Factors affecting professional delay in diagnosis and treatment of oral cancer in Iran.
BACKGROUND
Oral cancer is the most common malignant tumor among head and neck cancers. Delay in diagnosis affects the treatment and prognosis of oral cancer. We measured the professional delay in the diagnosis and its attributes in the Cancer Institute of Iran, the largest referral center for oral cancer patients in the country.


METHODS
We interviewed oral cancer patients to measure the delay and used case-control approach to study association of various prognostic factors with professional delay and tumor stage.


RESULTS
Out of 206 patients, 71.4% were diagnosed at the advanced stage. The median of the patient, professional and total delays were 45, 86 and 140 day, receptively. In the univariate model, prescription of medicines like analgesics (OR = 5.3, 95% CI 2.2-12.9) and history of dental procedure (OR=6.8, 95% CI 1.7-26.9) were associated with higher risk of delay compared to patient who were biopsied from the beginning. History of loose teeth increased risk of delay 4 times (OR = 4.0, 95% CI 1.6-9.8). Patients with primary education had 70% lower risk of delay compared to the illiterate patients (OR = 0.3, 95% CI 0.1-0.7) and the risk was lower among patients who had diploma (OR = 0.04, 95% CI 0-0.7) and college education (OR = 0.1, 95% CI 0-0.4). The delayed patients were diagnosed in more advanced stage compared to the patients without delay (OR = 2.1, 95% CI 1.0-4.4).


CONCLUSIONS
Development of a national guideline for follow-up of oral lesions, training and awareness of health care professionals about oral cancer diagnosis may decrease the delay and improve the oral cancer outcome in Iran.
Department of Surgery, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Farhad
F
Esmaelbeigi
Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
Maryam
M
Hadji
Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
Iraj
I
Harirchi
1)Department of Surgery, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran. 2)Cancer Research Center,Cancer institute of Iran, Tehran University of Medicinal Sciences, Tehran, Iran.
Ramesh
R
Omranipour
2)Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran, 3)Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mojtaba
M
vand Rajabpour
Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
Kazem
K
Zendehdel
D000328:Adult; D000367:Age Factors; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy; D057210:Delayed Diagnosis; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology*; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000628:therapy; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D014076:Tooth Diseases / Q000150:complications
D000700:Analgesics