Patient and System Barriers to Early Diagnosis of Oral Cancer in the UK

Abstract

Objective: Oral cancer poses a significant public health challenge worldwide, especially in the UK, where delayed diagnosis negatively impacts patient outcomes and survival rates. This study aims to systematically review and synthesise evidence on patient and system barriers to early diagnosis of oral cancer within the UK context. Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of peer-reviewed studies published between 2000 and 2024. The databases we searched included PubMed, Scopus, EMBASE, Google Scholar and Web of Science including grey literature. Studies examining factors influencing patient and healthcare provider delays in oral cancer diagnosis were included. Key data such as the percentage of referrals by GPs and dentists, delay time, authors' names and year were extracted, and a meta-analytic approach was used to quantify the impact of barriers and facilitators on diagnostic timelines. The risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS) tool, and the findings were visualised using Robvis. R studio software was used for the quantitative analysis. Results: The main patient-level barriers are psychosocial factors, cost, anxiety, and structure of primary dental care, and healthcare-level barriers are lack of time and inadequate remuneration. The pooled referral proportion for GPs was 0.49, with a 95% CI of 0.40 to 0.59, derived using a random-effects model. The pooled proportion for dentists was 0.38, with a 95% confidence interval (CI) of 0.31 to 0.46. A pooled relative risk (RR) of 1.27 (95% CI: 0.96–1.68) was observed when comparing referrals made by general practitioners (GPs) to those made by dentists. Conclusion: The pooled relative risk indicates a marginally increased probability of referrals by general practitioners compared to dentists; however, the overlapping confidence intervals necessitate a cooperative strategy to enhance referral routes. Addressing these obstacles via specific interventions and policy reform could significantly improve the UK's early detection rates and patient outcomes for oral cancer.