Original Article

Treatment delay among oral cancer patients in Tehran, Iran


Introduction:  Despite  recent  advances  in  treatment  of  oral  cancer,  it  still causes high rates of mortality and morbidity worldwide. Delays in diagnosis and treatment of these cancers greatly affect the prognosis.  This study aimed to assess the treatment delay and its relation to diagnostic delay among oral cancer patients in Tehran, Iran.Materials and Methods: We studied 100 patients with primary oral squamous cell carcinoma who were admitted to three teaching hospitals between 2004 and 2006. Treatment delay was defined as the time from diagnosis to the beginning of treatment. Diagnostic delay is considered as the time elapsed between the onset of symptoms and diagnosis.Results: Of all the patients 53% were male with the mean age of 61.5 (SD 15.8 years; range 24-100 years) at diagnosis. The majority of tumors (61%) were at advanced stages when diagnosed (stages III or IV). The mean diagnostic delay was 7.2 months (SD 7.5) and the mean treatment delay was 33.16 days (SD14.1).  Patients  who  were  diagnosed  at earlier  stages  had  longer  treatment delays (p<0.05), and those who had longer diagnostic delay had shorter treatment delay (p<0.05).Conclusions:  Our  findings  indicated  a  need  for  oral  cancer  prevention campaigns, focused on reducing the delays between the appearance of signs and symptoms, and final diagnosis and treatment to ensure better prognosis and higher quality of life for patients.

Ferlay J, Shin H, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127 (12): 2893- 917.

Johnson NW, Warnakulasuriya S, Gupta P, Dimba E, Chindia M, Otoh E, et al. Global Oral Health Inequalities in Incidence and Outcomes for Oral Cancer: Causes and Solutions. Adv Dent Res. 2011; 23(2):237-46.

Oliveira LR, Ribeiro-Silva A, Costa JP,Simões AL, Matteo MA, Zucoloto S. Prognostic factors and survival analysis in a sample of oral squamous cell carcinoma patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106(5):685-95.

van Harten MC, de Ridder M, Hamming- Vrieze O, Smeele LE, Balm AJ, van den Brekel MW. The association of treatment delay and prognosis in head and neck squamous cell carcinoma (HNSCC) patients in a Dutch comprehensive cancer center. Oral Oncol. 2014 [Epub ahead of print].

Sadjadi A, Zahedi MJ, Darvish moghadam S, Nouraie M, Alimohammadian M, Ghorbani L A, et al. The first population-based cancer survey in Kerman, province of Iran. Iranian J Publ Health. 2007; 36: 26-34.

Iran Ministry of Health and Medical Education. A report of cancer situation in Iran. 2003.

Sargeran K, Murtomaa H, Safavi SM, Teronen O. Delayed diagnosis of oral cancers in Iran: challenge for prevention. Oral Health Prev Dent. 2009; 7: 69-76.

Sargeran K, Murtomaa H, Safavi SM, Vehkalahti M, Teronen O. Survival after diagnosis of cancer of the oral cavity. British Journal of Oral and Maxillofacial Surgery.2008; 46: 187-91.

WHO. International Statistical Classification of Diseases and Related Health Problems. WHO, Geneva 2003.

Sobin LH, Wittekind CL. UICC, International Union Against Cancer, TNM classification of malignant tumors. Wiley-Liss, New York 2002.

McLeod NM, Saeed NR, Ali EA. Oral cancer: delays in referral and diagnosis persist. Br Dent J 2005; 198:681-4.

Stefanuto P, Doucet J-C, Robertson C. Delays in treatment of oral cancer- a review of the current literature. Oral Surg, Oral Med, Oral Path, Oral Radiol. 2014 [Epub ahead of print].

Friedrich RE. Delay in diagnosis and referral patterns of 646 patients with oral and maxillofacial cancer: a report from a single institution in Hamburg, Germany. Anticancer Res. 2010; 30(5):1833-6.

Abdo EN, Garrocho Ade A, Barbosa AA, Oliveira EL, Franca-Filho L, Negri SL, Pordeus IA. Time elapsed between the first symptoms, diagnosis and treatment of oral cancer patients in Belo Horizonte, Brazil. Med Oral Patol Oral Cir Bucal. 2007; 12(7):E469-73.

Morelatto RA, Herrera MC, Fernández EN,Corball AG, López de Blanc SA. Diagnostic delay of oral squamous cell carcinoma in two diagnosis centers in Córdoba Argentina. J Oral Path Med 2007; 36(7): 405-8.

Seoane J, Varela-Centelles PI, Walsh TF, Lopez-Cedrun JL, Vazquez I. Gingival Squamous Cell Carcinoma: Diagnostic Delay or Rapid Invasion? J Periodontol. 2006; 77(7):1229-33.

Scott SE, Grunfeld EA, McGurk M. The idiosyncratic relationship between diagnostic delay and stage of oral squamous cell carcinoma. Oral Oncol. 2005; 41(4): Pages 396–403.

Llewellyn CD, Johnson NW, Warnakulasuriya S.Factors associated with delay in presentation among younger patients with oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97(6):707-13.

McGurk M, Chan C, Jones J, O’Regans, Sherriff M. Delay in diagnosis and its effect on outcome in head and neck cancer. Br J Oral Maxillofac Surg. 2005; 43(4): 281–4.

Scott SE, McGurk M, Grunfeld EA. The process of symptom appraisal: cognitive and emotional responses to detecting potentially malignant oral symptoms. J Psychosom Res.2007; 62(6):621-30.

Souza LM, Michel-Crosato E, Biazevic MG, Antunes JL. Scheduling delay in suspected cases of oral cancer. Rev Bras Epidemiol.2011; 14(4):642-50.

Patel M, Khan AQ, Thiruchelvam J.Importance of quality in referral letters sent for potentially malignant oral, head and neck lesions. Dent Update. 2011; 38(3):192-4, 196-8.

Melrose RJ. Failure to diagnose pathology: an avoidable complication in oral and maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2011; 23(3):465-73.

Peacock ZS, Pogrel MA, Schmidt BL.Exploring the reasons for delay in treatment of oral cancer. J Am Dent Assoc. 2008;139(10):1346-52.

Rogers SN, Pabla R, McSorley A, Lowe D, Brown JS, Vaughan ED. An assessment of deprivation as a factor in the delays in presentation, diagnosis and treatment in patients with oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2007;43(7):648-55.

Lydiatt DD. Cancer of the oral cavity and medical malpractice. Laryngoscope. 2002;112(5):816-9.

Sharp L, Lewin F, Hellborg H, Lundgren J, Hemmingsson E, Rutqvist LE. When does my treatment start?--The continuum of care for patients with head and neck cancer. Radiother Oncol. 2002; 63(3):293-7.

Hollows P, McAndrew PG, Perini MG.Erratum in: Br Dent J 2000 Apr 8;188(7):380. Delays in the referral and treatment of oral squamous cell carcinoma. Br Dent J. 2000;188(5):262-5.

IssueVol 1, No 3-4 (Summer/Autumn 2014) QRcode
SectionOriginal Article(s)
Diagnostic delay Iran Oral cancer Treatment delay

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Sargeran K. Treatment delay among oral cancer patients in Tehran, Iran. J Craniomaxillofac Res. 2015;1(3-4):37-41.