Diagnostic Delay of Oral Cancer in a Multinational Society: A Retrospective Study From the United Arab Emirates

Introduction and aims Delay in oral cancer diagnosis is strongly associated with poor prognosis. While various factors, including lower socioeconomic status, have been linked to diagnostic delays, the impact of patients’ residency status in a multinational community remains unclear. The United Arab Emirates (UAE) has a unique expatriate-dominated population with variations in accessibility to health care services. This study aimed primarily to assess whether the residency status of patients with oral cancer (ie, UAE nationals and non-UAE expatriates) has an association with delays in diagnosing their tumour. Methods A retrospective review of the medical records of 52 patients diagnosed with oral cancer was performed. Data analysed included patients’ demographics, lifestyle risk factors, anatomic site of the tumour, months between onset of earliest symptoms and the diagnostic biopsy, the number of visits to health care providers prior to diagnosis, and use of medications prior to biopsy. Results Median diagnostic delay was 2.5 months (interquartile range, 5.0; ranging from 1 to >6 months). No difference in diagnostic delays was observed between UAE nationals and non-UAE expatriates. However, the median diagnostic delay was significantly longer for medication users compared to nonusers ( P = .04, Mann-Whitney U test), and this association remained significant after adjustment for patients’ sex, age, residency status, and tobacco and/or alcohol use (odds ratio = 0.7; 95% CI, 0.51-0.99; P = .044). Interestingly, prior to diagnostic biopsy, non-UAE expatriates had more visits to health care professionals than UAE nationals ( P = .03, χ 2 test). Conclusions Despite the country’s remarkable societal diversity and varied accessibility to health care facilities, delays in oral cancer diagnosis were not associated with patients’ demographics. Instead, delays were significantly linked to prediagnosis medication use. Clinical relevance This study highlights the critical need to implement measures to control arbitrary use of empirical medications by both health care providers and laypersons to treat oral mucosal lesions without proper diagnostic workup. Furthermore, the finding that expatriates undergo more visits to health care providers prior to diagnostic biopsy highlights the need to standardise referral pathways to clinicians specialised in diagnosing and managing oral mucosal lesions.