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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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Kuriakose S, Krishnamurthy A, Vinutha RS, Ramshankar V, Sekhar S, Walia GK, Gupta R, Aggarwal A, Singh R, Rajan S, Kondal D, Grover S, Prabhakaran D, Dhillon PK, Shridhar K, Goodman M. Time intervals and patient-level factors in oral cancer diagnostic pathways: An application of the WHO framework in India. Cancer Epidemiol 2022; 81:102283. [PMID: 36335850 DOI: 10.1016/j.canep.2022.102283] [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: 09/01/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Oral cancer, a leading cancer-site in India, is often detected at advanced stages. We evaluated the time intervals from first symptom to help-seeking and diagnosis among oral cancer patients. METHODOLOGY In this cross-sectional study, we recruited 226 consecutive oral cancer patients (mean age ( ± SD) 51.9 years ( ± 10.9); 81.9% men; 70.3% advanced stage) registered for diagnosis and treatment, between 2019 and 2021 at a cancer care centre in South India. We used WHO framework and previously standardized tools to record time intervals (appraisal, help-seeking and diagnostic) and baseline characteristics. We utilized multivariable logistic regression models to test the associations between 'prolonged (i.e., over 1 month) time intervals') and patient-level factors to estimate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Over a half of patients presented with prolonged appraisal (60%) and help-seeking intervals (57%), and a third (34%) reported prolonged diagnostic interval. Patients with no formal education, no routine healthcare visits, no self-reported risk factors, and those who did not perceive initial symptoms to be serious were 2-4 times more likely to have prolonged appraisal and help-seeking than the rest. High travel costs and self-decision for visiting healthcare facility prolonged help-seeking. Diagnostic interval was prolonged only among women OR= 2.7 (95% CI: 1.2-6.1)) and in patients whose first doctor's opinion was 'nothing to worry' OR (=7.3 (95% CI: 2.6-20.5)). 'Correct knowledge of cancer' shortened appraisal and help-seeking intervals and 'incorrect knowledge and negative beliefs' prolonged diagnostic interval. CONCLUSION Our findings highlight that interventions targeting sociocultural and economic determinants, symptom awareness, sensitizing persons at risk (especially women) and primary care providers might reduce overall time to diagnosis. Further, patients without any known risk factors for oral cancer might be at-risk for prolonged appraisal interval. These might help inform 'pull' strategies for cancer control in India and similar settings.
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Affiliation(s)
- Steena Kuriakose
- Centre for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, Delhi 110016, India.
| | | | - R S Vinutha
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Vijayalakshmi Ramshankar
- Department of Preventive Oncology and Molecular Testing Laboratory, Cancer Institute WIA, Adyar, Chennai 600020, India.
| | | | - Gagandeep Kaur Walia
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Ruby Gupta
- Centre for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, Delhi 110016, India; Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Aastha Aggarwal
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Ranjana Singh
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Sheril Rajan
- Centre for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, Delhi 110016, India.
| | - Dimple Kondal
- Centre for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, Delhi 110016, India; Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Surbhi Grover
- Hospital of the University of Pennsylvania, Department of Radiation Oncology, 3400 Civic Center Blvd., Philadelphia, PA 19104, United States.
| | - D Prabhakaran
- Centre for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, Delhi 110016, India; Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Preet K Dhillon
- Centre for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, Delhi 110016, India; Department of Real World Data, PD Data Sciences, Genentech Inc., South San Francisco, CA, USA.
| | - Krithiga Shridhar
- Centre for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, Delhi 110016, India; Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002, India.
| | - Michael Goodman
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
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Gaballah K, Kujan O. The Impact of Educational Intervention on Junior Dentists' Capacity to Detect Oral Mucosal Lesions and Suspect Malignant Potential. Asian Pac J Cancer Prev 2022; 23:3673-3676. [PMID: 36444579 PMCID: PMC9930960 DOI: 10.31557/apjcp.2022.23.11.3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aimed to assess the impact of Continuing Education (CE) activity on junior dentists' competency to identify oral mucosal abnormalities those suggestive of oral cancer or potentially malignant disorders. MATERIALS AND METHODS This multiphase study administered a pre-validated quiz to dental interns and junior dentists. The quiz was designed to assess the respondent's competency to recognize different oral lesions and stratify their potential for malignancy. Invited candidates attempted the quiz and then attended an informative half-day workshop focused on identifying oral mucosal changes, diagnosing various oral lesions, and recognizing the risk factors and features that suggest the malignant potential of oral lesions. The post-intervention survey was sent to the workshop attendees by 7 months. RESULTS 67 out of 110 invitees attended the workshop, with an overall response rate of 60.1%. In the initial quiz, the overall accuracy of diagnosis was 55.1±9.04%. The participants correctly identified most normal variations (80.60±5.05), but less than half of the benign lesions (40.96±8.30) and potentially malignant lesions (43.62±6.02). The malignant lesions were correctly diagnosed by 55.22±3.98% of the participants. The CE intervention has improved the overall diagnostic accuracy (74.81±5.84% (p,0.015); benign to 70.18±6.68% (p,0.02), the potentially malignant lesions to 62.99±4.63% (p,0.01). CONCLUSIONS This study highlights the importance of CE activity in improving the role of dentists in the detection of oral cancer. CE activity has remarkably enhanced the junior dentists' ability to accurately diagnose various oral lesions and effectively stratify their malignant potential.
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Affiliation(s)
- Kamis Gaballah
- Department of oral and Craniofacial Health sciences, College of Dental Medicine, University of Sharjah, UAE. ,For Correspondence:
| | - Omar Kujan
- Oral Diagnostic and Surgical Sciences, UWA Dental School, The University of Western Australia, Nedlands, WA, Australia.
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FREIRE MMDS, ZANIN L, FLÓRIO FM. Câncer bucal: o que sabem os cirurgiões-dentistas da Baixada Litorânea-RJ? REVISTA DE ODONTOLOGIA DA UNESP 2022. [DOI: 10.1590/1807-2577.04922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumo Introdução Apesar das estratégias para prevenção e diagnóstico precoce, o câncer bucal está entre os mais incidentes no Brasil. Objetivo Avaliar o conhecimento de cirurgiões-dentistas da Atenção Primária à Saúde sobre o câncer bucal. Material e método Pesquisa censitária, exploratória e quantitativa, realizada em 2021. Cirurgiões-dentistas vinculados à rede pública dos 9 municípios da Baixada Litorânea/RJ preencheram um questionário com 41 questões, divididas em 5 blocos: 1. Perfil sociodemográfico, 2. Conhecimento sobre câncer bucal, 3. Fatores de risco para câncer bucal, 4. Segurança para diagnóstico do câncer bucal e 5. Experiência na identificação de lesões suspeitas. Resultado Dos 128 cirurgiões-dentistas habilitados, 89,1% (n=114) participaram e caracterizavam-se por terem menos de 40 anos (50%), serem do sexo feminino (64,9%) e formados há mais de 16 anos (57,9%). Quanto ao conhecimento sobre o câncer bucal e fatores de risco, 84,2% consideraram seu nível de conhecimento regular ou bom e 65,8% consideraram baixo o seu nível de segurança para realização de procedimentos de diagnóstico do câncer bucal. Quanto à identificação de lesões suspeitas de câncer bucal, 86,8% realizavam exame da cavidade bucal, 7,9% não realizam porque o tempo da consulta é insuficiente e 5,3% porque não sabem fazer. Além disso, 50,9% identificaram alguma lesão suspeita nos últimos 12 meses. Notou-se também que 65,8% dos CDs não tinham conhecimento do fluxograma do município para diagnóstico e tratamento do câncer bucal. Conclusão Os achados evidenciaram lacunas com relação ao conhecimento e procedimentos para diagnóstico precoce do câncer bucal.
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Affiliation(s)
| | - Luciane ZANIN
- Centro de Pesquisas Odontológicas São Leopoldo Mandic, Brasil
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