Background

Oral squamous cell carcinoma (OSCC) is the most prevalent malignancy of the head and neck region¹. The prognosis for patients with advanced disease is generally worse than for patients with small volume disease². It is well accepted that reasons for late presentation are a combination of tumour, patient and professional factors².

Objectives

The purpose of this study was to review the referral patterns for patients with OSCC managed by the RMH Head and Neck Oncology Tumour Stream and to evaluate changes in referral patterns and management delay compared to a report published 20 years ago³.

Methods

The ACCORD Database and hospital records of patients treated at RMH for OSCC between Jan 1 2008 and Dec 31 2010 were reviewed retrospectively. Clinical data (including demographics, symptoms, TNM staging⁴, referral source, dates of presentation, diagnosis, management) were obtained.  The data was transferred to an Excel datasheet and analysed.

Results

Of the 101 patients, fifty-two patients first sought help from general medical practitioners, whilst 43% initially attended a dentist. The time between the onset of symptoms to diagnosis ranged from zero to over 3 years, with a median time of 11 weeks. The most common presentation was of an ulcer. Seventy percent of patients presented with T1(39%) or T2(31%) SCC. 37% of people were initially managed inappropriately, of these 21% were initially treated with antibiotics. Fifty percent of patients were referred to specialist as initial management.

Conclusion

The results of this study show a reduction in the overall diagnostic delay.  A shift towards initial presentation to a medical practitioner is noted. There are multiple factors contributing to delay including denial of the significance of symptoms by patients, inappropriate initial management and failure to recognise the malignancy by practitioners. Further improvement should be possible with both community and clinician education.