Patient delay in oral cancer: a qualitative study of patients' experiences

Abstract

Up to 30% of patients delay seeking the advice of a healthcare professional after self-discovery of symptom(s) of oral cancer. Reasons for this patient delay are poorly understood. The aim of the present study was to explore patients' initial experiences and reactions to developing symptoms of oral cancer, and to identify factors influencing their decision to consult a health care professional. In-depth semi-structured interviews were conducted with 17 consecutive patients who had received a diagnosis of oral squamous cell carcinoma, but had yet to start treatment. Participants were asked about their beliefs about their symptoms over the course of the disease and their decision to seek help. The tape-recorded interviews were transcribed verbatim and analysed using 'Framework analysis'. Oral symptoms were rarely attributed to cancer and were frequently interpreted as minor oral conditions. As a result of these beliefs, patients tended to postpone seeking help or fail to be concerned over their symptoms. Prior to seeking help, patients responded to symptoms by using self-medication, changing the way they ate and disclosing their discovery of symptoms to friends or family. Problems with access to healthcare professionals and patients' social responsibilities acted as barriers to prompt help-seeking. This study has documented that an individual's interpretation of oral cancer symptoms may be misguided and this can adversely affect subsequent help-seeking behaviour.

The experiences of young oral cancer patients in Scotland: symptom recognition and delays in seeking professional help

“…8 Early detection of oral cancer is key to reducing mortality and possible disfigurement, but previous studies have shown that patients delay seeing a health professional after noticing symptoms. 23 In the present study, most interviewees reported that they attempted some form of self-treatment before seeking help -and this process of self-treatment lasted anything from a few days to a few months. Interviewees purchased over the counter remedies (such as Bonjela) to treat inflammation, for example, or merely 'waited' to see if their symptoms would pass without intervention.…”

“…Both these concepts have been the subject of previous research with patients presenting with cancer or precancer [23][24][25]14 and particularly with younger people in Southern England. 8 Early detection of oral cancer is key to reducing mortality and possible disfigurement, but previous studies have shown that patients delay seeing a health professional after noticing symptoms.…”

“…Scott and colleagues have described the time between first awareness of symptoms and the first appointment with a health professional regarding those symptoms to be the duration of patient delay. 23 In the SE England study the median delay in presentation among young people with oral cancer was five weeks. 8 For those with potentially malignant lesions (precancer) the delay was longer; 30% of patients waited more than three months before seeking attention.…”

Clinical profile of oral squamous cell carcinoma patients attending a tertiary care hospital

“…Most common reasons are the initial wrong diagnosis and the ignorance from the patient or from the attending physician. 10 Regarding this issue, a few study have been done in our country but this does not reflect actual scenario.…”

Early Diagnosis of Oral Cancer

“…38 As early symptoms of oral cancer are often unspectacular, they are easily attributed to trivial causes by uninformed patients. 52 Socioeconomic status and barriers to access to a healthcare professional may be causes of patient delay, which is defined as the period between the patient first noticing a symptom and their first consultation with a healthcare professional concerning the symptom. 52 -54 Public awareness of oral cancer seems alarmingly low, as demonstrated by Horowitz et al, 55 who found that fewer than 25% of subjects could name alcohol or tobacco as risk factors.…”