Delay in presentation of oral cancer: a multifactor analytical study

Patients with oral cancer often present late to the doctor making treatment difficult, expensive and sometimes unsuccessful. Delay in presentation may be considered to be a health risk-taking behaviour. The present study analyses the psychosocial factors related to delay in presentation of oral cancer patients through the Triandis' model of health-seeking behaviour and also examines the relationship between delay and the stage of cancer.

Seventy-nine oral cancer patients were interviewed after evolving a valid and reliable questionnaire, and determining the sample size. Univariate and multivariate logistic regression analysis was applied between demographic variables, psychosocial factors, primary delay (defined as delay between the first symptom and the seeking of medical advice), secondary delay (interval between the first consultation and presentation at the medical college), tertiary delay (delay in definitive treatment even after being seen at a tertiary care centre) and stage of the disease. Multiple logistic regression was also carried out.

Primary delay ranged from less than a week in 5 (6.3%) patients to more than 1 year in 8 (10%) patients. A linear relationship was found between primary and secondary delay (F-statistic p < 0.0152). A majority of patients (70.9%) had advanced oral cancer. The stage of cancer at presentation to the hospital was significantly related to primary (G-test 6.3; p < 0.0121) but not to secondary delay. Multivariate analysis revealed that five variables, 'ill fated to have cancer', 'cancer a curse', 'non-availability of transport', 'trivial ulcers in mouth are self-limiting' and 'prolonged treatment renders family stressful' were significant independent predictors of primary delay.

The identified independent predictors of primary delay should be used to develop the main theme of an educational intervention programme for patients with oral cancer.