Diagnostic delay in oral squamous cell carcinoma: the role of cognitive and psychological variables

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This retrospective study investigated, in two cohorts of subjects living in Southern Italy and awaiting treatment for oral squamous cell carcinoma (OSCC), the variables related to diagnostic delay ascribable to the patient, with particular reference to the cognitive and psychological ones. A total of 156 patients with OSCC (mean age: 62 years, M/F: 2.39∶1) were recruited at the Universities of Palermo and Naples. Risk factors related to patient delay included: sociodemographic, health-related, cognitive and psychological variables. The analysis was conducted by considering two different delay ranges: dichotomous (≤1 month vs. >1 month) and polytomous (<1 month, 1–3 months, >3 months) delay. Data were investigated by univariate and multivariate analyses and a P value ≤0.05 was considered statistically significant. For both delay measurements, the most relevant variables were: ‘Personal experience of cancer’ (dichotomous delay: P=0.05, odds ratio (OR)=0.33, 95% confidence interval (CI)=0.11–0.99; polytomous delay: P=0.006, Chi-square=10.224) and ‘Unawareness’ (dichotomous delay: P<0.01, OR=4.96, 95% CI=2.16–11.37; polytomous delay: P=0.087, Chi-square=4.77). Also ‘Denial’ (P<0.01, OR=6.84, 95% CI=2.31–20.24) and ‘Knowledge of cancer’ (P=0.079, Chi-square=8.359) were found to be statistically significant both for dichotomous and for polytomous categorization of delay, respectively. The findings of this study indicated that, in the investigated cohorts, the knowledge about cancer issues is strongly linked to the patient delay. Educational interventions on the Mediterranean population are necessary in order to increase the patient awareness and to emphasize his/her key role in early diagnosis of OSCC. Better education and awareness campaigns are needed to encourage people who notice symptoms of oral cancer to quickly have their lesions inspected by medical or dental professionals. Led by Giuseppe Colella and Giuseppina Campisi, a research team from the Universities of Palermo and Naples in Italy interviewed 156 people with squamous cell carcinoma of the oral cavity to determine the time taken between patients first noticing signs of cancer and then consulting physicians or dentists. People with knowledge or personal experience with cancer tended to seek medical assistance much earlier than people who were in denial or were unaware of the problem, the researchers found. Older patients showed a shorter delay than younger patients. The team calls for educational interventions to encourage early diagnosis and treatment of oral cancer, a disease responsible for an estimated 130 000 deaths worldwide each year.