Barriers to improving survival from oral cancer

INTRODUCTION: Oral cancer (OCa) survival rates are high and remained stable over the past half a century. OBJECTIVE: To examine factors associated with OCa survival and develop theoretical basis for assessing the public health impact of these factors. METHODS: A theoretical conceptual model for interaction of factors that could impact OCa survival was developed, grouping the factors sequentially into components, effectors, sub-domains and domains. The domains included different heads such as socio-economic and demographic factors, OCa related biological, diagnostic, and treatment factors and others. These domains interacted with each other and a hierarchically interacting cascading system was developed. A comprehensive literature review was carried out to list all factors associated with OCa survival. These factors were classified into primary- , secondary- and tertiary prevention related factors and then super-imposed on the conceptual model developed in the previous step. A computer-simulation of the model was developed and examined. RESULTS: A theoretical ‘web of causation' model-system of interacting factors contributing to OCa survival was synthesized and tested with computer simulation suggesting that public health impact for increasing oral cancer survival resided at the early OCa detection level. CONCLUSIONS: Improving early detection and prompt diagnosis seems to be a major point of action that could substantially improve OCa survival for OCa. The model also provides pointers for impact points for targeting public health policies to increase OCa survival.