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      Patient Interval and Associated Factors in the Diagnostic Journey of Oral Cancer: A Hospital-Based Cross-Sectional Study from Kerala, India

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          Abstract

          Background:

          The incidence of oral cancer is increasing in south-central Asia. Though it can be detected early, most cases were reported in late stages, resulting in a poor prognosis. Reducing the patient interval will facilitate early diagnosis and better disease survival. The paucity of research on the patient interval in oral cancer has limited our ability to design and evaluate programs for early diagnosis.

          Methods:

          The study was conducted to identify the duration of patient interval and associated factors in oral cancer. Patients with oral cancer reporting at a tertiary cancer center during the study period were interviewed using validated data collection tools. The ‘Aarhus statement’ guidelines were followed in designing and reporting the study.

          Results:

          Among the 261 participants, 54% reported a patient interval of more than 90 days. The median (IQR) patient interval was 92 (38-168) days. In the multivariate binary logistic regression model, those who approached healthcare facilities due to pain (OR, 8.3, 95% CI, 2.9 to 23.4) were more likely to have a patient interval of more than 90 days over those who came due to insistence by family. Smoking status (Current smoker vs. never smoker) at the time of diagnosis (OR, 2.518, 95% CI, 1.3 to 4.7), Stage of cancer (late vs. early) of participants (OR, 2.62, 95% CI, 1.3 to 5.2), and time of travel (>30 minutes vs. ≤ 10 minutes) to health care facility (OR 5.8, 95% CI, 1.6 to 21.7) were the other significant predictors for the patient interval of more than 90 days.

          Conclusion:

          Patient interval in oral cancer can be reduced by improving symptom awareness, abstinence from tobacco use, and facilitating access to health care facilities. The double burden of tobacco use in oral cancer, as it increases the risk of disease occurrence and delays symptom presentation, needs serious policy considerations in the context of cancer prevention.

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          Most cited references27

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          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            Influence of delay on survival in patients with breast cancer: a systematic review.

            Most patients with breast cancer are detected after symptoms occur rather than through screening. The impact on survival of delays between the onset of symptoms and the start of treatment is controversial and cannot be studied in randomised controlled trials. We did a systematic review of observational studies (worldwide) of duration of symptoms and survival. We identified 87 studies (101,954 patients) with direct data linking delay (including delay by patients) and survival. We classified studies for analysis by type of data in the original reports: category I studies had actual 5-year survival data (38 studies, 53,912 patients); category II used actuarial or multivariate analyses (21 studies, 25,102 patients); and category III was all other types of data (28 studies, 22,940 patients). We tested the main hypothesis that longer delays would be associated with lower survival, and a secondary hypothesis that longer delays were associated with more advanced stage, which would account for lower survival. In category I studies, patients with delays of 3 months or more had 12% lower 5-year survival than those with shorter delays (odds ratio for death 1.47 [95% CI 1.42-1.53]) and those with delays of 3-6 months had 7% lower survival than those with shorter delays (1.24 [1.17-1.30]). In category II, 13 of 14 studies with unrestricted samples showed a significant adverse relation between longer delays and survival, whereas four of five studies of only patients with operable disease showed no significant relation. In category III, all three studies with unrestricted samples supported the primary hypothesis. The 13 informative studies showed that longer delays were associated with more advanced stage. In studies that controlled for stage, longer delay was not associated with shorter survival when the effect of stage on survival was taken into account. Delays of 3-6 months are associated with lower survival. These effects cannot be accounted for by lead-time bias. Efforts should be made to keep delays by patients and providers to a minimum.
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              Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review

              Objectives To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this. Design Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south. Settings A wide range of settings within primary and secondary care (these were not restricted in the search). Results 108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies. Conclusions The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.
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                Author and article information

                Journal
                Asian Pac J Cancer Prev
                Asian Pac J Cancer Prev
                APJCP
                Asian Pacific Journal of Cancer Prevention : APJCP
                West Asia Organization for Cancer Prevention (Iran )
                1513-7368
                2476-762X
                October 2021
                : 22
                : 10
                : 3143-3149
                Affiliations
                [1] Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
                Author notes
                [* ]For Correspondence: kannansrini@ymail.com
                Article
                10.31557/APJCP.2021.22.10.3143
                8858242
                34710990
                84ba5f32-08a1-4cd9-8757-b6dbc6c6c3d5

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                delay in presentation,patient delay,early diagnosis,symptom awareness,aarhus statement

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