How do primary care doctors compare to dentists in the referral of oral cancer?

Abstract

Data sources The authors searched electronic databases of Medline, Embase, Web of Science, Scopus, CINAHL and Google Scholar until May 2019. They also searched within the reference lists of studies, citation indexes and related articles from these electronic databases. Ongoing studies were searched in Research Registry, and Electronic Theses Online Service was used for searching theses.

Study selection The authors conducted a systematic review with meta-analyses of studies that looked at the oral cancer referral by general practitioners (GPs; also referred to as primary care doctors or physicians) and dentists. Specifically, their objectives were to find out the percentage or proportion of oral cancers referred by GPs and dentists, oral cancer stage, and the delay in referral. Twenty-two studies from ten countries fulfilled the inclusion criteria. These were predominantly case series, with some studies being questionnaires, patient interviews and a combination of these.

Data extraction and synthesis The data from the studies were independently extracted by three authors, and when they had disagreement, they discussed it as a group to reach a consensus. They used MINORS index to assess the quality of included studies. They did due diligence to contact the authors of included studies to collect missing data. When missing data was not attainable, they assessed the available data. They used appropriate software for data analysis and generated forest plots and heterogeneity tests. They also conducted sub-group analyses of data from within the UK, which has the same medical care system.

Results A total of 4,953 oral cancers were included in this systematic review of 22 studies originating from ten countries. For the first objective on percentage or proportion of oral cancers referred by GPs and dentists, the GPs referred 13-86% compared to dentists who referred between 15-80%. Meta-analysis of 22 studies showed that GPs referred more oral cancers than dentists (RR: 1.36; 95 CI: 0.99-1.86). In other words, for every ten patients referred by a dentist, GPs referred 14 patients. Doing the same analysis for the eight studies in the UK, the result was similar with GPs referring more than dentists (RR: 1.36; 95% CI 1.05-1.96). For the second objective on oral cancer stage on presentation, meta-analysis was feasible only on four studies, which showed that dentists tend to refer early-stage (stage 1 and 2) oral cancers more than GPs (RR: 1.37; 95% CI 1.17-1.60). In other words, for every ten early-stage oral cancer patients referred by GPs, dentists referred 14. For the third objective on the delay in referral, the authors were unable to conduct meta-analyses due to the inconsistency of measurement of delay in referral. The studies revealed no statistically significant difference between GPs and dentists.

Conclusions Both GPs and dentists refer the majority of oral cancer patients. While GPs tend to refer more oral cancers than dentists, the dentists referred more early-stage oral cancers.