Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors

Temporal trends in treatment delays for oral and oropharyngeal cancer in Brazil: An analysis of the national database

OBJECTIVES

This study investigated regional trends in delays between the histological diagnosis of oral and oropharyngeal cancer and initiation of treatment across Brazil's federal units from 2013 to 2019.

METHODS

A retrospective, observational study was conducted using secondary data from the Brazilian Health System Database (DATASUS) for the years 2013-2019. Variables collected included the year of treatment, sex, age group, anatomical location, disease stage, treatment method, and federal unit of Brazil. Thematic maps were generated, and time series were analyzed using joint-point regression.

RESULTS

A total of 72,062 cases were included in the study. Majority of cases were of men (79.32%) and individuals older than 45 years (91.15%). Treatment was initiated earlier in younger patients, in cases of lip cancer, and among those who had undergone surgery. In 11 states, a significant decrease was observed in initiating treatment for oral cancer 60 days from diagnosis, whereas a significant increase was observed in three states. For oropharyngeal cancer, a significant decrease was observed in initiating treatment at 60 days from diagnosis in three states, whereas a significant increase was observed in five states.

CONCLUSIONS

The findings revealed a high degree of heterogeneity in treatment delays for oral and oropharyngeal cancer across Brazil from 2013 to 2019. The northern states of Brazil exhibited a high percentage of treatment delays exceeding 60 days.

Lack of knowledge, understanding, and delayed attitudes towards health-seeking behavior in oral cancer patients: a qualitative pilot study

OBJECTIVE

This study aimed to explore coping strategies adopted by patients diagnosed with oral squamous cell carcinoma (OSCC) and investigate the reasons for delayed healthcare-seeking help STUDY DESIGN: Data were collected through semi-structured interviews based on the Semi-Structured Self-Regulatory Model (SRM) with participants diagnosed with advanced OSCC, between 2021 and 2023. The sample size was determined based on the saturation point. In this context, saturation refers to the point when no new issues emerge, signaling sufficient sample size. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using framework analysis.

RESULTS

The sample consisted of 15 patients, 13 male and 2 female, aged between 52 and 80 years (mean 64.5, SD ± 7.5). Four types of coping strategies causing delayed help-seeking emerged: 1) self-medication, 2) seeking medical appointments, 3) abandoning consultations (or treatment), and 4) consulting general dental practitioners. Participants believed that the disease could heal spontaneously and did not consider seeking health help immediately. Socio-economic factors and lack of knowledge on the part of healthcare professionals may have influenced the delay in the diagnosis CONCLUSION: Patients with advanced OSCC demonstrated inadequate disease awareness, oral cancer knowledge, misdiagnosis, and insufficient referrals to specialized treatments.

Mast cells and factor XIIIa+ dendrocytes in actinic cheilitis and lip squamous cell carcinoma

There is an interaction between dendrocytes and mast cells in the skin. However, in elastosis-related diseases such as actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), this interaction remains unknown. We investigated the presence of intact and degranulated mast cells in AC and LLSCC. Associations of mast cells with factor XIIIa+ dendrocytes and inflammatory infiltrate were assessed. Forty cases of AC (20 with low-grade and 20 with high-grade epithelial dysplasia), 50 cases of LLSCC, and 10 cases of normal oral mucosa were evaluated. Toluidine blue staining was performed to identify mast cells, and mast cell densities were calculated in the inflammatory infiltrate. Factor XIIIa+ dendrocytes were immunohistochemically quantified. The highest ratio of intact/degranulated mast cells density was detected in LLSCC (5.9 cells/mm2), followed by AC with high-grade epithelial dysplasia (4.8 cells/mm2). Statistically significant differences were found in the density of intact mast cells compared to degranulated mast cells in AC with low-grade epithelial dysplasia (p<0.001), AC with high-grade epithelial dysplasia (p=0.005), and LLSCC (p<0.001). A positive correlation between degranulated mast cells and total inflammatory infiltrate (p=0.03) was observed in the LLSCC group. The expression of factor XIIIa+ dendrocytes was highest in AC with low-grade epithelial dysplasia (16.5 cells/mm2). The link between mast cell density, factor XIIIa+ dendrocytes, and inflammatory infiltrate indicates a potential crosstalk in lip carcinogenesis.

Can oral cancer screening reduce late-stage diagnosis, treatment delay and mortality? A population-based study in Taiwan

OBJECTIVE

This study evaluates the effectiveness of Taiwan's nationwide oral cancer screening programme in reducing late-stage diagnosis, treatment delays and mortality.

DESIGN

A retrospective cohort study was conducted.

SETTING

The study utilized Nationally representative datasets, including the Cancer Registry, Oral Mucosal Screening and National Health Insurance databases in Taiwan.

PARTICIPANTS

The study included patients with oral cancer diagnosed between 1 January 2010 and 31 December 2013, with follow-up through 31 December 2018. The final analysis included 16 430 patients.

INTERVENTION

The intervention was Taiwan's nationwide oral cancer screening programme which provides visual inspection and palpation of the oral mucosa.

PRIMARY OUTCOME MEASURES

The primary outcomes measured were late-stage diagnosis (stages III and IV), treatment delay (time from diagnosis to treatment >30 days) and all-cause mortality.

RESULTS

Oral cancer screening was statistically significantly associated with a reduced likelihood of late-stage diagnosis (adjusted OR (AOR)=0.85, 95% CI 0.80 to 0.91, p<0.01). However, screening was also associated with a higher likelihood of treatment delay (AOR=1.09, 95% CI 1.00 to 1.19, p=0.049). Taken together, the screening programme is associated with a slightly lower hazard of death (adjusted HR=0.94, 95% CI 0.89 to 0.99, p=0.01).

CONCLUSION

While Taiwan's nationwide oral cancer screening programme effectively reduced late-stage diagnoses and mortality, barriers to timely treatment access remain. Ensuring prompt diagnosis and treatment following screening may further enhance the survival benefits of the programme.

Can predictive factors determine the time to treatment initiation for oral and oropharyngeal cancer? A classification and regression tree analysis

This ecological study aimed to identify the factors with the greatest power to discriminate the proportion of oral and oropharyngeal cancer (OOC) records with time to treatment initiation (TTI) within 30 days of diagnosis in Brazilian municipalities. A descriptive analysis was performed on the variables grouped into five dimensions related to patient characteristics, access to health services, support for cancer diagnosis, human resources, and socioeconomic characteristics of 3,218 Brazilian municipalities that registered at least one case of OOC in 2019. The Classification and Regression Trees (CART) technique was adopted to identify the explanatory variables with greater discriminatory power for the TTI response variable. There was a higher median percentage of records in the age group of 60 years or older. The median percentage of records with stage III and IV of the disease was 46.97%, and of records with chemotherapy, radiation, or both as the first treatment was 50%. The median percentage of people with private dental and health insurance was low. Up to 75% had no cancer diagnostic support services, and up to 50% of the municipalities had no specialist dentists. Most municipalities (49.4%) started treatment after more than 30 days. In the CART analysis, treatment with chemotherapy, radiotherapy, or both explained the highest TTI in all municipalities, and it was the most relevant for predicting TTI. The final model also included anatomical sites in the oral cavity and oropharynx and the number of computed tomography services per 100,000. There is a need to expand the availability of oncology services and human resources specialized in diagnosing and treating OOC in Brazilian municipalities for a timely TTI of OOC.

The impact of colonialism on head and neck cancer in Brazil: a historical essay focussing on tobacco, alcohol and slavery

Colonialism's enduring impact on Brazil has had significant implications for health and oncology outcomes. This historical essay delves into the profound changes brought about by the transatlantic slave trade from Africa to the Americas, particularly in terms of its influence on the economy, sociocultural habits, and health outcomes. This essay explores the enduring connections between the colonial period's operational dynamics in Brazil and the current epidemiological panorama of head and neck cancer (HNC). The examination provides original insights on the role of tobacco and alcohol production and consumption, alongside the investigation of structural racism, which contributes to disparities in access to diagnosis, treatment, and prognosis for patients with HNC. This article presents novel visions and an analysis of evidence-based strategies to disrupt the adverse impact of colonialism's legacy on the epidemiology of HNC in Brazil.