Mouth Cancer Action Month – Delayed Diagnosis worsens prognosis

Our campaign to raise awareness during Mouth Cancer Action Month has so far covered the signs and symptoms of mouth cancer and the after-care and treatment to be expected once it has been diagnosed. In a bid to encourage awareness amongst patients and health practitioners, particularly dental practitioners, this blog highlights the consequences of a delayed or missed diagnosis of mouth cancer. 

It is widely accepted that an early diagnosis of mouth cancer means there is a higher likelihood of treatment being successful and therefore, a higher likelihood that those suffering with mouth cancer will survive.

Once a diagnosis of mouth cancer is confirmed, most patients will tell you that survival is their sole focus but a delayed diagnosis can also have a negative effect on their quality of life. In particular delay may lead to the use of more toxic treatments, the need for surgery leading to facial deformity, and treatments which cause sensitivity to light followed by the inability to swallow comfortably or speak without impediment.  Together with an increased likelihood of the need for reconstructive surgery and of psychological distress  when mouth cancer has been allowed to advance, it is understandable that there are patients out there who, despite survival, are still disappointed by their delayed diagnosis.

There are a number of factors which can cause a delayed diagnosis. Broadly,these factors fall into two categories: patient delay and system delay.

PATIENT DELAY

Research has shown that a high percentage of patients wait at least a month after symptoms commence before seeking help from a healthcare practitioner, and that a significant percentage of patients wait for more than three months before seeking any professional advice, becaue they attribute symptoms to minor, self-correcting conditions ( Brouha XD. et al. Oral and pharyngeal cancer: analysis of patient delay at different tumor stages. Head Neck 2005; 27: 939-945)

Patient delay describes the period whereby the patient either does not recognise the signs and symptoms of oral cancer, they do not seek medical opinion or the advice of their GP through fear of the diagnosis or they are dismissive of the seriousness of their symptoms or forgot to list all of the symptoms they have been suffering from.

Mouth Cancer Action Month is designed to increase awareness and my colleague, has already written a blog to decrease these patient delays ensuring members of the public will recognise the signs and symptoms and seek medical advice.

SYSTEM DELAY

System delay is when a patient experiences a delayed diagnosis caused through primary or secondary care problems. Such delays could arise for any of the following reasons:

– The health practitioner fails to adequately investigate/screen the patient or fully appreciate the described symptoms;
– The health practitioner fails to refer for further investigation;
– Following investigation, the diagnosis is missed;
– The diagnosis given is incorrect;
– A test result or diagnosis has been made but then is not communicated to a clinician so that the information is acted upon; or
– In rare circumstances, the diagnosis or test result has been communicated to a clinician but no treatment has commenced

The longer mouth cancer goes unnoticed or misdiagnosed, the more likely it is to spread and the more treatment may be required. Treatment like radiotherapy and/or chemotherapy may be necessary and the symptoms after that can be severe and life-changing.

The simplest way to screen for signs of mouth cancer is during a dental check-up. This November, dental practices across the country are holding screening days for members of the public to take advantage of free mouth cancer checks. We fully support these free screenings and encourage attendance ; however, most patients should also be being screened at their dental check-ups at least once a year, if not more frequently.

It is vital to seek medical advice if you suspect that you may have typical symptoms of mouth cancer and it is equally important that doctors and dentists take screening for mouth cancer seriously. Should you feel you have experienced a delay in the diagnosis of your mouth cancer or that your diagnosis was missed through negligent dental treatment then please contact a member of the dental negligence team who can offer you independent legal advice.