Delays in the Diagnosis and Treatment of Oral Cancer Delays in the Diagnosis and Treatment of Oral Cancer M. A. Pogrel FDS, FRCS Professor and Chairman Department of Oral and Maxillofacial Surgery University of California, San Francisco

Although there have been improvements in the cure rate of Oral Cancer due to better diagnostic aids and more aggressive combined treatment The best chance of improving the cure rate at the present time lies in early presentation and treatment

Early Diagnosis and Treatment- Decreases morbidityDecreases morbidity Improves the cure rateImproves the cure rate

True Screening is not Possible Must be a common enough diseaseMust be a common enough disease Must be able to identify “at risk” groups.Must be able to identify “at risk” groups. Must have an acceptable test.Must have an acceptable test. Must have no false positives or false negativesMust have no false positives or false negatives Diagnosis must make a differenceDiagnosis must make a difference Must be cost effective.Must be cost effective.

We do the best we can by carrying out a full intra-oral examination on all patients, but- We miss the high risk groups

We looked at the delay in the different stages of the referral process for 25 consecutive referrals for oral cancer

Time from patient first aware of problem to seeking professional advice 128.1days(14-730)Time from patient first aware of problem to seeking professional advice 128.1days(14-730) Time from primary presentation to referral to specialist (Dents. better than Docs.) 28.2 days(0- 176) Time from primary presentation to referral to specialist (Dents. better than Docs.) 28.2 days(0- 176) Time from referral to actually being seen Time from referral to actually being seen 9.9 days(0-30) 9.9 days(0-30) Time for completion of imaging and tests Time for completion of imaging and tests 6.6 days(0-25) 6.6 days(0-25) Time from tests to presentation to H&N Tumour Board 19.8 days(1-223) Time from tests to presentation to H&N Tumour Board 19.8 days(1-223) Time from Tumour Board to definitive treatment 19.6 days(4-76) Time from Tumour Board to definitive treatment 19.6 days(4-76) TOTAL TIME days ( ) 7 months TOTAL TIME days ( ) 7 months

NHS fast track initiative If cancer is suspected patient should be treated within 62 days of referral to a specialist(14 to be seen, 17 for tests and 31 to schedule treatment.)If cancer is suspected patient should be treated within 62 days of referral to a specialist(14 to be seen, 17 for tests and 31 to schedule treatment.) 55.9 in present study (range days) with only 3 above the 62 day guidelines.55.9 in present study (range days) with only 3 above the 62 day guidelines.

The biggest delay is still getting the patient with symptoms to go and see someone (128.1 days out of days) Fear (apprehension, denial, time)Fear (apprehension, denial, time) Infirmity, languageInfirmity, language Cost (money, time off work)Cost (money, time off work)