Summary
Background
The incidence of oral cancer is increasing. The National Institute for Health and Care Excellence (NICE) oral cancer guidance is unique in recommending cross-primary care referral from GPs to dentists.
Aim
This review investigates knowledge about delays in the diagnosis of symptomatic oral squamous cell carcinoma (OSCC) in primary care.
Design and configuration
An independent literature search strategy with multiple investigators and an analysis of study methodologies using a modified data extraction tool based on Aarhus checklist criteria relevant to primary care.
Method
The authors conducted a focused systematic review involving document retrieval from five databases up to March 2018. Studies examining the diagnosis of OSCC from the time patients accessed primary care to referral were included, including delay and stage of the disease at the time of definitive diagnosis. .
Results
Patients had two or three consultations before referral
Of 538 records, 16 articles were eligible for full-text review. In the UK, over 55% of patients with OSCC were referred by their GP and 44% by their dentist. Prescribing rates between dentists and GPs were similar, and both had similar delays in referral, although one study found greater delays attributed to dentists as they had carried out dental procedures.
On average, patients had two or three consultations before referral. Less than 50% of studies described the primary care aspect of referral in detail. There was no information on referrals between dentists and intergenics.
Conclusion
It is necessary to perform primary care studies in the diagnosis of OSCC. There was no evidence that GPs performed less well than dentists, which calls into question NICE cancer’s choice to refer to dentists, particularly in the absence of robust auditable pathways.
