Scott et al, 2005 UK26 | Structured interviews 245 patients with oral cancer | Stage of disease at diagnosis by referring healthcare professional | Stage at diagnosis by referring HCP: GP: Stage I or II: 41.3% Stage III or IV: 58.7% (stage I/II versus stage III/IV): OR 1.85, 95% CI = 0.8 to 4.1 Dentist: Stage I or II: 56.6% Stage III or IV: 43.4% or (stage I/II versus stage III/IV): 1.0 (reference) |
Scott et al, 2006 UK27 | Semi-structured interviews 17 patients with oral cancer | Deterrents from accessing GP/dental practice | Narrative as provided by patients: ‘I was having trouble getting an NHS dentist and didn’t want to pay for an expensive private dentist’ ‘Nearest appointment at dentist was over a week, so I didn’t bother’ |
Rogers et al, 2007 UK28 | Case-series analysis 559 patients with cancer of the mouth or oropharynx | Length of delay in sending referral from primary to secondary care Time interval from presentation in primary care to referral being sent Referral delay by referral destination | Interval between primary care consultation and referral being sent to secondary care: 78% (n= 253) of referrals were sent on the same day as the consultation (GP and dentist) 11% (n= 36) of referrals were sent 21 days after the consultation If referral was delayed by at least 1 day, the median time for the referral to be sent was 17 days (IQR 7 to 42 days) Interval between first presentation in primary care and referral being sent to secondary care: GP: n= 194 mean 22 days, IQR 12 to 48 Dentist: n = 174 mean 22, IQR 9 to 65, P= 0.48 Referral delay by referral destination: Delay was found to be 1 week longer if sent to a peripheral hospital compared with the regional maxillofacial unit or university dental school |
Crossman et al, 2016 UK29 | Structured postal questionnaire 161 patients with oral cancer | Barriers in visiting a primary medical practitioner Actions from first consultation with GP | Barriers to visiting a doctor: ‘I didn’t realise the problem or symptoms were serious’ 77% (n= 74) ‘I was too worried about what the doctor might find’ 6% (n= 6) ‘I was too busy to make time to go to the doctor’ 4% (n= 4) ‘I was worried I was wasting the doctor’s time’ 3% (n= 3) ‘I was too scared to go to the doctor’ 2% (n= 2) ‘I found my doctor difficult to talk to’ 1% (n= 1) Actions from first consultation with GP: 53% (n= 58) referred to a specialist at a hospital clinic 22% (n= 24) referred for tests 12% (n= 13) treated for another condition 7% (n= 8) symptom not serious, told to come backif continued 5% (n= 5) symptoms not serious, not told to comeback if continued 1% (n= 1) sent straight to hospital the same day |
Schnetler, 1992 UK30 | Case-series analysis 96 patients with oral cancer | Presence of delay by referring HCP Correct diagnosis by referring HCP Practitioner working diagnosis Other HCP management | Delay by referring HCP (delay defined as > 2 days from physical examination): Dentist: 62.0% delayed (n= 24/39) GP: 36.0% delayed (n= 18/50) Hospital doctor: 14.3% (n= 1/7) Correct diagnosis by referring HCP: Dentist: 20.5% correct (n= 8/39) GP: 52.0% correct (n= 26/50) χ2 test P<0.01 Practitioner working diagnosis: Malignancy: GP: 52% (n= 26) Dentist: 20.5% (n= 8) Infection: GP: 22% (n= 11) Dentist: 31% (n= 31) White patch: GP: 8% (n= 4) Dentist: 10% (n= 4) Chronic ulcer: GP: 4% (n= 2) Dentist: 5% (n= 2) Other actions from first consultation with HCP: Antiviral medication: GP: 30% (n= 15) Dentist: 33% (n= 13) Topical steroids: GP: 4% (n= 2) Dentist: 3% (n= 1) Carbamazepine: GP: 2% (n= 1) Dentist: 0% (n= 0) Dental work: GP: 0% (n= 0) Dentist: 23% (n= 9) |
Hollows et al, 2000 UK31 | Case-series analysis 100 patients with oral cancer | Length of delay in sending referral from primary to secondary care Interpretation of referral urgency by secondary care | Length of delay in sending referral from primary to secondary care: GP: mean 14.5 days, SD 32.3, range 0 to 173 days Dentist: mean 8.4 days, SD 17.6, range 0 to 90 days 69% of patients were referred within 1 week by primary care physician (GP and dentist) Interpretation of referral urgency by secondary care: Dentist: 7% interpreted as urgent GP: 27% interpreted as urgent (χ2= 2.6, 1 df, P= 0.05) |
Kaing et al, 2016 Australia34 | Case-series analysis 101 patients with oral cancer | Initial referral destination from first consultation with HCP Actions from first consultation with HCP Total diagnostic delay by referring HCP | Initial referral destination from first consultation with HCP: Referral to oral medicine surgeon: Dentist: 78.6% (n= 33/42) GP: 49.1% (n= 26/53) Referral to other dental specialist (oral medicine, periodontist): Dentist: 40.5% (n= 17) GP: 20.8% (n= 11) Referral to another medical specialist: Dentist: 0% (n= 0) GP: 20.8% (n= 11) Referral to dentist: Dentist: 0% (n= 0) GP: 11.3% (n= 6) Actions from first consultation with HCP: Antibiotic prescription: Dentist: 40.5% (n= 17/42) GP: 47.2% (n= 25/53) Ulcer management: Dentist: 35.7% (n= 15) GP: 24.5% (n= 13) Extraction: Dentist: 28.5% (n= 12) GP: 0% (n= 0) Reassurance/monitoring: Dentist: 11.9 % (n= 5) GP: 7.5% (n= 4) Biopsy: Dentist: 0% (n= 0) GP: 7.5% (n= 4) Diagnostic delay by referring HCP: Dentist: mean 5.8 months, range 0 to 3 years GP: mean 5.3 months (3.5 months excluding outliers), range 0 to 8 years |
Jovanovic et al, 1992 Netherlands32 | Case-series analysis 50 patients with oral cancer | Length of delay by first HCP consulted | Length of delay by first HCP consulted: GP (n= 27): 0–4 weeks: 81.5% 5–16 weeks: 14.8% >16 weeks: 3.7% Dentist (n= 12): 0–4 weeks: 67.0% 5–16 weeks: 25.0% >16 weeks: 8.3% |
Kowalski et al, 1994 Brazil35 | Structured interviews 336 patients with cancer of the mouth or oropharynx | Stage of disease at diagnosis by referring HCP | Stage of disease at diagnosis by referring HCP: GP: Stage I or II: 27.3% Stage III or IV: 72.7% Dentist: Stage I or II: 14.3% Stage III or IV: 85.7% |
Peacock et al, 2008 US40 | Case-series analysis 50 patients with oral cancer | Primary care component of diagnostic journey | Time from the patient visiting a primary care clinician to undergoing a biopsy or being referred Mean 35.9 days, range 0 to 280 days |
Groome et al, 2011 Canada36 | Case-series analysis 2033 patients with oral cancer | Stage of disease at diagnosis by dentist/doctor status | Stage of disease at diagnosis by dentist/doctor status: Participants responding ‘yes’ to ‘do you have a regular dentist?’: Stage I (n= 661): 39.9% Stage II (n= 550): 34.0% Stage III (n= 289): 34.6% Stage IV (n= 524): 32.1% P= 0.03 Participants responding ‘yes’ to ‘do you have a family doctor?’: Stage I (n= 660): 92.6% Stage II (n= 550): 96.0% Stage III (n= 288): 97.6% Stage IV (n= 523): 92.2% P= 0.001 |
Wildt et al, 1995 Denmark37 | Structured questionnaire 167 patients with oral cancer | Patient preference of primary medical contact for oral symptoms | Patient preference of primary medical contact for oral symptoms: GP: 45% (n= 75) Dentist: 35% (n= 58) ENT specialist: 14% (n= 23) Other: 7% (n= 11) |
Tromp et al, 2005 Netherlands33 | Structured interviews 306 patients with cancer of the mouth or oropharynx | Stage of disease at diagnosis versus length of referral delay | Stage of disease at diagnosis versus length of referral delay (stage I and II versus stage III and IV):a <1 month: 107 versus 50 (OR 1.00) 1–3 months: 49 versus 29 (OR 1.22, 95% CI = 0.69 to 2.17) >3 months: 35 versus 18 (OR 1.10, 95% CI = 0.57 to 2.13) |
Kantola et al, 2001 Finland38 | Case-series analysis 75 patients with oral cancer | Actions from first HCP consulted with Stage of disease at diagnosis Stage of disease at diagnosis, based on referral patterns | Referral actions: first HCP consulted with: Referred for further examination: 65% (n= 49) Scheduled follow-up only: 16% (n= 12) No referral or follow-up: 19% (n= 14) Stage of disease at diagnosis: Stage I and II: 41% (n= 31) Stage III and IV: 59% (n= 44) TNM stage and malignancy grade at diagnosis, based on referral patterns (median): Referred (n= 49): Stage I and II: 51% (n= 25) Stage III and IV: 49% (n= 24) Average malignancy grade: 10 (range 7 to 16) Not referred but followed up (n= 12): Stage 1 and II: 16% (n= 2) Stage III and IV: 84% (n= 10) Average malignancy grade: 12 (range 9 to 14) Neither referred nor followed up (n= 14): Stage I and II: 28% (n= 4) Stage III and IV: 72% (n= 10) Average malignancy grade: range 9 to 16, P= 0.02 |
Onizawa et al, 2003 Japan39 | Case-series analysis 144 patients with cancer of the mouth or oropharynx | Delay in referral by HCP Stage of disease at diagnosis by referral delay | Delay in interval between first presentation to HCP and referral by HCP (defined as >6 days) Dentist: Delay: 55.3% (n= 47) No delay: 44.7% (n= 38) OR 1.0, 95% CI = referent GP: Delay: 51.7% (n= 15) No delay: 48.3% (n= 14) P= 0.739, OR 0.87, 95% CI = 0.37 to 2.02 T category of disease at diagnosis, based on delay/no delay in referral from primary care (defined as >6 days) T1 category: Delay: 66.7% (n= 16) No delay: 33.3% (n= 8) OR 1.0, 95% CI = referent T2 category: Delay: 51.9% (n= 27) No delay: 48.1% (n= 25) P= 0.231, OR 0.54, 95% CI = 0.20 to 1.48 T3 category: Delay: 29.6% (n= 8) No delay: 70.3% (n= 19) P= 0.010, OR 0.21, 95% CI = 0.06 to 0.69 T4 category: Delay: 48.8% (n= 20) No delay: 51.2% (n= 21) P= 0.165, OR 0.48, 95% CI = 0.17 to 1.36 |
Kerdpon et al, 2001 Thailand41 | Structured questionnaire 161 patients with oral cancer | Actions from first consultation with HCP | Actions from first consultation with HCP: Referral or biopsy: 52.2% (n= 84) Medication (non-antibiotics): 28.6% (n= 46) Antibiotics: 9.3% (n= 15) Dental work: 5.0% (n= 8) Reassurance: 0.6% (n= 1) |