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Delay in diagnosis of retinoblastoma: risk factors and treatment outcome
A G Goddard1, J E Kingston, J L Hungerford
1Department of Paediatric Oncology, St Bartholomew's Hospital, London.
Insights
Early detection of retinoblastoma is crucial. Delays in diagnosing this eye cancer in children, particularly those with squint, increase the risk of tumor invasion, highlighting the need for improved primary healthcare professional awareness.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Primary Healthcare
Background:
- Retinoblastoma diagnosis delays cause parental distress.
- Primary healthcare professionals (PHPs) may miss key symptoms like leucocoria or misinterpret common ocular issues in children.
- PHPs may not recognize retinoblastoma as the underlying cause of pediatric ocular symptoms.
Purpose of the Study:
- To assess diagnostic delays in retinoblastoma.
- To identify risk factors associated with delayed diagnosis.
- To determine the impact of diagnostic delay on treatment outcomes.
Main Methods:
- Interviewed parents of 100 retinoblastoma patients.
- Collected data on diagnostic timelines and risk factors.
- Analyzed the influence of delay on treatment outcomes.
Main Results:
- One quarter of patients experienced diagnostic delays exceeding 8 weeks.
- Younger patients, those with squint (vs. leucocoria), and those initially seen by health visitors faced higher delay risks.
- Diagnostic delay significantly increased the risk of local tumor invasion but not primary enucleation or mortality.
Conclusions:
- Primary healthcare professionals need enhanced education on pediatric ocular symptoms, especially squint.
- Improved recognition of retinoblastoma signs by PHPs is essential for timely diagnosis and treatment.
- Addressing diagnostic delays can mitigate risks like local tumor invasion.
Background:
Delay in diagnosis of retinoblastoma causes considerable parental distress; however, the primary healthcare professional (PHP) may have difficulty detecting the most common presenting symptom-leucocoria. Alternatively, the PHP may not appreciate that retinoblastoma is the pathology underlying more common ocular symptoms in infants and young children.
Method:
The parents of 100 recently diagnosed patients with retinoblastoma were interviewed to establish the extent of diagnostic delay, ascertain any associated risk factors, and to determine whether or not delay influenced treatment outcome.
Results:
Although nearly 50% of patients were referred to an ophthalmologist within 1 week of first consulting a PHP, one quarter waited more than 8 weeks. There was a significantly increased risk of diagnostic delay in younger patients, those presenting with squint rather than leucocoria, and those first presenting to a health visitor rather than to a general practitioner. The risk of local tumour invasion was significantly increased by diagnostic delay. Treatment with primary enucleation was not increased by diagnostic delay. There were no deaths during the study period.
Conclusion:
Primary healthcare professionals require education about the importance of ocular symptoms, especially squint, in paediatric patients.