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Late diagnosis of retinoblastoma in a developing country
G Chantada1, A Fandiño, J Manzitti
1Servicio de Hemato-oncología, Hospital JP Garrahan, Buenos Aires, Argentina. garrahan@giga.com.ar
Insights
In developing countries, pediatricians often misdiagnose retinoblastoma, delaying crucial ophthalmologist referrals. Socioeconomic factors and parental education significantly impact diagnosis timelines for this eye cancer.
Area of Science:
- Ophthalmology
- Pediatrics
- Global Health
Background:
- Retinoblastoma is a common intraocular malignancy in children.
- Timely diagnosis is critical for successful treatment and vision preservation.
- Understanding diagnostic pathways in developing countries is essential for improving outcomes.
Purpose of the Study:
- To evaluate the diagnostic process for retinoblastoma in a developing country setting.
- To identify factors contributing to diagnostic delays and advanced disease presentation.
Main Methods:
- A prospective survey was conducted with 95 parents of children diagnosed with retinoblastoma.
- Data collected included initial consultation patterns, referral accuracy, and diagnostic timelines.
Main Results:
- Most children (56%) initially saw a pediatrician, often presenting with younger age and advanced disease.
- Only 50% of pediatric referrals to ophthalmology were appropriate; pediatricians underestimated symptoms in others.
- Late consultations were linked to advanced disease, lower parental education, lack of health insurance, and geographic location.
Conclusions:
- Pediatricians frequently encounter retinoblastoma but often fail to establish an early diagnosis.
- Parental delays in seeking care, influenced by socioeconomic factors and healthcare access, contribute to advanced disease.
- Improving pediatrician awareness and addressing socioeconomic barriers are crucial for earlier retinoblastoma detection.
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.
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