Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain. Relative contribution of patient interval

• Pablo Varela-Centelles ^[1] ; José-Luis López-Cedrún ^[4] ; Jacinto Fernández-Santromán ^[2] ; Pablo Álvarez-Nóvoa ^[1] ; Ramón Luaces-Rey ^[4] ; María-Josefa Pombo-Castro ^[4] ; María-Pía López-Jornet ^[3] ; Juan Seoane ^[1]
  1. [1] Universidade de Santiago de Compostela

     Universidade de Santiago de Compostela

     Santiago de Compostela, España

     
  2. [2] Hospital POVISA

     Hospital POVISA

     Vigo, España

     
  3. [3] Universidad de Murcia

     Universidad de Murcia

     Murcia, España

     
  4. [4] Service of Oral and Maxillofacial Surgery. Complexo Hospitalario Universitario de A Coruña (CHUAC). Galician Health Service. A Coruña. Spain

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• Localización: Medicina oral, patología oral y cirugía bucal. Ed. inglesa, ISSN-e 1698-6946, Vol. 22, Nº. 4 (July), 2017
• Idioma: inglés
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• Resumen

  • Despite continuous advances in diagnosis and therapy, oral cancers are mostly diagnosed at advanced stages with minor survival improvements in the last two decades. Both phenomena have been attributed to delays in the diagnosis. This study aims at quantifying the time elapsed until definitive diagnosis in these patients and the patient interval’s contribution.

    A hospital-based, ambispective, observational study was undertaken on incident cases with a pathological diagnosis of oral squamous cell carcinoma recruited during 2015 at the Oral and Maxillofacial Surgery services of CHUAC (A Coruña) and POVISA (Vigo) hospitals.

    74 consecutive oral cancer patients (59.5% males; median age: 65.0 years (IQ:57-74)) were studied. Most cases (52.7%; n=39) were at advanced stages (TNM III-IV) at diagnosis.

    The period since first sign/symptom until the patient seeks health care was the longest interval in the pathway to diagnosis and treatment (median: 31.5 days; IQR= 7.0 – 61.0) and represents >60% of the interval since symptom onset until referral to specialised care (pre-referral interval). The average interval assigned to the patient resulted to be relatively larger than the time elapsed since the patient is seen at primary care until a definitive diagnosis is reached (diagnostic interval). Median of the referral interval for primary care professionals: 6.5 days (IQR= 0.0 – 49.2) and accounts for 35% (19% - 51%) of the diagnostic interval.

    The patient interval is the main component of the pathway to treatment since the detection of a bodily change until the definitive diagnosis. Therefore, strategies focused on risk groups to shorten this interval should be implemented in order to ease an early diagnosis of symptomatic oral cancer.