of Naples, Napoli, Italy
| | - Michele Mignogna Davide
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - Oral Medicine Complex Unit - University "Federico II" of Naples, Napoli, Italy
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Abstract
The most important prognostic factor in predicting the outcome of oral and oropharyngeal cancer (OPC) is the stage at which it is diagnosed. Only 30% of patients are diagnosed with early-stage disease. The oral health care provider performs an important role in early diagnosis of oral cancer. The conventional oral examination consists of a visual and tactile assessment of accessible oral, and head and neck structures. Any suspicious or equivocal lesion should be reevaluated within 4 weeks. Evidence supporting the use of adjunctive devices to improve the ability to screen for and identify OPCs and oral premalignant lesions remains low.
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Affiliation(s)
- Michaell A Huber
- Department of Comprehensive Dentistry, UT Health San Antonio School of Dentistry, 7703 Floyd Curl Drive (Mail Code 7919), San Antonio, TX 78229, USA.
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Hassona Y, Scully C, Abu Tarboush N, Baqain Z, Ismail F, Hawamdeh S, Sawair F. Oral Cancer Knowledge and Diagnostic Ability Among Dental Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:566-570. [PMID: 26660959 DOI: 10.1007/s13187-015-0958-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study is to examine factors that influence the diagnostic ability of dental students with regards to oral cancer and oral potentially malignant disorders. Dental students at different levels of study were directly interviewed to examine their oral cancer knowledge and diagnostic ability using a validated and pre-tested survey instrument containing validated clinical images of oral cancer and oral potentially malignant disorders. An oral cancer knowledge scale (0 to 31) was generated from correct responses on oral cancer general knowledge, and a diagnostic ability scale (0 to 100) was generated from correct selections of suspicious oral lesions. Knowledge scores ranged from 0 to 27 (mean 10.1 ± 6.0); mean knowledge scores increased with year of study; 5th year students had the highest mean knowledge score (19.1 ± 4.0), while 1st year students had the lowest (5.6 ± 3.5). Diagnostic ability scores increased with year of study and ranged from 0 to 88.5 % (mean 41.8 % ± 15.6). The ability to recognize suspicious oral lesions was significantly correlated with knowledge about oral cancer and oral potentially malignant disorders (r = 0.28; P < 0.001). There is a need to improve oral cancer education curricula; increasing students' contact with patients who have oral lesions including oral cancer will help to improve their future diagnostic ability and early detection practices.
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Affiliation(s)
- Y Hassona
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, PO Box 11942, Jordan.
| | - C Scully
- WHO Collaborating Centre for Oral Health-General Health, University College London, London, UK
| | - N Abu Tarboush
- Department of Physiology and Biochemistry, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Z Baqain
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, PO Box 11942, Jordan
| | - F Ismail
- Department of Dentistry, The University of Jordan Hospital, Amman, Jordan
| | - S Hawamdeh
- Department of Dentistry, The University of Jordan Hospital, Amman, Jordan
| | - F Sawair
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, PO Box 11942, Jordan
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Queenan JA, Gottlieb BH, Feldman-Stewart D, Hall SF, Irish J, Groome PA. Symptom appraisal, help seeking, and lay consultancy for symptoms of head and neck cancer. Psychooncology 2017; 27:286-294. [PMID: 28543939 DOI: 10.1002/pon.4458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/02/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Early diagnosis is important in head and neck cancer (HNC) patients to maximize the effectiveness of the treatments and minimize the debilitation associated with both the cancer and the invasive treatments of advanced disease. Many patients present with advanced disease, and there is little understanding as to why. This study investigated patients' symptom appraisal, help seeking, and lay consultancy up to the time they first went to see a health care professional (HCP). METHODS We interviewed 83 patients diagnosed with HNC. The study design was cross sectional and consisted of structured telephone interviews and a medical chart review. We gathered information on the participant's personal reactions to their symptoms, characteristics of their social network, and the feedback they received. RESULTS We found that 18% of the participants thought that their symptoms were urgent enough to warrant further investigation. Participants rarely (6%) attributed their symptoms to cancer. Eighty-nine percent reported that they were unaware of the early warning signs and symptoms of HNC. Fifty-seven percent of the participants disclosed their symptoms to at least one lay consultant before seeking help from an HCP. The lay consultants were usually their spouse (77%), and the most common advice they offered was to see a doctor (76%). Lastly, 81% of the participants report that their spouse influenced their decision to see an HCP. CONCLUSIONS The results of this study suggest that patients frequently believe that their symptoms were nonurgent and that their lay consultants influence their decision to seek help from an HCP.
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Affiliation(s)
- J A Queenan
- Cancer Research Institute at Queen's University, Kingston, Ontario, Canada
| | | | - D Feldman-Stewart
- Cancer Research Institute at Queen's University, Kingston, Ontario, Canada
| | - S F Hall
- Cancer Research Institute at Queen's University, Kingston, Ontario, Canada
| | - J Irish
- University of Toronto, Toronto, Ontario, Canada
| | - P A Groome
- Cancer Research Institute at Queen's University, Kingston, Ontario, Canada
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Howell JL, Shepperd JA. Social exclusion, self-affirmation, and health information avoidance. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2017. [DOI: 10.1016/j.jesp.2016.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Chiou SJ, Lin W, Hsieh CJ. Assessment of duration until initial treatment and its determining factors among newly diagnosed oral cancer patients: A population-based retrospective cohort study. Medicine (Baltimore) 2016; 95:e5632. [PMID: 27977607 PMCID: PMC5268053 DOI: 10.1097/md.0000000000005632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Few studies have focused on the early treatment stages of cancer, and the impact of treatment delay on oncologic outcomes is poorly defined. We used oral cancer as an example to investigate the distribution of durations until initial treatment.This study was conducted using the National Health Insurance Research Database, which is linked to Taiwan's Cancer Registry and Death Registry databases. We defined "cutoff points for first-time treatment" according to a weekly schedule and sorted the patients into 2 groups based on whether their duration until initial treatment was longer or shorter than each cutoff. We then calculated the Kaplan-Meier estimator to determine the difference in survival rates between the 2 groups and performed logistic regression to identify determining factors.The average time between diagnosis and initial treatment was approximately 22.45 days. The average survival duration was 1363 days (standard deviation: 473.06 days). Oral cancer patients had no statistically significant differences in survival until a cutoff point of 3 weeks was used (with survival duration 71 days longer if initial treatment was received within 3 weeks). Patients with higher incomes or higher Charlson comorbidity index scores and patients treated at a hospital in a region with medium urbanization had lower likelihoods of treatment delay, whereas older patients were at higher risk of treatment delay.The attitudes, beliefs, and social contexts of oral cancer patients influence the treatment-seeking behaviors of these patients. Therefore, the government should advocate the merits of the referral system for cancer treatment or improve quality assurance for cancer diagnoses across different types of hospitals. Health authorities should also educate patients or use a case manager to encourage prompt treatment within 3 weeks and should provide screening and prevention services, particularly for high-risk groups, to reduce mortality risk.
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Affiliation(s)
- Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei
| | - Wender Lin
- Department of Health Care Administration, Chang Jung Christian University, Tainan City
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Oriental Institute of Technology, Taipei, Taiwan
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43
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Inadequate critical appraisal of studies in systematic reviews of time to diagnosis. J Clin Epidemiol 2016; 78:43-51. [DOI: 10.1016/j.jclinepi.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/02/2016] [Accepted: 03/21/2016] [Indexed: 01/07/2023]
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44
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Early and late physical and psychosocial effects of primary surgery in patients with oral and oropharyngeal cancers: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:583-94. [DOI: 10.1016/j.oooo.2015.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/23/2015] [Accepted: 12/21/2015] [Indexed: 11/21/2022]
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45
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Jensen LF, Hvidberg L, Pedersen AF, Aro AR, Vedsted P. Time from first symptom experience to help seeking for colorectal cancer patients: Associations with cognitive and emotional symptom representations. PATIENT EDUCATION AND COUNSELING 2016; 99:807-813. [PMID: 27529089 DOI: 10.1016/j.pec.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim was to assess the association between cognitive and emotional symptom representations prior to diagnosis and the length of the patient interval (i.e. the time from the first symptom is experienced until healthcare is sought) for colorectal cancer patients. METHOD The study population included 436 newly diagnosed colorectal cancer patients. Questionnaire data were collected using the Danish Revised Illness Perception Questionnaire (IPQ-R), including cognitive and emotional symptom representations and information on the patient interval. RESULTS High score in treatment control was associated with short patient interval (PR = 0.52, 95% CI: 0.31-0.89) and high score on the timeline cyclical dimension was associated with long patient interval (PR = 2.14, 95% CI: 1.29-3.57). Hence, patients with negative beliefs about the treatability of their symptoms and patients with strong beliefs about the cyclical nature of their symptoms were more likely to have a long patient interval. Assigning blood in stool as the most important symptom significantly interacted in the association between the patient interval and the two cognitive symptom representations consequence and personal control. CONCLUSION The results indicate that aspects of symptom representations were associated with the patient's help-seeking. PRACTICAL IMPLICATIONS These findings may help clinicians and public health planners shorten patient intervals.
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46
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Casotti E, Monteiro ABF, Castro Filho ELD, Santos MPD. Organização dos serviços públicos de saúde bucal para diagnóstico precoce de desordens com potencial de malignização do estado do Rio de Janeiro, Brasil. CIENCIA & SAUDE COLETIVA 2016; 21:1573-82. [DOI: 10.1590/1413-81232015215.10742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/24/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo Estudo sobre a organização dos serviços públicos de saúde no estado do Rio de Janeiro referente ao diagnóstico precoce de desordens com potencial de malignização (DPM). Foram utilizados os dados secundários do banco do primeiro ciclo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica.Verificou-se a realização de ações nos diferentes níveis de prevenção ao câncer, a disponibilidade de serviços de apoio diagnóstico e sobre a organização da rede de atenção. Os resultados mostram que só 58,8% das equipes de saúde bucal registram e acompanham os casos suspeitos; que somente 47.1% relatam dispor de fluxos preferenciais para encaminhamento e há grande variação nos tempos de espera para confirmação do diagnóstico. Ações gerenciais locais e de apoio regional podem melhorar a organização da rede de cuidado ao câncer bucal no estado.
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Hassona Y, Taimeh D, Marahleh A, Scully C. YouTube as a source of information on mouth (oral) cancer. Oral Dis 2016; 22:202-8. [DOI: 10.1111/odi.12434] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Y Hassona
- Faculty of Dentistry; The University of Jordan; Amman Jordon
| | - D Taimeh
- Department of Dentistry; The University of Jordan Hospital; Amman Jordon
| | - A Marahleh
- Department of Dentistry; The University of Jordan Hospital; Amman Jordon
| | - C Scully
- WHO Collaborating Centre for Oral Health-General Health; University College London; London UK
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48
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Osazuwa-Peters N, Christopher KM, Hussaini AS, Behera A, Walker RJ, Varvares MA. Predictors of stage at presentation and outcomes of head and neck cancers in a university hospital setting. Head Neck 2015; 38 Suppl 1:E1826-32. [PMID: 26695355 DOI: 10.1002/hed.24327] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND To increase early detection of head and neck cancers, it is important that disparities associated with access to care are addressed. METHODS A total of 351 patients aged 20 to 91 years (58.72 ± 11.70 years) diagnosed with head and neck cancers at a university hospital from 1997 to 2010 were analyzed. Logistic regression assessed the association between clinical stage at presentation and predictors. Cox proportional hazards model assessed the effect of stage at presentation on survival. RESULTS Being African American was associated with increased odds of late stage at presentation (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.01-4.59), and those without health insurance were 10.97 times more likely to present at late stage (95% CI = 1.30-92.49). Unmarried patients were 1.6 times at an increased hazard of death (95% CI = 1.12-2.24). CONCLUSION Disparities, such as race and health insurance status, are important predictors of stage at presentation of patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1826-E1832, 2016.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Saint Louis University Cancer Center, Saint Louis, Missouri.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri.,Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Kara M Christopher
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri
| | - Adnan S Hussaini
- Saint Louis University, School of Medicine, Saint Louis, Missouri
| | - Anit Behera
- Saint Louis University, School of Medicine, Saint Louis, Missouri.,Saint Louis University Center for Outcomes Research, Saint Louis, Missouri
| | - Ronald J Walker
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri.,Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Philiponis G, Malloy KM, Kagan SH. Living in limbo: Being diagnosed with oral tongue cancer. Asia Pac J Oncol Nurs 2015; 2:242-249. [PMID: 27981120 PMCID: PMC5123504 DOI: 10.4103/2347-5625.158021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Oral tongue cancer presents clinical challenges to effective diagnosis that affect patient experience. Patient experience of the diagnostic process is poorly described, making opportunities for nursing intervention unclear. METHODS We qualitatively describe, using constant comparative analysis, oral tongue cancer diagnosis using data from a larger grounded theory study of oral tongue cancer survivorship. Using constant comparative analysis - in keeping with the methodology of the main study - we analyzed 16 survivor interviews for themes explaining the patient experience of oral tongue cancer diagnosis. RESULTS We termed the broader diagnostic process "living in limbo." This process includes the themes describing the peri-diagnostic process itself - "self-detected lesion," "lack of concern," "seeking help," "not a straightforward diagnosis," and "hearing the diagnosis." Entry into treatment concludes "Living in Limbo" and is described by the theme "worry and trust." CONCLUSIONS Our findings are limited by retrospective interviews and participant homogeneity among other features. Future research with prospective designs and diverse groups of people at risk for and diagnosed with oral tongue cancer, as well as targeting those who have had negative biopsies with no eventual diagnosis of oral tongue cancer, will build on our findings. Further, study of patient experience in other sociocultural context and healthcare systems is needed to inform nursing science and practice. Finally, "living in limbo" suggests that clinician and public education about oral tongue cancer diagnosis is needed.
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Affiliation(s)
| | - Kelly M Malloy
- School of Medicine, University of Michigan, Michigan, USA
| | - Sarah H Kagan
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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50
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Hassona Y, Scully C, Abu Ghosh M, Khoury Z, Jarrar S, Sawair F. Mouth cancer awareness and beliefs among dental patients. Int Dent J 2014; 65:15-21. [PMID: 25371164 DOI: 10.1111/idj.12140] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of the present study was to assess the levels of awareness, knowledge about signs and risk factors of mouth (oral) cancer, and attitudes towards early diagnosis and treatment among dental outpatients. MATERIAL AND METHODS A total of 1,200 adult outpatients attending dental clinics at the University of Jordan Hospital for dental examination and treatment were randomly selected to participate in the study. An 18-item pretested close-ended questionnaire was used for the study. Descriptive statistics were generated and chi-square tests, t-tests, one-way analysis of variance (ANOVA), and Spearman's rho test were used to examine differences between groups. RESULTS Only 45.6% of the subjects had heard about oral cancer. Some 66.9% and 33.8%, respectively, were able to correctly identify tobacco and alcohol as risk factors. Some 24.1% had no knowledge about any signs of oral cancer. Male subjects, smokers, alcohol drinkers, older participants (>40 years), and participants with less than a university education were significantly less aware, and had much less knowledge, of the signs and risk factors of oral cancer (P<0.05). CONCLUSION Awareness about oral cancer among Jordanian dental outpatients is low. These dental patients, especially those in high-risk groups for mouth cancer and those of lower socio-economic status (SES), are less well informed about the signs and risk factors of oral cancer. Interventions to improve public knowledge about oral cancer and attitudes towards early diagnosis and treatment are urgently indicated.
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Affiliation(s)
- Yazan Hassona
- Department of Oral Surgery, Oral Medicine, and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, Jordan
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