The general practice burden of oral symptom management and subsequent upper aerodigestive tract cancer diagnosis

Background The signs and symptoms of upper aerodigestive tract (UADT) cancer may lead to patients presenting to medical general practitioners (GPs). Aim This study aimed to identify the frequency which patients seek care for oral symptoms from GPs and the proportion of patients who subsequently developed a UADT cancer in Victoria, Australia. Design & setting A retrospective cohort study utilising the University of Melbourne’s Patron primary care data repository and the Victorian Cancer Registry (VCR) from 2008-2022. Method The datasets were linked using a deterministic approach by the Centre for Victorian Data Linkage. Descriptive and comparative analyses were performed in R (v4.3.1) to assess subgroups defined by presentation over time, with and without oral symptoms. Results One in 200 GP visits was related to oral symptoms, with a total of 81 492 (0.3%) of 25 635 768 linked patients seeking care for these symptoms. There was an average of 8463 visits related to oral symptoms per year across equating to approximately 2116 practice hours. Only 0.1% of patients presenting with oral symptoms develop UADT cancer within 12 months. Forty per cent of UADT cancer patients had visited a GP in the 12 months preceding their diagnosis with majority of those with cancers visible in the oral cavity. However, only 7% of UADT cancer patients presented for oral symptoms. Conclusion Majority of UADT cancer patients did not utilise GP care in the 12 months preceding their diagnosis. For those who did, it was not commonly for oral symptoms. This suggests opportunistic oral examination should not be driven by symptoms alone.