Barriers to Diagnostic and Treatment Delay in Oral Cancer Across Income Settings: Systematic Review

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Timely diagnosis and treatment are crucial for improving oral cancer outcomes.
• Delays in the oral cancer care pathway contribute to advanced disease at presentation.
• Understanding barriers is essential for developing effective interventions.

Purpose of the Study:

• To synthesize barriers to oral cancer diagnosis and treatment initiation.
• To compare barriers in high-income countries (HICs) and low- and middle-income countries (LMICs).
• To align identified barriers with the Aarhus diagnostic-therapeutic intervals.

Main Methods:

• Systematic literature search across major databases (PubMed, Scopus, Web of Science, Embase, ProQuest).
• Inclusion of observational, qualitative, and mixed-methods studies on adult oral cancer.
• Narrative synthesis of data, semantic standardization, and mapping of barriers to Aarhus intervals.

Main Results:

• Sixteen studies identified barriers across psychosocial, symptom appraisal, health literacy, structural, professional, and organizational domains.
• Patient-interval delays were linked to psychosocial and appraisal barriers.
• Diagnostic and total-interval delays were associated with professional and organizational barriers, particularly in LMICs.

Conclusions:

• Oral cancer care delays result from interconnected individual, professional, and system-level factors.
• Barriers form a complex, trajectory-based process requiring integrated interventions.
• Addressing the entire care continuum is necessary to mitigate delays.