The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis

Abstract

Introduction: Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival.

Materials and methods: We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist.

Results: Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31-73), k = 18, of the diagnosis interval 35 days (95% CI = 21-38), k = 11, and of the treatment interval 30 days (95% CI = 23-53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates.

Conclusion: Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.

Keywords: TNM staging; early diagnosis; intervals; oral cancer; survival.

Figure 1

PRISMA flow diagram of the study selection process.

Figure 2

Forest plot representing the pooled median duration and 95% confidence intervals for the patient (A), diagnostic (B), and treatment (C) intervals in oral cancer. The asterisk (*) represents a median obtained from only one study, which prevented an estimation of the confidence interval. CI, confidence interval; IQR, interquartile range. k: number of studies or, alternatively, number of groups of patients in whom an interval duration was measured (e.g., a study may have reported the duration of the treatment interval for women and men separately). N: number of patients with available information on each interval’s duration.