Secondary Care Delay in Diagnosis and Treatment of Oral Cancer at Asir Central Hospital, Saudi Arabia: A Case Series Study
Author(s): Hussain Almubarak, Mohammad Almagbol, Saad Albishri, Bayan Dulim, Yusra Alshahrani, Afnan Mohammed, Abdulrahman Alshehri, Ibrahim Alsharif, Sultan Mohammed Kaleem, M Zakirulla*
Background: The stage of disease at the diagnosis of oral cancer is thought to be a significant factor in prognosis and outcome. Unfortunately, we continue to diagnose almost 2/3 of these cancers at advanced stages of disease despite the ongoing research for devices/methods to aid the clinicians in detection and accurate oral mucosal lesion diagnosis. This paper explores both the nature of oral cancer and the adjuncts available for detection and presents the current issues in diagnostic delays of oral cancer detection. Aims: To estimate the professional delay between the first consultation till confirming definitive diagnosis and initiation of treatment of oral cancer patients at Asir central hospital. To determine demographic distribution, site, and stage of tumor presentation at the time of diagnosis & to determine referral time needed to refer a patient from Asir central hospital to tertiary hospitals or other medical centers. Materials & Methods: This study design is a case series-based study done on patients who are preliminarily diagnosed as having oral cancer and is focused on the secondary care delay occurring in diagnosing and initiation of treatment at Asir Central Hospital in the southern province of Saudi Arabia, Abha from 1st of January 2005 till 31st December 2015. A convenience sampling was done and a data extraction form was used to collect relevant details of the patient's age, gender, site, type and staging of the tumor, the time of the first consultation with a health care provider, time of completing the histopathologic report and the time of initiation of treatment. Data analysis was done by using SPSS software, and statistical analysis was done to frame the results. Results: Out of 63 patients consulted in the time period of one year, 36 were males, and 27 were females, and 95.2% (60) were Saudis, and 4.8% (3) were expatriate subjects. The mean age of the study subjects is 61years standing between 29 years to 69 years of age. Twenty-eight subjects (44.4%) were unknown of oral cancer on their first consultation, and 35 subjects (55.5%) are directly referred through the first consultation with a dentist or a physician. Based on the analysis of results, the tongue followed by the floor of the mouth were the most common sites of the tumor and the majority of cases were diagnosed as squamous cell carcinoma (77.8%) followed by basal cell carcinoma (6.3%) and non-Hodgkin’s lymphoma (4.8%). Sixty-one subjects were considered as oral cancer cases based on their histopathological diagnosis, and two subjects were excluded from the study as they were benign tumors at the time of diagnosis. Most reported cases are in stage 2 (29.5%), followed by stage 1 (3.2%), and in (67%) of patients, the staging was not reported. Conclusions: Timeline analysis between the first consultation till the date of final diagnosis reveals a mean time of 24.27 days in 54% of cases, and 18.2% were diagnosed on the same day. Timeline analysis for the time needed between the final diagnosis to the initiation of treatment resulted in 82 days approximately. The most prolonged time interval noted was 2yrs 26months, and the shortest interval is 1day. Further investigations are needed to assess diagnostic delay components more comprehensively and at a larger scale. This study highlights the structural needs to improve the quality of the health care services by closing the gaps and addressing the delay issues in the diagnosis and treatment of oral cancer.