Estudo dos fatores relacionados no atraso no diagnóstico do carcinoma epidermóide bucal

Abstract

Oral cancer, as represented by oral squamous cell carcinoma (OSCC) is responsible for high morbidity and mortality. This has been associated to the delay in seeking professionals together with establishing definitive diagnosis of lesions as the main factor responsible for the advanced stage of disease. The aim of this study was to evaluate the delay in diagnosis of oral cancer patients treated at the Uberlandia Federal University Hospital and analyze its relationship with socio-demographic data, illness-related behaviors and health care as well as clinical features of the disease. The different types of delay were assessed from the amplitude of time (variations) and medians. Statistical analysis was carried out using U Mann-Whitney and Kruskal-Wallis and univariate logistic regression analysis. A sample of 136 of squamous cell cases carcinoma located in different regions of the mouth was included in the study. Twenty-two variables related to patients were considered, being sociodemographic (age, sex, skin color, origin, marital status, employment status, educational level and income), behavior-related disease (exposure to tobacco or alcohol), health care (use of prosthesis, type of access to health services, patient patterns of referral) and clinical features of disease (location, size and signs and symptoms and clinical staging injuries). Three types of delay were examined: 1) delay of the patient, referring to the time elapsed between the perception of signs and symptoms and first appointment with health professionals, 2) delay of the professional, considered the time between the first appointment with health professional and definitive diagnosis of the disease (histopathological diagnosis) and 3) total delay as a result of the sum of two delays aforementioned. The results showed delays related to patient around 127 days (4.2 months), 19 days for professionals and 176 days (~ 6 months) for the total delay in cancer diagnosis. The delay of patients was responsible for longer time spent in the process of diagnosis, and 64% of patients had delays greater than 90 days. Two of the variables studied showed statistically different values: gender (p = 0.007) and presence of painful symptoms (p = 0.027). The delay for female patients (120 days) was lower than for males (225 days). For patients with pain, the delay was longer (150 days) than patients without pain (120 days). Only a marginal statistical association was observed for sex (p = 0.06, OR = 2.42), the delay was significantly associated with patients with lesions of intermediate size (p = 0.009, OR = 0.35). These patients had lower median delay. Regarding the delay of the professional, the median was 19 days, and approximately 50% of delays were greater than 15 days. No variable had categories with significantly different medians. Moreover, only the variable sex was statistically associated with professional delay (p = 0.033, OR = 2.60). Smaller lesions showed lower median and a lower risk of delay in diagnosing professional. The pattern of delayed diagnosis of median total values were significantly higher for males (p = 0.007) and patients with pain (p = 0.022) significantly different from its counterpart. However, only the variable size of the lesion were significantly associated to the total delay (p = 0.016, OR = 0.35). The pattern of delay observed is equal to those observed in studies in Brazil and abroad. Our findings also show that it does not seem common to identify associations between socio-demographic data related to behavior and care of illness and health with clinical disease and different types of delay. Also, the delay of the patient to the professional does not seem to be a risk factor for determining the staging of oral cancer.