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UBC Theses and Dissertations

Patient experiences with high-risk oral lesions from detection to diagnosis Tam, Darlene Melody


With <50% 5-year survival rates, oral cancer is often diagnosed at late-stage. Detection of lesions at earlier stages results in better prognosis. Continued tobacco use after cancer treatment is a risk for recurrence. However, little is known of the process from lesion identification to diagnosis, impact of smoking behavioural changes and barriers for tobacco cessation in patients with a high-risk oral lesion (HRL) diagnosis. Two survey-type questionnaires were used to collect data on tobacco usage and patient experiences leading to HRL diagnosis. Patients attending the BC Cancer Agency diagnosed with HRLs within 12 months of interview were invited to participate in Study I. Patients who also smoked ≥100 cigarettes within 5 years of questionnaire were eligible for Study II. Among 150 Study I patients, 61% were self-identified (SIG) and 39% were professionally screened (PSG; 88% by dental professionals). PSG identified significantly more precancerous lesions compared with SIG (54% vs. 23%, P = 0.0003) and was more likely to screen ever smokers (P = 0.05). SIG showed significantly higher rates of time delay from detection to diagnosis ≥3 months, compared with PSG (58% vs. 36%, P = 0.007). Frequency of dental visits strongly correlated with identification of HRLs by healthcare professionals (P = 0.004). Common symptoms for SIG were pain (77%) and non-healing ulcers (62%), which prompted patients to seek healthcare, while 71% of PSG patients were asymptomatic. Surprisingly, almost half (47%) of patients were not aware of oral cancer. Of 58 Study II patients, main tobacco cessation barriers included stress (67%), smoking enjoyment (64%), and not being ready to quit (60%). Increased nicotine intake may be associated with increased difficulties with tobacco cessation. Knowledge of health risks from tobacco usage (71%) and tobacco cessation aids (43%) were main cessation facilitators. The HRL diagnosis was a pivotal factor for patients to stop or reduce cigarette consumption. Oral cancer screening by healthcare professionals, particularly dental professionals, can facilitate identification of earlier oral lesions at risk of cancer progression. Promotion of oral cancer awareness and tobacco cessation for patients and healthcare professionals may facilitate earlier diagnosis of oral lesions and prevent recurrent lesions.

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