New NICE referral guidance for oral cancer: does it risk delay in diagnosis?

Grimes, David Robert; Patel, J. D.; Avery, C.M.E.

doi:10.1016/j.bjoms.2016.09.022

Cited by 16 publications

(6 citation statements)

References 2 publications

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“…The UK NICE guidelines on recognition and referral of suspected cancer recommends an appointment with a dentist (within two weeks) followed by referral to a specialist 27. A retrospective audit of all two week referrals for head and neck cancer in the UK noted that diagnosis is sometimes delayed, with several layers of appointments before a specialist consultation 29. In countries such as India with a higher burden of oral cancer, screening in high risk populations can ensure early referral of patients with suspicious lesions to secondary care for biopsy and confirmation 30.…”

Section: What Investigations Are Required?mentioning

confidence: 99%

Tobacco related oral cancer

Chaturvedi

Singh

Chien

et al. 2019

BMJ

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Section: What Investigations Are Required?mentioning

confidence: 99%

Tobacco related oral cancer

Chaturvedi

Singh

Chien

et al. 2019

BMJ

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“…A small case-series trial modelling the impact of the updated NICE guidance revealed that one in nine diagnoses of oral cancer would be delayed, primarily due to the lack of clear referral pathways. 44 Significantly, in the 24-month period up until January 2018, only 50.9% of the adult population was seen by an NHS dentist in England. 45 National dental statistics and some review studies demonstrate that being male, low socioeconomic status, patient denial of severity of symptoms, nervousness, financial issues, lack of NHS dentist access, increasing age, need for domiciliary visits, living in a care home, and refugee status are associated with the lowest usage of primary dental care services, 46,47 Some of these factors are associated with the greatest risk of developing oral cancer.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Diagnosis and referral delays in primary care for oral squamous cell cancer: a systematic review

2018

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BackgroundThe incidence of oral cancer is increasing. Guidance for oral cancer from the National Institute for Health and Care Excellence (NICE) is unique in recommending cross-primary care referral from GPs to dentists.AimThis review investigates knowledge about delays in the diagnosis of symptomatic oral squamous cell carcinoma (OSCC) in primary care.Design and settingAn independent multi-investigator literature search strategy and an analysis of study methodologies using a modified data extraction tool based on Aarhus checklist criteria relevant to primary care.MethodThe authors conducted a focused systematic review involving document retrieval from five databases up to March 2018. Included were studies looking at OSCC diagnosis from when patients first accessed primary care up to referral, including length of delay and stage of disease at time of definitive diagnosis.ResultsFrom 538 records, 16 articles were eligible for full-text review. In the UK, more than 55% of patients with OSCC were referred by their GP, and 44% by their dentist. Rates of prescribing between dentists and GPs were similar, and both had similar delays in referral, though one study found greater delays attributed to dentists as they had undertaken dental procedures. On average, patients had two to three consultations before referral. Less than 50% of studies described the primary care aspect of referral in detail. There was no information on inter-GP–dentist referrals.ConclusionThere is a need for primary care studies on OSCC diagnosis. There was no evidence that GPs performed less well than dentists, which calls into question the NICE cancer option to refer to dentists, particularly in the absence of robust auditable pathways.

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“…Whilst some work suggests 2 that increased GP-dentist collaboration is desirable, others consider that such an approach, whilst potentially reducing the secondary care workload, may result in diagnostic delay. This may be worsened by a lack of formal GP-dentist referral systems and insufficient access to dental care for many patients 66 .…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

Comparison of primary care doctors and dentists in the referral of oral cancer: a systematic review

Langton

Cousin

Plüddemann

et al. 2020

British Journal of Oral and Maxillofacial Surgery

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Background: Oral cancer is referred to specialists by both GPs and dentists, with varying proportions reported in different studies. However, some have also noted that dentists more frequently refer oral cancer in the absence of patient-perceived symptoms and may refer oral cancers at an earlier stage. Unfortunately, approximately half the UK adult population do not receive regular dental care.Objectives: Conduct a systematic review on studies that compare GPs and dentists in the referral of oral cancer focusing on three aspects: (1) proportion of diagnosed oral cancers (2) stage on presentation (3) delay.

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New NICE referral guidance for oral cancer: does it risk delay in diagnosis?

Cited by 16 publications

References 2 publications

Tobacco related oral cancer

Tobacco related oral cancer

Diagnosis and referral delays in primary care for oral squamous cell cancer: a systematic review

Comparison of primary care doctors and dentists in the referral of oral cancer: a systematic review

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