Late diagnosis of retinoblastoma in a developing country

Abstract

Objectives-To assess the diagnostic process of retinoblastoma in a developing country. Study design-Prospective survey of 95 consecutive parents of patients with retinoblastoma. Results-Fifty six parents consulted initially with a paediatrician. Their children tended to be younger, with a significantly higher frequency of advanced disease. Only half of the patients who consulted with a paediatrician were appropriately referred to an ophthalmologist; the paediatrician underestimated the complaints in the remainder. Children taken to an ophthalmologist were older and had less advanced disease. In about three quarters of these children, a diagnosis of retinoblastoma was suspected by the ophthalmologist on the first visit. Parents of patients with more advanced disease consulted significantly later. Poor parental education correlated significantly with late consultation. Lack of health insurance and living outside Buenos Aires City correlated significantly with an increased risk of extraocular disease. Conclusions-Paediatricians are the first health professional seen by most children with retinoblastoma. However, the diagnosis is not readily established. There is also a delay in consultation by parents, which is significantly longer in cases with advanced extraocular disease. Socioeconomic factors and access to health care might play a role in delayed diagnosis. (Arch Dis Child 1999;80:171-174)

Diagnóstico precoce do câncer infantil: responsabilidade de todos

“…É um dado preocupante saber que em ¼ dos casos houve falha do oftalmologista em detectar o retinoblastoma. Nestes casos, não foi realizado uma fundoscopia (fundo de olho) sob anestesia 25 .…”

Strategies to manage retinoblastoma in developing countries

“…Delayed diagnosis accounts for the increased prevalence of advanced retinoblastoma in developing countries and explains why retinoblastoma is diagnosed at a later age in these countries [9,10,26,27]. Brazilian investigators were the first to report the importance of lag time (i.e., the interval between the onset of symptoms and diagnosis) in determining outcome [9].…”

“…Brazilian investigators were the first to report the importance of lag time (i.e., the interval between the onset of symptoms and diagnosis) in determining outcome [9]. In most cases, the reason for this delay in diagnosis is either because the child was not brought in for medical attention or because the initial diagnosis was incorrect [10].…”

“…Another problem critically influencing survival in developing countries is that offamilies opting out of recommended treatment, but it received less attention than late diagnosis in the literature [11]. Therefore, the survival of children with retinoblastoma in developing countries may be more influenced by socioeconomic and cultural factors causing delays in diagnosis that lead to extraocular dissemination than by the unavailability of sophisticated treatments as was described for other malignancies like acute leukemias or other solid tumors [9,10,12].…”

“…When retinoblastoma extends outside the eye, it is difficult to cure, even with sophisticated and intense treatments [8]. Advanced extraocular retinoblastoma correlates with longer lag times from the onset of symptoms to the diagnosis [9,10]. Another problem critically influencing survival in developing countries is that offamilies opting out of recommended treatment, but it received less attention than late diagnosis in the literature [11].…”