Patient delay in oral cancer in North-Western Spain: Where do we stand?

Timely diagnosis remains a major challenge in oral cancer, with more than half of cases diagnosed at advanced stages. Although the patient interval has been suggested as a key component of the diagnostic pathway, its relative contribution and temporal evolution remain insufficiently characterized. This study aimed to quantify diagnostic and treatment intervals in oral cancer and to evaluate the relative contribution of the patient interval using the Aarhus Statement framework, comparing current data with a historical cohort recruited a decade earlier in North-Western Spain.

A hospital-based ambispective observational study was conducted including consecutive incident cases of histologically confirmed oral squamous cell carcinoma diagnosed in 2025 at a tertiary referral center. Time intervals from first symptom to treatment initiation were defined according to the Aarhus Statement. Recall bias was minimized through triangulation of patient interviews, relatives' reports, and clinical records. Median intervals and interquartile ranges were calculated, and comparisons were performed with a historical cohort recruited in 2015 under identical methodological criteria. Ratios between intervals were estimated to assess the relative contribution of the patient interval.

The median patient interval decreased slightly in 2025 compared with 2015 (25 vs. 31.5 days). Primary care and diagnostic intervals were shorter, whereas specialist and pre-treatment intervals increased. The total pre-treatment interval remained stable between cohorts. Ratio analyses showed that the patient interval represented a limited proportion of the total diagnostic and treatment pathway, with no significant temporal differences.

Temporal changes in the oral cancer pathway were heterogeneous, suggesting a redistribution of delays toward later intervals of care. The patient interval was not the main contributor to overall time to treatment, highlighting the need for system-level strategies targeting specialist assessment and treatment initiation phases.