There are approximately 30,000 new cases of oral cancer in the United States every year, resulting in about 9,000 deaths. The main risk factors for oral cancer are tobacco use and alcohol consumption — the greater the use, the higher the risk. Tobacco and alcohol use are associated with about 75% of oral cancers, with Human Papilloma Virus (HPV) and diet accounting for much of the other cases of oral cancer.
The 5-year survival rate for oral cancer ranges from 81% for those with localized disease, to 50.7% for those with regional disease, to 29.5% for those with distant metastasis. In general, the sooner the oral cancer is diagnosed, the better the chances for longer-term survival. However, the more aggressive the form of the oral cancer (often manifesting abruptly with signs of distant spread), the shorter the window to diagnosis and treat the cancer for the best possible outcome.
Delay in diagnosis can be classified by the following stages: “Appraisal” (the time between when a person first detects an unexplained symptom and the moment when they infer an illness); “Illness” (the time between when a person first infers a illness to when they decide to seek medical help); “Behavioral” (the time between when a person decides to seek medical help to the time when they act to schedule an appointment); “Scheduling” (the time between when a person acts to schedule a medical appointment to the time of the first contact with a medical care provider); and, “Treatment” (the time between the first contact with a medical provider to the time when they begin treatment). The first three stages involve delay by the patient (“patient delay”) while the last two stages involve delay by the medical care provider (“professional delay”).
Patient delay accounts for the largest portion of total delay in diagnosing oral cancer, with one-half of patients with oral cancer making their first visit to a medical care provider within 1 to 2 months after first becoming aware of symptoms (20% to 30% of patients delay more than 3 months).
Professional delay can occur at any point between the time that the patient enters professional care and the start of definitive treatment. Professional delay begins when the patient first visits the first medical care provider to have a symptom of oral cancer evaluated. The scheduling delay depends on how the patient describes the symptoms and whether it is the doctor or the office staff to whom the patient speaks (the scheduling delay tends to be shorter when it is the doctor with whom the patient speaks when scheduling an appointment).
There is often a two-week delay based on clinical guidelines between when the patient is first examined for a suspicious lesion and the follow-up appointment so that the doctor can determine if the lesion is cancerous or a more common trauma or non-cancerous inflammatory-based lesion. The two week period is not considered a professional delay (there may also be a “referral delay,” which is the time between when a primary care physician first evaluates the patient and the referral — primary care physicians refer such patients for further assessments more than dentists, in terms of numbers).
There is a relationship between professional delay and patient prognosis. A period of greater than one month in professional delay is associated with a greater risk of late stage oral cancer (one study found that the risk is 1.56 greater for a late stage tumor for those patients experiencing one to three months professional delay compared to a delay of less than one month — a delay of more than three months had a three-times increased risk of having a late stage tumor). The risk of death for patients with delayed treatment for oral cancers was 1.7 greater, which would support the connection between professional delay and poor prognosis.
The conclusion that professional delay contributes to an increased risk of late stage cancer tumors is supported by a study finding that head and neck cancers proceeded from one stage to the next progressively faster as later stages were reached (the median period is 5.5 months for tumors progressing from one stage to a subsequent stage and subsequent stages are reached progressively faster).
If you believe that professional delay has contributed to the diagnosis of later stage cancerous tumors, a poorer prognosis, or an earlier death, a medical malpractice attorney may be able to find answers to your medical malpractice questions. Visit our website to be connected with medical malpractice lawyers in your local area who may be able to assist you with your medical malpractice claim. You may also reach us toll free at 800-295-3959.
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