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Matsumoto K, Tanaka F, Kumai Y. Questionnaire Survey to Identify the Medical Departments That Patients With Possible Head and Neck Cancer (HNC) Symptoms Tend to Choose. Cureus 2024; 16:e55715. [PMID: 38586627 PMCID: PMC10998474 DOI: 10.7759/cureus.55715] [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] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
In the treatment of head and neck cancer (HNC), any delay in omit initiation worsens the overall prognosis. Thus, the early start of HNC treatment is crucial. Unfortunately, treatment delays persist in clinical practice. There are several possible reasons for this. One reason is that patients with HNC do not visit an ear, nose, and throat (ENT) doctor. This is because non-ENT doctors (e.g., general practitioners {GPs}) lack expertise in HNC and therefore may unrecognize it. Therefore, guiding patients with suspected HNC symptoms to an otorhinolaryngologist, an HNC specialist, is necessary. To determine the departments that patients with potential HNC symptoms tend to select, we administered a questionnaire survey to 140 participants. Fewer than 60% of respondents indicated they would consult an otorhinolaryngologist even when recognizing symptoms suggestive of HNC. Notably, a significantly low percentage of respondents mentioned they would consult an otorhinolaryngologist for neck masses. Public awareness of HNC symptoms, especially the association between a neck mass and HNC, is limited. The lack of understanding by the general public regarding the relationship between neck masses and HNC is a challenge to prompt initiation of treatment.
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Affiliation(s)
- Kohei Matsumoto
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Fujinobu Tanaka
- Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization (NHO) Nagasaki Medical Center, Omura, JPN
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Medicine, Nagasaki, JPN
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Shih YJ, Huang JY, Lai YC, Lin HM, Kuo TJ. Tooth extraction within 2 weeks before radiotherapy and osteoradionecrosis: A nationwide cohort study. Oral Dis 2024; 30:575-585. [PMID: 35951468 DOI: 10.1111/odi.14349] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/05/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The theory of at least 2-week waiting period between tooth extraction and head and neck radiotherapy could reduce osteoradionecrosis remains controversial. Thus, this study examined the theory and associated factors. MATERIALS AND METHODS Data were retrieved from the National Health Insurance Research Database, Taiwan Cancer Registry Database, and Cause of Death Statistics. We included 24,353 patients with head and neck cancer who received radiotherapy from 2011 to 2017 and were followed up until 2019. The patients were divided into three groups: those undergoing tooth removal 2-8 weeks before radiotherapy, those undergoing tooth removal within 2 weeks before radiotherapy, and others. Confounding factors were clinical information, physical conditions, and risky habits. We used the Cox regression model to assess osteoradionecrosis risk. RESULTS No significant difference in osteoradionecrosis risk was observed between those undergoing tooth extraction within 2 weeks before radiotherapy and the other groups. An irradiation dose of ≥60 Gy, chemotherapy, tumor excision, post-radiotherapy tooth extraction, mandibulectomy, hyperlipidemia, and oral cavity as the tumor subsite were significantly positively associated with osteoradionecrosis risk. CONCLUSION A waiting period of ≥2 weeks between tooth extraction and radiotherapy did not significantly reduce osteoradionecrosis risk.
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Affiliation(s)
- Yin-Ju Shih
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Oral and Maxillofacial Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Cheng Lai
- Department of Orthopedics, Asia University Hospital, Taichung, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hsin-Mei Lin
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsu-Jen Kuo
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
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3
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Belnap C, Divis T, Kingsley K, Howard KM. Differential Expression of MicroRNA MiR-145 and MiR-155 Downstream Targets in Oral Cancers Exhibiting Limited Chemotherapy Resistance. Int J Mol Sci 2024; 25:2167. [PMID: 38396844 PMCID: PMC10889714 DOI: 10.3390/ijms25042167] [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] [Received: 01/11/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
New evidence has suggested that non-coding microRNAs play a significant role in mediating and modulating chemotherapy resistance, particularly among oral cancers. One recent study found that the upregulation of miR-145 and the downregulation of miR-155 strongly correlated with a limited chemotherapy resistance to Cisplatin, 5-Fluorouracil, and Paclitaxel, although the mechanism(s) responsible for these observations remain unidentified. Using commercially available cell lines of oral squamous cell carcinoma, RNA was isolated, converted into cDNA, and subsequently screened for the expression of downstream targets of miR-145 and miR-155 using qPCR. These results demonstrated the upregulation of miR-21, miR-125, miR-133, miR-365, miR-720, and miR-1246, as well as the downregulation of miR-140, miR-152, miR-218, miR-221, and miR-224. This screening also confirmed the differential expression and regulation of mir-145 and miR-155 among the cell lines with limited chemotherapy resistance (SCC15). In addition, several downstream targets of these specific microRNAs were upregulated by all oral cancer cell lines, such as MBTD1 and FSCN1, or downregulated in all cell lines, such as CLCN3, FLI-1, MRTFB, DAB, SRGAP1, and ABHD17C. However, three miR-145 downstream targets were identified in the least chemotherapy-resistant cells, exhibiting the differential upregulation of KCNA4 and SRGAP2, as well as the downregulation of FAM135A, with this expression pattern not detected in any of the other oral cancer cell lines. These data strongly support that the differential regulation of these three downstream targets may be related to the chemosensitivity of this oral cancer cell line. The potential involvement of these targets must be further investigated to determine how and whether mechanisms of these cellular pathways may be involved in the observed lack of chemotherapy resistance. These data may be important to design targets or treatments to reduce chemotherapy resistance and improve patient treatment outcomes.
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Affiliation(s)
- Conner Belnap
- Department of Advanced Education in Orthodontic Dentistry, School of Dental Medicine, University of Nevada-Las Vegas, 1700 W. Charleston Boulevard, Las Vegas, NV 89106, USA;
| | - Tyler Divis
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada-Las Vegas, 1700 W. Charleston Boulevard, Las Vegas, NV 89106, USA;
| | - Karl Kingsley
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada-Las Vegas, 1001 Shadow Lane, Las Vegas, NV 89106, USA;
| | - Katherine M. Howard
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada-Las Vegas, 1001 Shadow Lane, Las Vegas, NV 89106, USA;
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Jafer M, Moafa I, Hoving C, Candel M, Kaabi AA, Van Den Borne B. The ISAC Paradigm to Tame Oral Cancer in Saudi Arabia: A Quasi-experimental Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1901-1909. [PMID: 37594623 PMCID: PMC10656309 DOI: 10.1007/s13187-023-02356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 08/19/2023]
Abstract
Late detection of oral cancer (OC) cases in Saudi Arabia is concerning. It reduces survival rate and complicates treatment. The ISAC intervention was developed to bridge the gaps observed in dentists' practice of OC examination and patient education. The ISAC stands for I, informing patients of OC screenings; S, screening for OC; A, advising high-risk patients to quit risk factors; and C, connecting patients to advanced services. This study tested the potential effect of the ISAC in influencing dentists' cognitive and behavioral skills, to enhance early detection and prevention of OC. A quasi-experimental study was conducted among dental interns (DIs) at dental setting to test the effect on comprehensive oral cancer examination score (COCE), awareness, self-efficacy, descriptive-norms, and self-reported behavior. Data were collected through triangulation of methods pre and post the intervention at two-months. Multiple linear mixed effects regression models were utilized for data analysis. Between October 2020 and April 2021, 47 DIs participated in the study. The final model showed the significant effects of time (ISAC) on COCE (95% CI = 25.12-29.42, P < .001). DIs had a significant improvement in awareness, self-efficacy, descriptive norms, and self-reported behavior. The findings showed promising effects of the intervention toward the early detection and prevention of OC. Dentists, dental organizations, and policymakers in areas with a high risk of OC could benefit from the current intervention which contributes to capacity building and improved community health. A pragmatic study with a robust design is needed to test the effectiveness of the intervention on a wider scale.
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Affiliation(s)
- Mohammed Jafer
- Dental Public Health Division, Department of Preventive Dental Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ibtisam Moafa
- Dental Public Health Division, Department of Preventive Dental Sciences, Jazan University, Jazan, Saudi Arabia.
| | - Ciska Hoving
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Math Candel
- Department of Research and Methodology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Abdulrahman A Kaabi
- Community Service Unit, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Bart Van Den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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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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Atula M, Aro K, Irjala H, Halme E, Jouppila-Mättö A, Koivunen P, Wilkman T, Blomster H, Mäkitie A, Atula T. Patient and health care delays in large (class T3-T4) oral, oropharyngeal, and laryngeal carcinomas. Head Neck 2023; 45:1215-1225. [PMID: 36880833 DOI: 10.1002/hed.27335] [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: 08/18/2022] [Accepted: 01/16/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Head and neck cancers (HNCs) are often diagnosed at an advanced stage. We investigated the lengths and factors associated with patient, primary health care (PHC), and specialist care (SC) delays in T3-T4 oral, oropharyngeal, and laryngeal cancer. METHODS A nationwide prospective questionnaire-based study (n = 203) with the 3-year long data collection period. RESULTS The median patient, PHC and SC delays were 58, 13, and 43 days, respectively. Lower level of education, heavy alcohol use, hoarseness, difficulties breathing, and eventual palliative treatment associated with a longer patient delay. A lump on the neck or facial swelling associated with a shorter PHC delay. Conversely, if symptoms were treated as an infection, PHC delay was longer. The treatment modality and tumor site affected SC delay. CONCLUSIONS Patient delay stands as the most notable factor contributing to delays before treatment. HNC symptom awareness thus remains especially important among HNC risk groups.
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Affiliation(s)
- Markus Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Elina Halme
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Anna Jouppila-Mättö
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology - Head and Neck Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Henry Blomster
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Clinical Sciences, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Ngokwe ZB, Ntep David Bienvenue N, Azicha Shannen A, Stephane NK, Siafa Antoine B, Zacharie S. Treatment of an oral malignant lesion following mucosal insult; a case report. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2023. [DOI: 10.1016/j.adoms.2023.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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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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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: 12] [Impact Index Per Article: 6.0] [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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11
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Petrova D, Špacírová Z, Fernández-Martínez NF, Ching-López A, Garrido D, Rodríguez-Barranco M, Pollán M, Redondo-Sánchez D, Espina C, Higueras-Callejón C, Sánchez MJ. The patient, diagnostic, and treatment intervals in adult patients with cancer from high- and lower-income countries: A systematic review and meta-analysis. PLoS Med 2022; 19:e1004110. [PMID: 36264841 PMCID: PMC9584443 DOI: 10.1371/journal.pmed.1004110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Longer time intervals to diagnosis and treatment are associated with worse survival for various types of cancer. The patient, diagnostic, and treatment intervals are considered core indicators for early diagnosis and treatment. This review estimated the median duration of these intervals for various types of cancer and compared it across high- and lower-income countries. METHODS AND FINDINGS We conducted a systematic review with meta-analysis (prospectively registered protocol CRD42020200752). Three databases (MEDLINE, Embase, and Web of Science) and information sources including grey literature (Google Scholar, OpenGrey, EThOS, ProQuest Dissertations & Theses) were searched. Eligible articles were published during 2009 to 2022 and reported the duration of the following intervals in adult patients diagnosed with primary symptomatic cancer: patient interval (from the onset of symptoms to first presentation to a healthcare professional), diagnostic interval (from first presentation to diagnosis), and treatment interval (from diagnosis to treatment start). Interval duration was recorded in days and study medians were combined in a pooled estimate with 95% confidence intervals (CIs). The methodological quality of studies was assessed using the Aarhus checklist. A total of 410 articles representing 68 countries and reporting on 5,537,594 patients were included. The majority of articles reported data from high-income countries (n = 294, 72%), with 116 (28%) reporting data from lower-income countries. Pooled meta-analytic estimates were possible for 38 types of cancer. The majority of studies were conducted on patients with breast, lung, colorectal, and head and neck cancer. In studies from high-income countries, pooled median patient intervals generally did not exceed a month for most cancers. However, in studies from lower-income countries, patient intervals were consistently 1.5 to 4 times longer for almost all cancer sites. The majority of data on the diagnostic and treatment intervals came from high-income countries. Across both high- and lower-income countries, the longest diagnostic intervals were observed for hematological (71 days [95% CI 52 to 85], e.g., myelomas (83 days [47 to 145])), genitourinary (58 days [50 to 77], e.g., prostate (85 days [57 to 112])), and digestive/gastrointestinal (57 days [45 to 67], e.g., colorectal (63 days [48 to 78])) cancers. Similarly, the longest treatment intervals were observed for genitourinary (57 days [45 to 66], e.g., prostate (75 days [61 to 87])) and gynecological (46 days [38 to 54], e.g., cervical (69 days [45 to 108]) cancers. In studies from high-income countries, the implementation of cancer-directed policies was associated with shorter patient and diagnostic intervals for several cancers. This review included a large number of studies conducted worldwide but is limited by survivor bias and the inherent complexity and many possible biases in the measurement of time points and intervals in the cancer treatment pathway. In addition, the subintervals that compose the diagnostic interval (e.g., primary care interval, referral to diagnosis interval) were not considered. CONCLUSIONS These results identify the cancers where diagnosis and treatment initiation may take the longest and reveal the extent of global disparities in early diagnosis and treatment. Efforts should be made to reduce help-seeking times for cancer symptoms in lower-income countries. Estimates for the diagnostic and treatment intervals came mostly from high-income countries that have powerful health information systems in place to record such information.
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Affiliation(s)
- 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
| | - 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
- Interlevel Clinical Management Unit for Prevention, Promotion and Health Surveillance, Reina Sofía University Hospital, Córdoba, Spain
| | - Ana Ching-López
- 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
| | - Dunia Garrido
- Department of Developmental and Educational Psychology, University of Granada, Granada, 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
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Daniel Redondo-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
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | - Maria 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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Analysis of Intervention Effect and Satisfaction of Holistic Nursing after Oral Tumor Resection. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3788605. [PMID: 35872954 PMCID: PMC9307384 DOI: 10.1155/2022/3788605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
Objective. To explore the intervention effect and satisfaction analysis of holistic nursing after oral tumor resection. Methods. A total of 70 oral tumor patients who underwent surgical treatment in our hospital from April 2020 to September 2021 were randomly divided into two groups, with 35 patients in each group. The control group was given basic oral care, the observation group was given overall oral care, and the actual effects of the two groups of care were compared, including the emotional status, compliance and nursing satisfaction, hospital stay and nursing quality scores, pain level, quality of life, and complications occurred. Results. After nursing, the patients in the observation group had good mood, higher compliance and nursing satisfaction, shorter hospital stay, higher nursing quality and quality of life scores, lower pain level, and lower incidence of complications, when compared with the control group. Conclusion. Holistic nursing has obvious effects on patients after oral tumor surgery, which can relieve patients’ negative emotions, improve patients’ compliance with treatment, improve their quality of life, and effectively reduce the degree of pain and the occurrence of complications, which is worthy of clinical promotion.
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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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Early Diagnosis and Diagnostic Delay in Oral Cancer. Cancers (Basel) 2022; 14:cancers14071758. [PMID: 35406530 PMCID: PMC8996863 DOI: 10.3390/cancers14071758] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 12/21/2022] Open
Abstract
Oral cancer is a very serious public health problem in many parts of the world, particularly in developing countries, where about two-thirds of incident cases occur [...].
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15
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Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer. Cancers (Basel) 2021; 13:cancers13205163. [PMID: 34680312 PMCID: PMC8533728 DOI: 10.3390/cancers13205163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3-76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61-0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.
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Overview of Oral Potentially Malignant Disorders: From Risk Factors to Specific Therapies. Cancers (Basel) 2021; 13:cancers13153696. [PMID: 34359597 PMCID: PMC8345150 DOI: 10.3390/cancers13153696] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a very aggressive cancer, representing one of the most common malignancies worldwide. Oral potentially malignant disorders (OPMDs) regroup a variegate set of different histological lesions, characterized by the potential capacity to transform in OSCC. Most of the risk factors associated with OSCC are present also in OPMDs' development; however, the molecular mechanisms and steps of malignant transformation are still unknown. Treatment of OSCC, including surgery, systemic therapy and radiotherapy (alone or in combination), has suffered a dramatic change in last years, especially with the introduction of immunotherapy. However, most cases are diagnosed during the advanced stage of the disease, decreasing drastically the survival rate of the patients. Hence, early diagnosis of premalignant conditions (OPMDs) is a priority in oral cancer, as well as a massive education about risk factors, the understanding of mechanisms involved in malignant progression and the development of specific and more efficient therapies. The aim of this article is to review epidemiological, clinical, morphological and molecular features of OPMDs, with the purpose to lay the foundation for an exhaustive comprehension of these lesions and their ability of malignant transformation and for the development of more effective and personalized treatments.
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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: 13] [Impact Index Per Article: 4.3] [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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19
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Edo-Izquierdo S, Martínez-Blanquet LJ, Rovira T. Hierarchy of the main factors predicting the decision to go to the doctor in a general population sample: A factorial survey design. PATIENT EDUCATION AND COUNSELING 2020; 103:1407-1414. [PMID: 32044189 DOI: 10.1016/j.pec.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To obtain a hierarchy of the main factors that predict the decision to go to the doctor when symptoms are not yet linked to a specific disease. METHOD 64 representative vignettes, combinations of nine factors, were presented to 168 adults between 28-60 years of age. RESULTS Multilevel multiple regression models were used to rank the main factors predicting urgency to see a doctor in order of importance: the interference of symptoms in daily activities (B = -1.29; p < .001), fear (B = -0.96; p < .001), pain (B = -0.90; p < .001), access to medical care (B = -0.64; p < .001) and confidence in the doctor (B = -0.27; <.05). Moreover, gender (B = 0.56; p < .05) and educational level (B =-0.31; p < .05) explained part of the interindividual variation in the daily symptoms' interference. CONCLUSION When a specific disease has not yet been diagnosed, daily symptoms' interference is the factor that most strongly increases the urgency to visit a doctor, especially among men and among people with a higher level of education. PRACTICE IMPLICATIONS To reduce delay, generic health prevention campaigns should place more emphasis on possible interference in daily activities than on the meaning of symptoms for health.
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Affiliation(s)
| | | | - Tatiana Rovira
- Department of Basic Psychology, Autonomous University of Barcelona, Spain.
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20
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Nieminen M, Atula T, Bäck L, Mäkitie A, Jouhi L, Aro K. Factors influencing patient and health care delays in Oropharyngeal Cancer. J Otolaryngol Head Neck Surg 2020; 49:22. [PMID: 32326977 PMCID: PMC7181590 DOI: 10.1186/s40463-020-00413-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing. Patients with HPV-associated and HPV-unassociated OPSCC differ in many aspects, which may also impact their diagnostic and management timelines. This study aims at studying the patient, primary health care (PHC) and specialist-care (SC) delays and possible differences between these two patient groups in seeking medical care. METHODS We reviewed all new patients with OPSCC treated between 2016 and 2018 at our institute, which covers a referral area of 1.6 million people. We collected data on patients' symptoms and factors influencing why they sought medical care using a patient-reported questionnaire and hospital records. We compared delays based on patient and tumor characteristics. RESULTS In our study population of 83 patients, the median patient delay was 30 days (range, 0-366), with a median PHC delay of 15 days (range, 0 days-2.5 years), and a median SC delay of 54 days (range, 12-231). The SC delay was further divided into diagnostic hospital delay and treatment delay, each with a median length of 16 days (range, 0-237) and 29 days (range, 0-73), respectively. Furthermore, we found that p16 status did not associate with delays. A longer patient delay associated with specific tumor factors, such as a larger primary tumor and a lower UICC 7th edition stage. Patients that had multiple visits or did not have a follow-up visit scheduled at the initial appointment had longer PHC delays. Treatment delay was significantly longer for patients scheduled for (chemo-)radiotherapy than for those undergoing surgery with or without (chemo-)radiotherapy. CONCLUSIONS Although delays remained short for the majority of OPSCC patients, long delays require further evaluation and improvement of management. Awareness of presenting symptoms among cancer risk patients and prompt referral practice or a follow-up visit at PHC represent key factors to shortening these delays. Ultimately, the causes for delays in SC appear multifactorial and require institutional quality control.
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Affiliation(s)
- Markus Nieminen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland.
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland.,Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland
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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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Lopez-Cedrún JL, Otero-Rico A, Vázquez-Mahía I, Seoane J, García-Caballero L, Seoane-Romero JM, Varela-Centelles P. Association between hospital interval and survival in patients with oral cancer: A waiting time paradox. PLoS One 2019; 14:e0224067. [PMID: 31652279 PMCID: PMC6814211 DOI: 10.1371/journal.pone.0224067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/04/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In early diagnosis studies on symptomatic cancer, survival was the most recommended outcome. The magnitude and impact of the patient interval and primary care interval is well-known in oral cancer; however, the hospital interval and its influence on surviving this neoplasia are not well known. AIMS To quantify the interval between the first contact with the specialist and the start of treatment for patients with oral cancer and to evaluate whether there was a link between this interval and disease survival. METHODS We designed a hospital-based study that included 228 patients diagnosed with oral/oropharyngeal squamous cell carcinoma between 1998 and 2008 at A Coruña University Hospital (Spain) who were followed up until 2016. The data were extracted retrospectively from hospital medical charts. The study interval was defined in the context of the "pathways to treatment" model as the interval from the first specialist visit (start point) to the start of treatment (end point). We calculated the total interval (from first symptom to treatment) to evaluate the relative length of the hospital interval, and we considered the variables age, sex, location, comorbidity and tumour classification stage. Survival time was defined as the interval from the first treatment to death or censoring. RESULTS The median hospital interval was 20 days, with an interquartile range of 15-29.1 days. The most relevant prognostic variable was the tumour stage (III-IV: Exp. ß = 2.8, p = 0.001). The hospital interval was part of the multivariate model, and its association with mortality showed a V-shaped association, where patients with short hospital intervals (3-18 days) and those with long hospital intervals (26-55 days) had significantly higher mortality than those with medium hospital intervals (19-25 days). CONCLUSION The hospital interval represents a relevant interval for the patient's path towards treatment, has prognostic implications and is subject to a severity bias (waiting time paradox) that should be avoided.
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Affiliation(s)
- José Luis Lopez-Cedrún
- Service of Oral and Maxillofacial Surgery, A Coruña University Hospital (CHUAC), Galician Health Service, A Coruña, Spain
| | - Ana Otero-Rico
- Service of Oral and Maxillofacial Surgery, A Coruña University Hospital (CHUAC), Galician Health Service, A Coruña, Spain
| | - Inés Vázquez-Mahía
- Service of Oral and Maxillofacial Surgery, A Coruña University Hospital (CHUAC), Galician Health Service, A Coruña, Spain
| | - Juan Seoane
- Department of Surgery and Medical-Surgical Specialities, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Lucía García-Caballero
- Department of Surgery and Medical-Surgical Specialities, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Juan Manuel Seoane-Romero
- Department of Surgery and Medical-Surgical Specialities, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
- * E-mail:
| | - Pablo Varela-Centelles
- Praza do Ferrol Health Centre, EOXI Lugo, Cervo e Monforte de Lemos, Galician Health Service, Lugo, Spain
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Chiang WF, Liu SY, Lin JF, Chiu SF, Gou SB, Chiou CT, Chang CH. Malignant development in patients with oral potentially malignant disorders detected through nationwide screening: Outcomes of 5-year follow-up at a single hospital. Head Neck 2019; 42:67-76. [PMID: 31589002 DOI: 10.1002/hed.25973] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/04/2019] [Accepted: 09/10/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although survival rate and quality of life are improved if patients with oral carcinoma can be detected early, however, such lesions are usually asymptomatic; therefore, it is hard to raise awareness. Screening has proved to be cost-effective for early detection. METHODS Sixty-two patients with oral carcinomas and 555 patients with oral potentially malignant disorders (OPMDs) who were detected through screening were examined the relationship between clinicopathological features and follow-up outcomes. RESULTS The 5-year cumulative cancer-free interval rate was 94.1%, and the annual malignant transformation rate was 1.16%. The rate of interval carcinoma development from Candida hyperplasia, oral submucous fibrosis, homogeneous leukoplakia, non-homogenous leukoplakia, and verrucous hyperplasia, was 13.6%, 5.7%, 4.6%, 12.1%, and 21.3%, respectively. Significant independent risk factors for interval carcinoma development were heavy betel quid chewing, verrucous hyperplasia, and surgery refusal. CONCLUSIONS Well-designed risk assessment, treatment, and surveillance program could lead to earlier cancer detection and thereby reduce mortality and morbidity.
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Affiliation(s)
- Wei-Fan Chiang
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Taiwan.,School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Shyun-Yeu Liu
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Yongkang, Taiwan
| | - Jen-Fen Lin
- Cancer Center, Chi-Mei Medical Center, Liouying, Taiwan
| | - Sheng-Fu Chiu
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Taiwan
| | - Shin-Bin Gou
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Taiwan
| | - Chang-Ta Chiou
- Department of Oral and Maxillofacial Surgery, An-Nan Hospital, Tainan, Taiwan
| | - Chi-Hua Chang
- Department of Oral and Maxillofacial Surgery, Chang-Chung Memorial Hospital, Kaohsiung, Taiwan
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Hameed Khaliq I, Mahmood HZ, Sarfraz MD, Masood Gondal K, Zaman S. Pathways to care for patients in Pakistan experiencing signs or symptoms of breast cancer. Breast 2019; 46:40-47. [PMID: 31075671 DOI: 10.1016/j.breast.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31-128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.
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Affiliation(s)
- Imran Hameed Khaliq
- Department of Public Health, University of Health Sciences Lahore, Pakistan.
| | - Hafiz Zahid Mahmood
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Pakistan
| | | | - Khalid Masood Gondal
- Vice Chancellor, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences Lahore, Pakistan
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Bezerra NVF, Leite KLF, de Medeiros MMD, Martins ML, Cardoso AMR, Alves PM, Padilha WWN, Cavalcanti YW. Impact of the anatomical location, alcoholism and smoking on the prevalence of advanced oral cancer in Brazil. Med Oral Patol Oral Cir Bucal 2018; 23:e295-e301. [PMID: 29680854 PMCID: PMC5945237 DOI: 10.4317/medoral.22318] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To evaluate the prevalence of oral cancer in Brazil according to the clinical stage, anatomical location, alcoholism and smoking. MATERIAL AND METHODS Data referring to 31,217 cases of oral cancer, from 2000 to 2010, were obtained from the Integrator Module of the Hospital Registry of Cancer. Inconsistent data ("non-classified" cases) was eliminated and 21,160 cases were analyzed. The frequency distribution according to clinical stage, anatomical location, alcoholism and smoking was analyzed descriptively and through a binary logistic regression model (α<0.05). The clinical stage (dependent variable) was dichotomized in early stage (I and II) or advanced stage (III and IV). The year of diagnosis, anatomical location and deleterious habits (alcoholism and smoking) were considered independent variables. RESULTS The most frequent characteristics were: oropharynx location (n=3856, 18.41%), clinical stage IV (n=11924, 56.09%) and combined use of alcohol and tobacco (n=19226; 61.59%). The year 2009 (p<0.01, PR = 1.162, CI-95%=1.053-1.283) and location at the base of tongue (p<0.01, PR = 2.485, CI-95% = 2.182-2.807) presented a higher prevalence ratio for advanced stage oral cancer. The combined use of alcohol and tobacco showed a higher prevalence rate for the advanced clinical stage of cancer (p<0.01, PR =1.449, CI-95%=1.382-1.520) if compared to individuals without habits, or just alcoholics. CONCLUSIONS Higher prevalence of advanced stage of oral cancer is related to the localization at the base of the tongue and to the concomitant use of alcohol and tobacco. Therefore, it can be suggested that all these characteristics lead to a worse prognosis of oral cancer.
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Affiliation(s)
- N-V-F Bezerra
- Clinical and Social Dentistry Department, Health Sciences Center, Federal University of Paraiba, Campus I, Cidade Universitária. João Pessoa-PB, ZIP code: 58051-900,
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