Impact of delay in diagnosis and treatment-initiation on disease stage and survival in oral cavity cancer: a systematic review

Figures & data

Figure 1. Prisma flowchart.

Table 1. Study characteristics: inclusion period, patient age and definition.

Authors (publication year, country)	Center/data source(s)	Inclusion period	Cases, n^a	Mean age at diagnosis (years)	WA, male patients	UICC stage	Type of delay	Definition
Abdo et al., 2007, Brazil [12]	The department of head and neck surgery in a public hospital from Belo Horizonte–Brazil	1999–2001	180	58.40	84.4	I + II = 21% III + IV = 79%	Patient delay	Time from first awareness of symptoms to first professional visit
Fujiwara et al., 2017, USA [13]	National Cancer Database (NCDB)	1998–2011	4,868	62.20	59.9	I = 39% II = 23% III = 10% IV = 29%	TTI	Time from diagnosis to treatment
Jensen et al., 2020, Denmark [17]	Copenhagen Oral Cavity Squamous Cell Carcinoma (COrCa) database with data on patients from Rigshospitalet, Copenhagen University Hospital, Denmark	2000–2014	862	62**	64	I = 29% II = 23% III = 16 IVa, IVb, IVc, IVx = 33%	TTI	Time from diagnosis to treatment.
Kerdpon et al., 2001, Thailand [20]	The Head and Neck Tumor Outpatient Clinic, the Radiotherapy Clinic and the Dental Clinic of Songklanagarind Hospital	1996–1998	161	63.00	72.7	I + II = 38% III + IV = 62%	Patient delay Professional delay Total diagnostic delay	Time from first awareness of symptoms to first professional visit Time from fist professional visit to first consultation with the treating specialist. 1 and 2 together
Kumar et al., 2001, India [21]	Department of Surgery, King George's Medical College	Not specified	79	48.80	57.0	Not specified	Patient delay (primary delay) Professional delay (secondary delay)	Time from first awareness of symptoms to first professional visit Time from fist professional visit to first consultation with the treating specialist
Liao et al., 2017, Taiwan [22]	Taiwan Cancer Registry	2004–2010	18,677	52.80	91.2	I = 28% II = 37% III = 10% IV = 26%	TTI	Time from diagnosis to treatment.
Polesel et al., 2017, Italy [23]	Friuli Venezia Giulia Cancer Registry (FVG-CR)	2003–2009	1,616 (in total) 462 (oral cavity)	Not specified	Not specified	I, II, III IV***	TTI	Time from diagnosis to treatment.
Rutkowska et al., 2020, Poland [19]	1: Clinical Department of Maxillofacial Surgery of the 4th Military Clinical Hospital and Polyclinic in Wrocław 2: Department of Maxillofacial Surgery of Wroclaw Medical University Hospital	1: 2008 − 2018 2: 2010–2018	305	60.7	63.3	I = 9% II = 18% III = 21% IV = 53%	Patient delay	Time from first awareness of symptoms to first professional visit
Rygalski et al., 2020, USA [18]	The National Cancer Database (NCDB), USA	2004–2016	37,730 (in total) 18,672 (oral cavity)	60**	71	I, II, III IV***	TTI	Time from diagnosis to treatment.
Sargeran et al., 2009, Iran [24]	Three university hospitals in Tehran	2004–2006	100	61.80	53.0	I + II = 39% III + IV = 61%	Patient delay Professional delay Total diagnostic delay	Time from first awareness of symptoms to first professional visit Time from first professional visit to final diagnosis 1 and 2 together
Scott et al., 2005, England [15]	Guy’s Hospital Head and Neck Cancer Service, London	1992–2003	245	61.00	64.1	I = 20% II = 29% III = 21% IV = 30%	Total diagnostic delay	Time from first awareness of symptoms to date of diagnosis
Seoane et al., 2010, Spain [27]	Central University Hospital of the Defence	1997–2002	63	61.80	73.0	I = 14% II = 32% III = 16% IV = 38%	Total diagnostic delay	Time from first awareness of symptoms to date of diagnosis.
Seoane et al., 2012, Spain [14]	Oral and Maxillofacial Surgery Service of the CHUAC	1998–2003	88	60.00	65.9	I + II = 45.5% III + IV = 54.5%	Total diagnostic delay	Time from first awareness of symptoms to date of diagnosis
Teppo et al., 2008, Finland [25]	The Registers of Oulu University Hospital	1986–1996	221 (in total) 62 (tongue)	61.00	47.0	I = 13% II = 35% III = 40% IV = 11%	Patient delay Professional delay	Time from first awareness of symptoms to first professional visit Time from initial medical visit to diagnosis
Thomas et al., 2020, Australia [16]	Australian Comprehensive Cancer Outcomes Database, The Royal Melbourne Hospital		100	63.4**	63	I + II = 58% III + IV = 42%	Total diagnostic delay	Time from first awareness of symptoms to date of diagnosis
Tong et al., 2014, China [26]	Department of Oral and Maxillofacial Surgery of the Third Xiangya Hospital of Central South University	2009–2011	77	52.95	81.8	T1 = 17% T2 = 46% T3 + T4 = 38% N0 = 62% N1 + N2a + N2b = 34%	Total diagnostic delay	Time from first awareness of symptoms to date of diagnosis
				Total weighted average:	82.93*

WA: weighted average.

^aOnly the number of malignant cases was included.

*Polelsel et al. and Rygalski et al. not included as these studies did not specify percentage of men among oral cavity cancer patients.

**Median age.

***Percentage not specified for oral cavity cancer specifically.

Table 2. Impact of delay in diagnosis and treatment initiation – results study by study.

Authors (publication year, country)	Results
Abdo et al., 2007, Brazil [12]	Patient delay did not significantly correlate with advanced stage at diagnosis
Fujiwara et al., 2017, USA [13]	TTI^a did not significantly correlate with OS^b
Jensen et al., 2020, Denmark [17]	TTI^a did not significantly correlate with OS^b (when adjusting for age, sex, smoking, UICC^c stage, tumor sublocation, and CCI^d in multivariate analyses)
Kerdpon et al., 2001, Thailand [20]	Patient delay significantly correlated with advanced stage at diagnosis
	Professional delay did not significantly correlate with advanced stage at diagnosis
	Total diagnostic delay did not significantly correlate with advanced stage at diagnosis
Kumar et al., 2001, India [21]	Patient delay significantly correlated with advanced stage at diagnosis
	Professional delay did not significantly correlate with advanced stage at diagnosis
Liao et al., 2017, Taiwan [22]	TTI^a significantly correlated with OS^b
Polesel et al., 2017, Italy [23]	TTI^a significantly correlated with OS^b (no clear advantage in OS for patients treated within 30 days, compared to patients treated between 30 and 44 days)
Rutkowska et al., 2020, Poland [19]	Patient delay did not significantly correlate with advanced stage at diagnosis
Rygalski et al., 2020, USA [18]	TTI^a significantly correlated with OS^b (significant correlation for TTI^a of 61 to 90 days, and longer than 90 days, compared with 0–30 days)
Sargeran et al., 2009, Iran [24]	Patients delay significantly correlated with advanced stage at diagnosis
	Professional delay significantly correlated with advanced stage at diagnosis
	Total diagnostic delay significantly correlated with advanced stage at diagnosis
Scott et al., 2005, England [15]	Total diagnostic delay did not significantly correlate with advanced stage at diagnosis
Seoane et al., 2010, Spain [27]	Total diagnostic delay did not significantly correlate with OS^b
Seoane et al., 2012, Spain [14]	Total diagnostic delay did not significantly correlate with advanced stage at diagnosis
Teppo et al., 2008, Finland [25]	Patient delay did not significantly correlate with advanced stage at diagnosis
	Professional delay did not significantly correlate with advanced stage at diagnosis
Thomas et al., 2020, Australia [16]	Total diagnostic delay did not significantly correlate with advanced stage at diagnosis
	Total diagnostic delay did not significantly correlate with OS^b
Tong et al., 2014, China [26]	Total diagnostic delay significantly correlated with OS^b

^aTTI: Time to Treatment Initiation.

^bOS: Overall Survival.

^cUICC: The Union for International Cancer Control.

^dCCI: Charlson Comorbidity Index

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