Delay in diagnosis and treatment of patients with oral cancer seeking treatment in a public tertiary hospital in India

Introduction : The burden of oral cancer is rising, especially in the Indian subcontinent, which contributes one-third of all global cases. Oral cancer, though preventable, often goes undetected until later stages. There is a paucity of literature on the duration of patient, diagnostic, and treatment intervals for oral cancer management in India. The study aimed to estimate the patient, diagnostic, and treatment intervals for oral cancer patients and to explore factors contributing to delays. Methods: This cross-sectional mixed-method study was conducted at Lok Nayak Hospital in Delhi. The study included 116 patients with histopathologically confirmed oral cancer in the quantitative survey and 11 in the qualitative in-depth interviews who were receiving treatment within the last three months. Purposive sampling was used for both the quantitative survey and qualitative interviews. Statistical analysis was performed using SPSS, while qualitative data were manually coded to identify themes. The ‘Aarhus statement’ guidelines were followed in designing and reporting the study. Results: The study population had a mean age of 48 years, with a majority being male (87.9%), and Hindu (66.4%), half were from lower socioeconomic groups (50%) and 65.5% presented with Stage IV disease. The median patient interval was 13.5 (5.0, 59.5) days, the diagnostic interval was 88.0 (39.0, 218.2) days, and the treatment interval was 54.5 (28.8, 92.5) days, with a total median interval of 194.5 (133.5, 427.5) days. Delays were mainly due to symptoms being dismissed as minor (98.2%), initial healthcare worker not suspecting cancer (50.0%) and pre-treatment investigation delays (19.8%). Key qualitative barriers included poor healthcare access (especially in rural areas), lack of awareness of symptom severity, reliance on self-medication, and family-related distractions. Delayed recognition by initial healthcare providers contributed to further delays. Family structure and advice by the first heart care provider significantly influenced diagnostic interval. Conclusion: A majority of the patients with oral cancer presented with advanced-stage disease with diagnostic interval being the longest followed by treatment and patient intervals. Future studies should study interventions to reduce these delays and also assess the impact of these delays on the disease outcome.