Time span from onset of oral cancer symptoms to treatment: a hospital based cross sectional study in South India

Shivaraj Nallur Somanna, Nandakumar Bidare Sastry, Ramesh Cheluvarayaswamy, K. S. Sabitha, Murthy Nandagudi Srinivasa, Nea Malila


Background: Oral cancer is one of the major health problems in India. Patient delay in seeking medical help usually contributes to late stage at diagnosis, high mortality and low survival. Our study aims to find the time span from first onset of oral cancer symptoms to cancer specific primary treatment.

Methods: A cross-sectional study was carried out from October 2015-September 2016 in one of the tertiary care cancer center in Bangalore. Histopathologically confirmed 212 incident oral cancer patients were interviewed using a pre-tested semi structured questionnaire.

Results: The median time span between onset of symptoms and seeking medical care was 60 [IQR 30, 104] days, the median time between seeking medical care and diagnosis was 30 [IQR 15, 90] days, and the median time between diagnosis and initiation of treatment was 20 [IQR 12, 33] days.

Conclusions: There is considerable delay in seeking cancer specific primary treatment among oral cancer patients. Efforts should be undertaken to increase awareness in the population and all stakeholders regarding symptoms and improve early diagnostics and access to care.


Oral cancer, Time span, Oral cancer symptoms, Primary treatment, Median time

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Gupta N, Gupta R, Acharya AK, Patthi B, Goud V, Reddy S, et al. Changing Trends in oral cancer - a global scenario. Nepal J Epidemiol. 2016;6(4):613–9.

Ferlay J, Soerjomataram I. ErvikM. et al. GLOBOCAN 2012 cancer incidence and mortality worldwide: IARC cancerbase No. 11. Lyon, France: International Agency for Research on Cancer, 2013.

Murthy NS, Nandakumar BS, Pruthvish S, George PS, Mathew A. Disability adjusted life years for cancer patients in India. Asian Pac J Cancer Prev APJCP. 2010;11(3):633–40.

Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol. 2012;2012.

Onizawa K, Nishihara K, Yamagata K, Yusa H, Yanagawa T, Yoshida H. Factors associated with diagnostic delay of oral squamous cell carcinoma. Oral Oncol. 2003;39(8):781–8.

WHO | Early detection of cancer. WHO. Available at: Accessed on 12 March 2018.

Ford PJ, Farah CS. Early detection and diagnosis of oral cancer: Strategies for improvement. J Cancer Policy. 2013;1(1):2–7.

Speight PM, Epstein J, Kujan O, Lingen MW, Nagao T, Ranganathan K, et al. Screening for oral cancer—a perspective from the Global Oral Cancer Forum. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(6):680–7.

Patton LL. The effectiveness of community-based visual screening and utility of adjunctive diagnostic aids in the early detection of oral cancer. Oral Oncol. 2003;39(7):708–23.

Murthy NS, Nandakumar BS, Shalini CN, Shivaraj NS, Gautham MS, Pruthvish S. Need for Cancer Screening program - Pitfalls and solutions. Rajiv Gandhi University of Health Sciences, Karnataka, India; 2010. (CME).

Joshi P, Nair S, Chaturvedi P, Nair D, Agarwal JP, D’Cruz AK. Delay in seeking specialized care for oral cancers: Experience from a tertiary cancer center. Indian J Cancer. 2014;51(2):95.

Maybury C, Horowitz AM, Goodman HS. Outcomes of oral cancer early detection and prevention statewide model in Maryland. J Public Health Dent. 2012;72:34-8.

Jafari A, Najafi S, Moradi F, Kharazifard M, Khami M. Delay in the Diagnosis and Treatment of Oral Cancer. J Dent. 2013;14(3):146–50.

Abdo EN, Garrocho A de A, Barbosa AA, Oliveira EL de, França-Filho L, Negri SLC, et al. Time elapsed between the first symptoms, diagnosis and treatment of oral cancer patients in Belo Horizonte, Brazil. Med Oral Patol Oral Cir Bucal Internet. 2007;12(7):469–73.

Hollows P, McAndrew PG, Perini MG. Oral medicine: Delays in the referral and treatment of oral squamous cell carcinoma. Br Dent J. 2000;188(5):262–5.

Kumar S, Heller RF, Pandey U, Agarwal GG, Misra RP. Factors causing delay in reporting by oral cancer patients in India. J Clin Epidemiol. 50:S6.

Akram M, Siddiqui SA, Karimi AM. Patient Related Factors Associated with Delayed Reporting in Oral Cavity and Oropharyngeal Cancer. Int J Prev Med. 2014;5(7):915–9.

Dwivedi AK, Dwivedi SN, Deo S, Shukla R, Pandey A, Dwivedi DK. An epidemiological study on delay in treatment initiation of cancer patients. Health (N Y). 2012;04(02):66.