Lag time for retinoblastoma in the UK revisited: a retrospective analysis. Issue 7 (13th July 2017)

• Record Type: Journal Article
• Authors: Posner, Marcus; Jaulim, Adil; Vasalaki, Marina; Rantell, Khadija; Sagoo, Mandeep S; Reddy, M Ashwin
• Is Part Of: BMJ open. Volume 7:Issue 7(2017)
• Publication Date: 2017-07-13
• Subjects: retinoblastoma -- lag time -- ocular oncology -- paediatric ophthalmology; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2016-015625
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To explore current delays in diagnosis of retinoblastoma (Rb) and effect on outcome with comparison to a study from the 1990s. Setting: Primary, secondary, tertiary care: majority from South of England. Participants: A retrospective analysis of 93 new referrals of sporadic (non-familial) Rb to a specialist Rb unit in London, UK from January 2006 to February 2014. Primary and secondary outcomes: International Intraocular Retinoblastoma Classification, lag times including parental delay and healthcare professional delay, patients requiring enucleation and requirement of adjuvant chemotherapy postenucleation (high-risk Rb). Results: During the study period, 29% presented via accident and emergency (A&E). The median referral time from symptom onset to visiting primary care (PC) was 28 days and PC to ophthalmologist 3 days (range 0–181 days). The median time from local ophthalmologist to the Rb Unit was 6 days (0–33). No significant correlation was found between delay and International Classification of Retinoblastoma grade (p>0.05) or between postenucleation adjuvant chemotherapy and enucleation groups (p>0.05). Less enucleations (60%) are being performed compared with the previous study (81%) (p=0.0015). Conclusions: Parents are attending A&E more compared with the 1990s and this may reflect the effect of public awareness campaigns. More eyes are being salvaged despite a similar number of children requiring adjuvant chemotherapy. High-risk Rb and Group E eyes do not correlate with increased lag time in the UK. Other determinants such as tumour biology may be more relevant.