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Berry JL, Pike S, Rajagopalan A, Reid MW, Fabian ID. Retinoblastoma Outcomes in the Americas: A Prospective Analysis of 491 Children With Retinoblastoma From 23 American Countries. Am J Ophthalmol 2024; 260:91-101. [PMID: 37949286 PMCID: PMC10982661 DOI: 10.1016/j.ajo.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Globally, disparities exist in retinoblastoma treatment outcomes between high- and low-income countries, but independent analysis of American countries is lacking. We report outcomes of American retinoblastoma patients and explore factors associated with survival and globe salvage. DESIGN Subanalysis of prospective cohort study data. METHODS Multicenter analysis at 57 American treatment centers in 23 countries of varying economic levels (low income [LIC], lower-middle income [LMIC], upper-middle income [UMIC], and high income [HIC]) of 491 treatment-naïve retinoblastoma patients diagnosed in 2017 and followed through 2020. Survival and globe salvage rates analyzed with Kaplan-Meier analysis and Cox proportional hazard models. RESULTS Of patients, 8 (1.6%), 58 (11.8%), 235 (47.9%), and 190 (38.7%) were from LIC, LMIC, UMIC, and HIC groups, respectively. Three-year survival rates in LICs were 60.0% (95% confidence interval [CI] 12.6-88.2) compared with 99.2% (95% CI 94.6%-99.9%) in HICs. Death was less likely in patients >4 years of age (vs ≤4 years, HR = 0.45 [95% CI 0.27-0.78], P = .048). Patients with more advanced tumors (eg, cT3 vs cT1, HR = 4.65 × 109 [95% CI 1.25 × 109-1.72 × 1010], P < .001) and females (vs males, HR = 1.98 [95% CI 1.27-3.10], P = .04) were more likely to die. Three-year globe salvage rates were 13.3% (95% CI 5.1%-25.6%) in LMICs and 46.2% (95% CI 38.8%-53.3%) in HICs. At 3 years, 70.1% of cT1 eyes (95% CI 54.5%-81.2%) vs 8.9% of cT3 eyes (95% CI 5.5%-13.3%) were salvaged. Advanced tumor stage was associated with higher enucleation risk (eg, cT3 vs cT1, subhazard ratio = 4.98 [95% CI 2.36-10.5], P < .001). CONCLUSIONS Disparities exist in survival and globe salvage in American countries based on economic level and tumor stage demonstrating a need for childhood cancer programs.
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Affiliation(s)
- Jesse L Berry
- From the University of Southern California Roski Eye Institute (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine of the University of Southern California, Los Angeles, California, USA; Children's Hospital Los Angeles (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - Sarah Pike
- From the University of Southern California Roski Eye Institute (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine of the University of Southern California, Los Angeles, California, USA; Children's Hospital Los Angeles (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Archeta Rajagopalan
- From the University of Southern California Roski Eye Institute (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine of the University of Southern California, Los Angeles, California, USA; Children's Hospital Los Angeles (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mark W Reid
- From the University of Southern California Roski Eye Institute (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine of the University of Southern California, Los Angeles, California, USA; Children's Hospital Los Angeles (J.L.B., S.P., A.R., M.W.R.), Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ido Didi Fabian
- Goldschleger Eye Institute (I.D.F.), Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel; and the International Centre for Eye Health (I.D.F.), London School of Hygiene & Tropical Medicine, London, United Kingdom
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Nishath T, Li X, Chandramohan A, Othus M, Ji X, Zou Y, Sultana S, Rashid R, Sherief ST, Cassoux N, Garcia Leon JL, Díaz Coronado R, López AMZ, Ushakova TL, Polyakov VG, Roy SR, Ahmad A, Reddy A, Sagoo MS, Al Harby L, Kim JW, Berry JL, Polski A, Astbury N, Bascaran C, Blum S, Bowman R, Burton MJ, Foster A, Gomel N, Keren-Froim N, Madgar S, Zondervan M, Kaliki S, Fabian ID, Stacey A. Risk factors associated with abandonment of care in retinoblastoma: analysis of 692 patients from 10 countries. Br J Ophthalmol 2023; 107:1818-1822. [PMID: 36113955 PMCID: PMC10017370 DOI: 10.1136/bjo-2022-321159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rates of care abandonment for retinoblastoma (RB) demonstrate significant geographical variation; however, other variables that place a patient at risk of abandoning care remain unclear. This study aims to identify the risk factors for care abandonment across a multinational set of patients. METHODS A prospective, observational study of 692 patients from 11 RB centres in 10 countries was conducted from 1 January 2019 to 31 December 2019. Multivariate logistic regression was used to identify risk factors associated with higher rates of care abandonment. RESULTS Logistic regression showed a higher risk of abandoning care based on country (high-risk countries include Bangladesh (OR=18.1), Pakistan (OR=45.5) and Peru (OR=9.23), p<0.001), female sex (OR=2.39, p=0.013) and advanced clinical stage (OR=4.22, p<0.001). Enucleation as primary treatment was not associated with a higher risk of care abandonment (OR=0.59, p=0.206). CONCLUSION Country, advanced disease and female sex were all associated with higher rates of abandonment. In this analysis, enucleation as the primary treatment was not associated with abandonment. Further research investigating cultural barriers can enable the building of targeted retention strategies unique to each country.
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Affiliation(s)
- Thamanna Nishath
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Xiudi Li
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Arthika Chandramohan
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Megan Othus
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yang Pu Qu, Shanghai, China
| | - Yihua Zou
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yang Pu Qu, Shanghai, China
| | - Sadia Sultana
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Riffat Rashid
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nathalie Cassoux
- Department of Ophthalmology, Institut Curie, Universite de Paris UFR de Medecine de Paris Centre, Paris, France
| | | | | | | | - Tatiana L Ushakova
- Head and Neck Tumors, SRI of Pediatric Oncology and Hematology of NN Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
- Pediatric Oncology, Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Vladimir G Polyakov
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of NN Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
- Russian Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Soma Rani Roy
- Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh
| | - Alia Ahmad
- The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Ashwin Reddy
- Ophthalmology, Barts Health NHS Trust, London, UK
- Paediatric Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mandeep S Sagoo
- Ophthalmology, Barts Health NHS Trust, London, UK
- NIHR Biomedical Research Centre for Ophthalmology, Joint Library of Ophthalmology Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Lamis Al Harby
- Ocular Oncology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Jonathan W Kim
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jesse L Berry
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ashley Polski
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nick Astbury
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Cova Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sharon Blum
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Matthew J Burton
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Allen Foster
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, and International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nir Gomel
- Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
- Division of Ophthalmology, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Naama Keren-Froim
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Shiran Madgar
- Ophthalmology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Marcia Zondervan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ido Didi Fabian
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Stacey
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
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Kruger M, van Elsland SL, Afungchwi GM, Bardin R, Njodzeka B, Kouya F, Nfor P, Nana P, Wharin P, Hesseling PB. Outcome of retinoblastoma treatment protocol in Cameroon as per SIOP-PODC recommendation for a low-income setting. Pediatr Blood Cancer 2022; 69:e29642. [PMID: 35403812 DOI: 10.1002/pbc.29642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP-PODC) group recommended graduated-intensity retinoblastoma treatment for children in low- and middle-income countries with limited local resources. AIM The aim was to improve outcome of children with retinoblastoma by means of a treatment protocol for low-income settings as recommended by the SIOP-PODC recommendation in Cameroon. METHODS Children diagnosed with retinoblastoma between 2012 and 2016 were treated in two Baptist Mission hospitals in Cameroon, staging according to the International Retinoblastoma Staging System. Treatment included local therapy and combination chemotherapy (vincristine, cyclophosphamide, and doxorubicin) with or without surgery as per SIOP-PODC guidelines for low-income countries. Endpoint was survival at 24 months. Kaplan-Meier curves with log-rank (Mantel-Cox) chi-square (χ2 ) with respective p-values were prepared. RESULTS Eighty-two children were included, of whom 79.3% had unilateral disease. The majority were males (61.0%) with median age 24 months (range 1-112 months; standard deviation [SD] 19). Limited disease was diagnosed in 58.5%, metastatic disease in 35.4%, and unknown stage in 6.1%. Overall survival (OS) was 50.0% at 24 months post diagnosis, but 68.8% for limited disease. Estimated cumulative survival at 24 months was 0.528 (standard error [SE] 0.056). Causes of death included disease progression/relapses (60.5%), neutropenic sepsis (15.9%), unknown causes (18.4%), unrelated infection (2.6%), and death post surgery (2.6%). Stage was significantly associated with OS (p < .001). CONCLUSION Stage was the most significant factor for good OS and demonstrated the efficacy and feasibility of the SIOP-PODC-proposed management guidelines for retinoblastoma in a lower middle-income setting.
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Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Glenn M Afungchwi
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.,Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Richard Bardin
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Bernard Njodzeka
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Patience Nfor
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Philippa Nana
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Paul Wharin
- Beryl Thyer Memorial Africa Trust, Warkton, UK
| | - Peter B Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Zhao J, Feng Z, Gallie BL. Natural History of Untreated Retinoblastoma. Cancers (Basel) 2021; 13:3646. [PMID: 34359552 PMCID: PMC8344972 DOI: 10.3390/cancers13153646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Treatment abandonment is a leading cause of death in children with retinoblastoma worldwide. We studied children who abandoned treatment upfront at diagnosis to delineate the natural history of untreated retinoblastoma. Studied were children who received no treatment, diagnosed between 2007 and 2017 at 29 Chinese centers. Data were retrospectively collected from medical chart reviews and interviews with each patient's family. During the study period, 44 children received no treatment after diagnosis of retinoblastoma. Clinical or radiologic evidence of orbital extension was available for 25 children, and radiologic evidence of systemic metastasis was available for 12 children. Median times from diagnosis of intraocular tumor to orbital disease was 13.7 months, orbital disease to metastasis was 2.6 months, and metastasis to death was 2.0 months. Children with brain metastasis had shorter survival than those with metastasis to other sites (median 1.0 vs. 3.1 months; p = 0.015). Overall, 36% of patients died within 12 months of diagnosis, 77% within 24 months, 95% within 36 months and 100% within 48 months. While multiple factors influence refusal of treatment, insights into the natural history of retinoblastoma derived from real-world evidence can inform clinicians and parents that retinoblastoma is life-threatening and encourage urgent treatment at diagnosis.
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Affiliation(s)
- Junyang Zhao
- Department of Ophthalmology, Chongqing Aier Children’s Eye Hospital, Chongqing 400020, China;
| | - Zhaoxun Feng
- Department of Ophthalmology, University of Ottawa, Ottawa, ON K1H 8M2, Canada;
| | - Brenda L. Gallie
- Department of Ophthalmology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Krembil Research Institute, Toronto, ON M5T 0S8, Canada
- Techna Institute, Toronto, ON M5G 1L5, Canada
- Department of Ophthalmology, Medical Biophysics, Molecular Genetics, University of Toronto, Toronto, ON M5T 3A9, Canada
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Santiago T, Polanco AC, Fuentes-Alabi S, Hayes C, Orellana E, Gomero B, González MT, Ruiz E, Durán ME, Rodriguez-Galindo C, Metzger M. Multinational Retrospective Central Pathology Review of Neuroblastoma: Lessons Learned to Establish a Regional Pathology Referral Center in Resource-Limited Settings. Arch Pathol Lab Med 2021; 145:214-221. [PMID: 33501494 DOI: 10.5858/arpa.2019-0570-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Several countries of the Central America and Caribbean region have been sharing regional neuroblastoma (NB) treatment guidelines. However, there is no standardization in the diagnosis, subclassification, or tumor biology to aid in the risk stratification of these patients. OBJECTIVE.— To examine the histology and assess the accuracy of the local pathology reports; to evaluate the usefulness of manual MYCN immunohistochemistry (IHC); and to use NB as a model to identify the needs to establish a central pathology review (CPR) program in this region. DESIGN.— A retrospective CPR of specimens derived from patients with a diagnosis of NB and treated under the regional NB guidelines between 2012 and 2017 was conducted, allowing for a comparison between local diagnoses and the CPR diagnoses. Manual MYCN IHC was performed in the confirmed NB specimens and the results compared with known fluorescence in situ hybridization or automated IHC results, when available. RESULTS.— The 156 specimens reviewed included 460 blocks and 183 original slides. Neuroblastoma was confirmed in 138 samples (88.5%), but low concordance rates for Shimada classification (n = 39; 25.0%), mitotic-karyorrhectic index (n = 4; 2.5%), and International Neuroblastoma Pathology Classification (n = 18; 11.5%) were noted. Manual MYCN IHC performed on 120 specimens showed conclusive results in 89.2% (28 positive, 23.4%; 79 negative, 65.8%) and questionable results in 10.8% (n = 13). CONCLUSIONS.— This retrospective CPR highlights the need for a CPR program to serve this region, to ensure correct diagnosis and subclassification of NB, and to provide manual MYCN IHC-with reflexing to fluorescence in situ hybridization, if questionable. This approach can further regional collaboration, enhance test utilization, and ultimately improve patients' outcomes.
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Affiliation(s)
| | - Ana C Polanco
- St Jude Children's Research Hospital, Memphis, Tennessee; the Departments of Pathology (Polanco) and Oncology (Fuentes-Alabi)
| | - Soad Fuentes-Alabi
- St Jude Children's Research Hospital, Memphis, Tennessee; the Departments of Pathology (Polanco) and Oncology (Fuentes-Alabi)
| | - Caleb Hayes
- From the Departments of Pathology (Santiago, Hayes)
| | - Elizabeth Orellana
- Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; the Department of Pathology, Francisco Marroquín Medical School, Guatemala City, Guatemala (Orellana)
| | - Belkis Gomero
- the Department of Pathology, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic (Gomero)
| | - Mázlova Toledo González
- the Department of Pathology, Hospital Escuela-Universitario, Tegucigalpa, Honduras (González)
| | - Eduviges Ruiz
- the Department of Pathology, Hospital Infantil Manuel de Jesus Rivera, Managua, Nicaragua (Ruiz)
| | - Moises Espino Durán
- the Department of Pathology, Hospital del Niño Dr. José Renán Esquivel, Panamá, Panama (Durán)
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López JP, Barriga MM, Lecea D, Parada C, Stephens G. Ophthalmology examination during well-child visits in primary care health centres: Knowledge and difficulties experienced by health workers. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:26-31. [PMID: 33067032 DOI: 10.1016/j.oftal.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The red reflex examination (RRE) and visual acuity testing (VA) is a mandatory part of the examination during the well-child visits (WCV) in primary health care centres of the public system of health in Chile. The eye examination is aimed at the early detection of severe eye diseases in children, such as retinoblastoma, congenital cataracts, and amblyopia. The knowledge and difficulties experienced by health workers in primary care health centres for evaluating the red reflex during WCV in Chile is unknown. MATERIAL AND METHODS A survey was performed in primary community health centres of XXX Santiago de Chile. RESULTS The WCV were mainly performed by physicians (45.2%) and nurses (35.8%). Only 34% of health workers performed the red reflex test, and 42.3% checked VA during the WCV. The main reasons for not doing it include the lack of direct ophthalmoscopes and VA charts (55.2% and 43.9%, respectively) at their centres, and not having the knowledge or skills (29.3% and 22%, respectively) to properly perform these clinical tests. CONCLUSION In this series, the eye examination of children attending WCV was unfrequently performed. A better implementation of the health centres and training of the health workers are needed in order to improve the access and quality of the paediatric eye examination in primary health care institutions in Chile.
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Affiliation(s)
- J P López
- Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile.
| | - M M Barriga
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - D Lecea
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - C Parada
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - G Stephens
- Departamento de Gestión de Redes, SSMS, Santiago, Chile
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Girdler H, Flegg K, Prochaska J, Dimaras H. Characterization of international partnerships in global retinoblastoma care and research: A network analysis. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000125. [PMID: 36962140 PMCID: PMC10021644 DOI: 10.1371/journal.pgph.0000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Global cooperation is an integral component of global health research and practice. One Retinoblastoma World (1RBW) is a cooperative network of global treatment centers that care for children affected by retinoblastoma. The study aimed to determine the number, scope and nature of collaborations within 1RBW, and uncover how they are perceived to contribute towards improving retinoblastoma outcomes. A cross-sectional, mixed-methods egocentric network analysis was conducted. Treatment centers (n = 170) were invited to complete an electronic survey to identify collaborative activities between their institution (ego), and respective partners (alters). Network maps were generated to visualize connectivity. Key informants (n = 18) participated in semi-structured interviews to add details about the reported collaborations. Interviews were analysed through inductive thematic analysis. Surveys were completed by 56/170 (33%) of 1RBW treatment centers. Collectively, they identified 112 unique alters (80 treatment centers; 32 other organizations) for a total network size of 168 nodes. Most collaborations involved patient referrals, consultations and twinning/capacity building. Interviews identified four main themes: conceptualization of partnership; primary motivation for collaborations; common challenges to collaboration; and benefits to partnership. There is extensive global collaboration to reduce global retinoblastoma mortality, but there is room to expand connectivity through active efforts to include actors located at network peripheries.
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Affiliation(s)
- Hannah Girdler
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, Canada
| | - Kaitlyn Flegg
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto Canada
| | - John Prochaska
- Department of Preventive Medicine & Community Health, University of Texas Medical Branch at Galveston, Galveston, Texas, United States of America
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto Canada
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
- Center for Global Child Health, SickKids Research Institute, Toronto, Canada
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8
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Graetz DE, Chen Y, Devidas M, Antillon-Klussmann F, Fu L, Quintero K, Fuentes-Alabi SL, Gassant PY, Kaye EC, Baker JN, Rodriguez Galindo C, Mack JW. Interdisciplinary care of pediatric oncology patients in Central America and the Caribbean. Cancer 2020; 127:2579-2586. [PMID: 33237591 DOI: 10.1002/cncr.33339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Interdisciplinary teamwork supports high-quality cancer care and effective utilization of limited resources. This study purposed to examine the value, structure, process, and effectiveness of interdisciplinary care (IDC) among pediatric oncology providers in low-income and middle-income countries in Central America and the Caribbean. METHODS A cross-sectional survey was disseminated to pediatric oncology providers at 5 centers participating in the Pediatric Hematology-Oncology Association of Central America. The survey included previously validated items and novel questions assessing the value (importance), structure (multidisciplinary meeting attendance), process (team climate), and effectiveness (job satisfaction, quality of care and communication) of IDC. RESULTS The survey was completed by 174 providers, including 22 oncologists, 9 pathologists, 9 radiologists, 5 radiation oncologists, 12 surgeons, 35 subspecialists, 60 nurses, 20 psychosocial providers, and 2 other staff. Participants agreed that IDC benefits team members (95%) and patients (96%). IDC structure and processes varied across the region. Multidisciplinary meeting attendance differed by center (P = .005) and discipline (P < .0001). Participants who frequently attended multidisciplinary meetings reported a more positive team climate (P = .0003). Team climate was positively associated with job satisfaction (P < .001). In multivariable analyses, team climate was predictive of an improved perception of communication between professionals (P < .0001), with families (P < .0001), and with patients (P = .0005), as well as with quality of the care environment (P = .006) and overall care quality (P < .0001). CONCLUSIONS Nearly all surveyed participants valued IDC, and the structure and processes supporting IDC varied by center. Associations between a collaborative professional climate, job satisfaction, and the perception of quality care encourage continued investigation and prioritization of IDC in these settings.
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Affiliation(s)
- Dylan E Graetz
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Federico Antillon-Klussmann
- National Unit of Pediatric Oncology, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Ligia Fu
- Pediatric Hematology and Oncology Unit, Tegucigalpa School Hospital, Tegucigalpa, Honduras
| | - Karina Quintero
- Pediatric Oncology Unit, Dr Jose Renan Esquivel Children's Hospital, Panama City, Panama
| | - Soad L Fuentes-Alabi
- Department of Oncology, Benjamin Bloom National Children's Hospital, El Salvador City, El Salvador
| | | | - Erica C Kaye
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.,Division of Palliative and End of Life Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Division of Palliative and End of Life Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Carlos Rodriguez Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer W Mack
- Pediatric Oncology/Oncology, Dana Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
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9
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Global Retinoblastoma Treatment Outcomes: Association with National Income Level. Ophthalmology 2020; 128:740-753. [PMID: 33007338 DOI: 10.1016/j.ophtha.2020.09.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare metastasis-related mortality, local treatment failure, and globe salvage after retinoblastoma in countries with different national income levels. DESIGN International, multicenter, registry-based retrospective case series. PARTICIPANTS Two thousand one hundred ninety patients, 18 ophthalmic oncology centers, and 13 countries on 6 continents. METHODS Multicenter registry-based data were pooled from retinoblastoma patients enrolled between January 2001 and December 2013. Adequate data to allow American Joint Committee on Cancer staging, eighth edition, and analysis for the main outcome measures were available for 2085 patients. Each country was classified by national income level, as defined by the 2017 United Nations World Population Prospects, and included high-income countries (HICs), upper middle-income countries (UMICs), and lower middle-income countries (LMICs). Patient survival was estimated with the Kaplan-Meier method. Logistic and Cox proportional hazards regression models were used to determine associations between national income and treatment outcomes. MAIN OUTCOME MEASURES Metastasis-related mortality and local treatment failure (defined as use of secondary enucleation or external beam radiation therapy). RESULTS Most (60%) study patients resided in UMICs and LMICs. The global median age at diagnosis was 17.0 months and higher in UMICs (20.0 months) and LMICs (20.0 months) than HICs (14.0 months; P < 0.001). Patients in UMICs and LMICs reported higher rates of disease-specific metastasis-related mortality and local treatment failure. As compared with HICs, metastasis-related mortality was 10.3-fold higher for UMICs and 9.3-fold higher for LMICs, and the risk for local treatment failure was 2.2-fold and 1.6-fold higher, respectively (all P < 0.001). CONCLUSIONS This international, multicenter, registry-based analysis of retinoblastoma management revealed that lower national income levels were associated with significantly higher rates of metastasis-related mortality, local treatment failure, and lower globe salvage.
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10
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Rojanaporn D, Attaseth T, Dieosuthichat W, Leelawongs K, Pakakasama S, Anurathapan U, Chanthanaphak E, Singhara Na Ayudhaya S, Aroonroch R, Hongeng S. Clinical Presentations and Outcomes of Retinoblastoma Patients in relation to the Advent of New Multimodal Treatments: A 12-Year Report from Single Tertiary Referral Institute in Thailand. J Ophthalmol 2020; 2020:4231841. [PMID: 33005446 PMCID: PMC7508219 DOI: 10.1155/2020/4231841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/16/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the clinical presentations and outcomes of retinoblastoma in relation to the advent of new multimodal treatments in Thailand. Patients and Methods. Retrospective case series. We evaluated the clinical presentation, staging, details of treatment, and treatment outcomes of retinoblastoma patients who were treated at Ramathibodi Hospital, Bangkok, Thailand, between January 1, 2007, and December 31, 2018. The log-rank test was used to explore clinical characteristics and treatment modalities that affected globe salvage and survival curves. RESULTS This study included 124 eyes of 81 patients with retinoblastoma. Forty-three patients (53.1%) had bilateral retinoblastoma. The median age at diagnosis was 8 months (range, 1-48 months). Of 124 eyes, 9 eyes (7.3%) had extraocular retinoblastoma and 115 eyes (92.7%) had intraocular retinoblastoma, which were classified by the International Classification of Retinoblastoma (ICRB) as group A, 4 eyes (3.5%); group B, 19 eyes (16.5%); group C, 6 eyes (5.2%); group D, 31 eyes (27%); and group E, 56 eyes (47.8%). Treatment included systemic chemotherapy, intra-arterial chemotherapy, ruthenium-106 plaque brachytherapy, external beam radiation therapy, cryotherapy, transpupillary thermotherapy, subtenon chemotherapy, and intravitreal chemotherapy. At the median follow-up period of 38.4 months (range, 0.2-148.2 months), the overall globe salvage rate of intraocular retinoblastoma was 51.7%. For unilateral retinoblastoma, globe salvage rate was 37.5% (group B, 100%; group C, 100%; group D, 50%; and group E, 18.8%). For bilateral intraocular retinoblastoma, the globe salvage rate was 57.8% (group A, 100 %; group B, 94.4%; group C, 100%; group D, 64.7%; and group E, 28.2%). The overall survival rate was 93.8%. CONCLUSIONS Recent advanced treatment modalities have improved the probability of globe salvage. However, enucleation remains an important life-saving intervention in many advanced cases.
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Affiliation(s)
- Duangnate Rojanaporn
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Taweevat Attaseth
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Wimwipa Dieosuthichat
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Kitikul Leelawongs
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Samart Pakakasama
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Usanarat Anurathapan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ekachat Chanthanaphak
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | | | - Rangsima Aroonroch
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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11
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Zhao J, Feng ZX, Wei M, Liu G, Solarte CE, Li B, Wang Y, Zhang C, Gallie BL. Impact of Systemic Chemotherapy and Delayed Enucleation on Survival of Children with Advanced Intraocular Retinoblastoma. Ophthalmol Retina 2020; 4:630-639. [PMID: 32387053 DOI: 10.1016/j.oret.2020.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Primary enucleation is a well-established method to achieve cure for advanced intraocular retinoblastoma. Recent treatment advances have induced a trend toward trial eye salvage using chemotherapy or other modalities. We investigated how pre-enucleation/postenucleation systemic chemotherapy and the resulting delayed enucleation affect patient survival after failed trial eye salvage. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS Children with Group D and E retinoblastoma primarily or secondarily enucleated at 29 Chinese treatment centers. METHODS Data reviewed included clinical staging, time from diagnosis to enucleation, numbers of cycles of carboplatin, etoposide/teniposide and vincristine chemotherapy, disease-specific survival (DSS), histopathology, and follow-up. MAIN OUTCOME MEASURES Primary outcome was DSS. Secondary outcome was histopathology of enucleated eyes. RESULTS Primarily enucleated eyes had significantly shorter delay from diagnosis to enucleation than eyes treated with pre-enucleation chemotherapy (P < 0.001). Delay between diagnosis and enucleation >3.5 months (Group D) and >2 months (Group E) decreased survival (Group D: P = 0.018; Group E: P = 0.017). Compared with primarily enucleated children, children with 1 to 3 cycles of pre-enucleation chemotherapy for Group E eyes had no significant difference in survival (P = 0.74), but those who received ≥4 cycles had worse survival (P = 0.025). After pre-enucleation chemotherapy, more children with Group E (but not Group D) eyes had high-risk histopathology (pT3/pT4) (Group D: P = 0.076; Group E: P < 0.001) and worse survival than those primarily enucleated (P < 0.001). Postenucleation chemotherapy improved survival of children with high-risk histopathology (pT3/pT4) (P = 0.001) but did not change survival of children with low-risk histopathology (pT1/pT2) (P = 0.52). CONCLUSIONS We observed that pre-enucleation chemotherapy offered no survival benefit and timely enucleation minimized risk of metastatic death. Postenucleation chemotherapy improved survival of children with high-risk histopathology but was not useful for those with low-risk histopathology. These findings facilitate informed discussion on the risks and benefits of delayed enucleation, the use of systemic chemotherapy for trial salvage of eyes with advanced intraocular retinoblastoma, and the specific children who benefit from postenucleation chemotherapy.
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Affiliation(s)
- Junyang Zhao
- Pediatric Oncology Center, Beijing Children's Hospital, Beijing, China
| | - Zhao Xun Feng
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Meirong Wei
- Department of Ophthalmology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
| | - Guohua Liu
- Department of Ophthalmology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Carlos E Solarte
- Department of Ophthalmology, University of Alberta, Edmonton, Canada
| | - Bin Li
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Yizhuo Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Chengyue Zhang
- Pediatric Oncology Center, Beijing Children's Hospital, Beijing, China
| | - Brenda L Gallie
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Canada; Krembil Research Institute, Toronto, Canada; Techna Institute, Toronto, Canada.
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12
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Al-Haddad C, Bashour Z, Farah L, Bayram L, Merabe Z, Ma'luf R, Alameddine R, Eid T, Geara F, Wilson M, Brennan R, Jeha S, Ghanem K, Yousef RA, Farah R, Noun P, Yassine N, Inati A, Muwakkit S, Abboud M, Tarek N, Hamideh D, Saab R. Establishment of a formal program for retinoblastoma: Feasibility of clinical coordination across borders and impact on outcome. Pediatr Blood Cancer 2019; 66:e27959. [PMID: 31423715 DOI: 10.1002/pbc.27959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 12/22/2022]
Abstract
Retinoblastoma is an ocular tumor that occurs in young children, in either heritable or sporadic manner. The relative rarity of retinoblastoma, and the need for expensive equipment, anesthesia, and pediatric ophthalmologic expertise, are barriers for effective treatment in developing countries. Also, with an average age-adjusted incidence of two to five cases per million children, patient number limits development of local expertise in countries with small populations. Lebanon is a small country with a population of approximately 4.5 million. In 2012, a comprehensive retinoblastoma program was formalized at the Children's Cancer Institute (CCI) at the American University of Beirut Medical Center, and resources were allocated for efficient interdisciplinary coordination to attract patients from neighboring countries such as Syria and Iraq, where such specialized therapy is also lacking. Through this program, care was coordinated across hospitals and borders such that patients would receive scheduled chemotherapy at their institution, and monthly retinal examinations and focal laser therapy at the CCI in Lebanon. Our results show the feasibility of successful collaboration across borders, with excellent patient and physician adherence to treatment plans. This was accompanied by an increase in patient referrals, which enables continued expertise development. However, the majority of patients presented with advanced intraocular disease, necessitating enucleation in 90% of eyes in unilateral cases, and more than 50% of eyes in bilateral cases. Future efforts need to focus on expanding the program that reaches to additional hospitals in both countries, and promoting early diagnosis, for further improvement of globe salvage rates.
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Affiliation(s)
- Christiane Al-Haddad
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Bashour
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Farah
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Layal Bayram
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Merabe
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Riad Ma'luf
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi Alameddine
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Toufic Eid
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Matthew Wilson
- Department of Ophthalmology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Rachel Brennan
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sima Jeha
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | - Roula Farah
- Division of Hematology/Oncology, Department of Pediatrics, Saint George Hospital University Medical Centre, Beirut, Lebanon
| | - Peter Noun
- Department of Pediatrics, Lebanese Hospital Geitaoui-University Medical Center, Beirut, Lebanon
| | - Nabil Yassine
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Adlette Inati
- Department of Pediatrics, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Samar Muwakkit
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miguel Abboud
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nidale Tarek
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dima Hamideh
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raya Saab
- Children's Cancer Institute, and Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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13
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Luna-Fineman S, Chantada G, Alejos A, Amador G, Barnoya M, Castellanos ME, Fu L, Fuentes-Alabi S, Girón V, Goenz MA, Maldonado C, Méndez G, Morales RA, Ortiz R, Sanchez G, Wilson M, Rodríguez-Galindo C. Delayed Enucleation With Neoadjuvant Chemotherapy in Advanced Intraocular Unilateral Retinoblastoma: AHOPCA II, a Prospective, Multi-Institutional Protocol in Central America. J Clin Oncol 2019; 37:2875-2882. [PMID: 31536438 PMCID: PMC6823891 DOI: 10.1200/jco.18.00141] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment abandonment because of enucleation refusal is a limitation of improving outcomes for children with retinoblastoma in countries with limited resources. Furthermore, many children present with buphthalmos and a high risk of globe rupture during enucleation. To address these unique circumstances, the AHOPCA II protocol introduced neoadjuvant chemotherapy with delayed enucleation. PATIENTS AND METHODS Patients with advanced unilateral intraocular disease (International Retinoblastoma Staging System [IRSS] stage I) were considered for upfront enucleation. Those with diffuse invasion of the choroid, postlaminar optic nerve, and/or anterior chamber invasion received six cycles of adjuvant chemotherapy (vincristine, carboplatin, and etoposide). Patients with buphthalmos and those with a perceived risk for enucleation refusal and/or abandonment were given two to three cycles of chemotherapy before scheduled enucleation followed by adjuvant chemotherapy to complete six cycles, regardless of pathology. RESULTS A total of 161 patients had unilateral IRSS stage I disease; 102 underwent upfront enucleation, and 59 had delayed enucleation. The estimated 5-year abandonment-sensitive event-free and overall survival rates for the group were 0.81 ± 0.03 and 0.86 ± 0.03, respectively. The 5-year estimated abandonment-sensitive event-free survival rates for patients undergoing upfront and delayed enucleation were 0.89 ± 0.03 and 0.68 ± 0.06, respectively (P = .001). Compared with AHOPCA I, abandonment for patients with IRSS stage I retinoblastoma decreased from 16% to 4%. CONCLUSION AHOPCA describes the results of advanced intraocular retinoblastoma treated with neoadjuvant chemotherapy. In eyes with buphthalmos and patients with risk of abandonment, neoadjuvant chemotherapy can be effective when followed by enucleation and adjuvant chemotherapy. Our study suggests that this approach can save patients with buphthalmos from ocular rupture and might reduce refusal of enucleation and abandonment.
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Affiliation(s)
- Sandra Luna-Fineman
- Children's Hospital Colorado, University of Colorado, Denver, CO.,Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | - Amanda Alejos
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | - Margarita Barnoya
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.,Hospital Herrera Llerandi, Guatemala City, Guatemala
| | | | - Ligia Fu
- Hospital Universitario, Tegucigalpa, Honduras
| | | | - Verónica Girón
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | - Gustavo Méndez
- Hospital Infantil Manuel de Jesús Rivera-La Mascota, Managua, Nicaragua
| | - Rosa Amelia Morales
- Hospital Infantil Manuel de Jesús Rivera-La Mascota, Managua, Nicaragua.,Centro Nacional de Oftalmología, Managua, Nicaragua
| | - Roberta Ortiz
- Hospital Infantil Manuel de Jesús Rivera-La Mascota, Managua, Nicaragua
| | | | - Matthew Wilson
- University of Tennessee Health Sciences Center, Memphis, TN.,St Jude Children's Research Hospital, Memphis, TN
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14
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Ferman S, Lima FFDS, Lage CRS, da Hora SS, Vianna DT, Thuler LC. Preventing treatment abandonment for children with solid tumors: A single-center experience in Brazil. Pediatr Blood Cancer 2019; 66:e27724. [PMID: 30938082 DOI: 10.1002/pbc.27724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/19/2019] [Accepted: 02/23/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND High rates of treatment abandonment have been considered one of the major limitations to achieving high cure rates of childhood cancer in developing countries. The aims of this study were to report the prevalence and factors associated with treatment abandonment for children diagnosed with solid tumors in one reference center in Brazil and to describe effective strategies to prevent it. PROCEDURES A retrospective review was conducted using data from 1139 children (0-18 years) treated for solid tumors at the Brazilian National Cancer Institute, during the period between January 2012 and December 2017. Treatment abandonment was defined as recommended by the International Society of Pediatric Oncology. The impact of implementing a patient-tracking system was evaluated. Descriptive statistics were used to analyze patient characteristics. Chi-square test was used for statistical analysis, with the significance level <0.05. RESULTS Of 1139 patients, 1.66% refused or abandoned treatment. Although from 2012 to 2013 there was an increase in the abandonment rate, it then decreased by 63.8% from 2013 to 2017 (2.5% to 0.9%). In the multivariate model, only retinoblastoma diagnosis was associated with abandonment (odds ratio = 5.0; 95% confidence interval, 1.2-20.4; P = 0.025). In our cohort, abandonment rates were not associated with increased death. CONCLUSION Monitoring missed appointments, and early interventions to address issues associated with providing resources to help families during treatment were effective in achieving very low abandonment rates.
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Affiliation(s)
- Sima Ferman
- Department of Pediatric Oncology, Brazilian National Cancer Institute, INCA, Brazil
| | | | | | - Senir Santos da Hora
- Department of Pediatric Oncology, Brazilian National Cancer Institute, INCA, Brazil
| | | | - Luiz Claudio Thuler
- Clinical Research Division, Brazilian National Cancer Institute, INCA, Brazil
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15
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Santiago T, Hayes C, Polanco AC, Miranda L, Aybar A, Gomero B, Orellana E, Anglade F, Toledo González ML, Ruiz E, Espino-Durán M, Rodriguez-Galindo C, Metzger ML. Improving Immunohistochemistry Capability for Pediatric Cancer Care in the Central American and Caribbean Region: A Report From the AHOPCA Pathology Working Group. J Glob Oncol 2018; 4:1-9. [PMID: 30241256 PMCID: PMC6223474 DOI: 10.1200/jgo.17.00187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Accessibility to immunohistochemistry (IHC) is invaluable to proper diagnosis and treatment of pediatric patients with malignant neoplasms. Whereas IHC is widely available in anatomic pathology laboratories in high-income countries, access to it in anatomic pathology laboratories of low- and middle-income countries remains a struggle, with many limitations. To advance the quality of the pathology service offered to children with cancer in areas with limited resources, a 5-day pathology training workshop was offered to pathologists and histotechnologists from various countries of the Central American and Caribbean region. An initial assessment of the workshop participants’ current laboratory capacities was performed, and a regional training center was selected. Didactic and hands-on activities were offered, and review and evaluation of the IHC slides produced during the training course were compared with original slides from the participants’ sites. This model of intensive 5-day training appears to be effective and can potentially be used in other budget-constrained regions. Moreover, it can serve as a continuing education activity for pathologists and histotechnologists, and as part of validations and quality improvement projects to build capacity and develop IHC assay proficiency in low- and middle-income countries.
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Affiliation(s)
- Teresa Santiago
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Caleb Hayes
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Ana Concepción Polanco
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Lisa Miranda
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Argelia Aybar
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Belkis Gomero
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Elizabeth Orellana
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Fabienne Anglade
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Mázlova Luxely Toledo González
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Eduviges Ruiz
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Moisés Espino-Durán
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Carlos Rodriguez-Galindo
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
| | - Monika L Metzger
- Teresa Santiago, Caleb Hayes, Carlos Rodriguez-Galindo, and Monika L. Metzger, St Jude Children's Research Hospital, Memphis, TN; Ana Concepción Polanco, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador; Lisa Miranda, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," San José, Costa Rica; Argelia Aybar, MediPath, Santiago City; Belkis Gomero, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; Elizabeth Orellana, Francisco Marroquín Medical School, Guatemala City, Guatemala; Fabienne Anglade, Laboratory Regional Stephen at Pilar Robert, Mirebelais, Haiti; Mázlova Luxely Toledo González, Hospital Escuela-Universitario, Tegucigalpa, Honduras; Eduviges Ruiz, Hospital Infantil Manuel de Jesus Rivera "La Mascota," Managua, Nicaragua; Moisés Espino-Durán, Hospital del Niño Dr. José Renán Esquivel, Panama City, Panama
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Vasquez L, Diaz R, Chavez S, Tarrillo F, Maza I, Hernandez E, Oscanoa M, García J, Geronimo J, Rossell N. Factors associated with abandonment of therapy by children diagnosed with solid tumors in Peru. Pediatr Blood Cancer 2018; 65:e27007. [PMID: 29431252 DOI: 10.1002/pbc.27007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Abandonment of treatment is a major cause of treatment failure and poor survival in children with cancer in low- and middle-income countries. The incidence of treatment abandonment in Peru has not been reported. The aim of this study was to examine the prevalence of and factors associated with treatment abandonment by pediatric patients with solid tumors in Peru. METHODS We retrospectively reviewed the sociodemographic and clinical data of children referred between January 2012 and December 2014 to the two main tertiary centers for childhood cancer in Peru. The definition of treatment abandonment followed the International Society of Paediatric Oncology, Paediatric Oncology in Developing Countries, Abandonment of Treatment recommendation. RESULTS Data from 1135 children diagnosed with malignant solid tumors were analyzed, of which 209 (18.4%) abandoned treatment. Bivariate logistic regression analysis showed significantly higher abandonment rates in children living outside the capital city, Lima (forest; odds ratio [OR] 3.25; P < 0.001), those living in a rural setting (OR 3.44; P < 0.001), and those whose parent(s) lacked formal employment (OR 4.39; P = 0.001). According to cancer diagnosis, children with retinoblastoma were more likely to abandon treatment compared to children with other solid tumors (OR 1.79; P = 0.02). In multivariate regression analyses, rural origin (OR 2.02; P = 0.001) and lack of formal parental employment (OR 2.88; P = 0.001) were independently predictive of abandonment. CONCLUSION Treatment abandonment prevalence of solid tumors in Peru is high and closely related to sociodemographical factors. Treatment outcomes could be substantially improved by strategies that help prevent abandonment of therapy based on these results.
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Affiliation(s)
- Liliana Vasquez
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Rosdali Diaz
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Sharon Chavez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Fanny Tarrillo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Ivan Maza
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Eddy Hernandez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Monica Oscanoa
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Juan García
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Jenny Geronimo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Nuria Rossell
- Amsterdam Institute for Social Sciences Research, University of Amsterdam, Amsterdam, The Netherlands
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Fernandes AG, Pollock BD, Rabito FA. Retinoblastoma in the United States: A 40-Year Incidence and Survival Analysis. J Pediatr Ophthalmol Strabismus 2018; 55:182-188. [PMID: 29257183 DOI: 10.3928/01913913-20171116-03] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/24/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the incidence of retinoblastoma in the United States from 1973 to 2012 (40 years) and characterize the 5-year overall survival rate of the included patients. METHODS Cases of retinoblastoma were derived from the Surveillance, Epidemiology, and End Results (SEER) Program (National Cancer Institute, Rockville, MD). Incidence rates were calculated using U.S. Census Bureau data as the standard population, and trends over time were determined using the chi-square test. Hazard ratios with a 95% confidence interval (CI) were estimated for variables associated with mortality using Cox regression models. Survival rates were calculated using the Kaplan-Meier method and compared among different clinical and demographic categories. RESULTS A total of 879 cases of retinoblastoma were derived from the SEER databases. The annual incidence rates of retinoblastoma for a period of 40 years were 12.14 (95% CI: 11.32 to 12.96) cases per 1 million children 4 years or younger and 0.49 (95% CI: 0.36 to 0.65) cases per 1 million children between the ages of 5 and 9 years. There was no significant trend for children 4 years or younger (P = .6324) or between the ages of 5 and 9 years (P = .7695). The 5-year overall survival rates were 97.6%, 92.7%, 91.1%, and 96.4% for children diagnosed at the first, second, third, and after the third year of life, respectively (P = .0136). The 5-year overall survival rates were 92.5% for bilateral and 96.3% for unilateral cases (P = .0116). The 5-year overall survival rates were 90.8%, 92.5%, 97.6%, 97.3% for increasing time intervals (1973 to 1979, 1980 to 1989, 1990 to 1999, and 2000 to 2012, respectively; P = .0017). CONCLUSIONS The incidence rate of retinoblastoma in the United States has remained stable for the past 40 years. Survival rate analysis indicates a significant effect of laterality of tumor, age at diagnosis, and decade of diagnosis. [J Pediatr Ophthalmol Strabismus. 2018;55(3):182-188.].
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Alvarez E, Seppa M, Rivas S, Fuentes L, Valverde P, Antillón-Klussmann F, Castellanos M, Sweet-Cordero EA, Messacar K, Kurap J, Bustamante M, Howard SC, Efron B, Luna-Fineman S. Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatr Blood Cancer 2017; 64. [PMID: 28423236 DOI: 10.1002/pbc.26560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/12/2017] [Accepted: 02/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. METHODS This was a retrospective study of Guatemalan children (0-18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001-2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan-Meier analysis estimated the survival. RESULTS Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. CONCLUSION This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.
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Affiliation(s)
- Elysia Alvarez
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Midori Seppa
- Stanford University School of Medicine, Palo Alto, California
| | - Silvia Rivas
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Lucia Fuentes
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - E Alejandro Sweet-Cordero
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kevin Messacar
- Section of Hospital Medicine and Infectious Diseases, Department of Pediatrics, University of Colorado/Children's Hospital Colorado, Aurora, Colorado
| | - John Kurap
- Hilo Bay Clinic, Community Health Center, Hilo, Hawaii
| | | | - Scott C Howard
- School of Health Studies, University of Memphis, Tennessee
| | - Bradley Efron
- Department of Statistics and Biostatistics, Stanford University, Palo Alto, California
| | - Sandra Luna-Fineman
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.,Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
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Singh U, Katoch D, Kaur S, Dogra MR, Bansal D, Kapoor R. Retinoblastoma: A Sixteen-Year Review of the Presentation, Treatment, and Outcome from a Tertiary Care Institute in Northern India. Ocul Oncol Pathol 2017; 4:23-32. [PMID: 29344495 DOI: 10.1159/000477408] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 05/01/2017] [Indexed: 01/21/2023] Open
Abstract
Purpose To study epidemiology, demographic profile, clinical characteristics, and outcome in pediatric patients with retinoblastoma. Methods This was a retrospective review of retinoblastoma patients of a tertiary institute from January 1st 1998 to December 31st 2014. Results The study included 467 patients (618 eyes) with a mean age of 34.7 ± 24.6 months (median = 30; 15 days to 144 months). Retinoblastoma was bilateral in 151 (32.3%) and there were 61.7% males. Intraocular disease was seen in 301 patients (451 eyes [72.9%]) and extraocular in 166 patients (167 eyes; 27.0%). Out of the 347 (74.3%) who received treatment, primary treatment was chemoreduction in 228 (65.7%) and enucleation in 117 (33.7%), while 25.6% of patients refused treatment and 151 (43.5%) defaulted therapy. Local recurrence was seen in 20 (4.3%), metastasis in 2 (0.4%), and deaths in 13 (2.8%) (average follow-up 28.5 ± 44.4 months). Histopathological high risk features were significantly less in the eyes that received chemoreduction (5.0%) versus primary enucleation (20.8%) (p < 0.0004), but there was no difference in the rate of metastasis, recurrence, and death between the two. Conclusions The majority of retinoblastoma patients in our study had advanced disease, and nearly a third had extraocular extension. There were a significant number of therapy refusals and dropouts. Chemoreduction led to a significant decrease in the histopathological risk factors without affecting the outcomes.
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Affiliation(s)
- Usha Singh
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat Ram Dogra
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey. PLoS One 2016; 11:e0163090. [PMID: 27736871 PMCID: PMC5063311 DOI: 10.1371/journal.pone.0163090] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding and addressing treatment abandonment (TxA) is crucial for bridging the pediatric cancer survival gap between high-income (HIC) and low-and middle-income countries (LMC). In childhood cancer, TxA is defined as failure to start or complete curative cancer therapy and known to be a complex phenomenon. With rising interest on causes and consequences of TxA in LMC, this study aimed to establish the lay-of-the-land regarding determinants of TxA globally, perform and promote comparative research, and raise awareness on this subject. METHODS Physicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Queries addressed social, economic, and treatment-related determinants of TxA. Free-text comments were collected. Descriptive and qualitative analyses were performed. Appraisal of overall frequency, burden, and predictors of TxA has been reported separately. RESULTS 581 responses from 101 countries were obtained (contact rate = 26%, cooperation rate = 70%). Most respondents were physicians (86%), practicing pediatric hematology/oncology (86%) for >10 years (54%). Providers from LMC considered social/economic factors (families' low socioeconomic status, low education, and long travel time), as most influential in increasing risk of TxA. Treatment-related considerations such as preference for complementary and alternative medicine and concerns about treatment adverse effects and toxicity, were perceived to play an important role in both LMC and HIC. Perceived prognosis seemed to mediate the role of other determinants such as diagnosis and treatment phase on TxA risk. For example, high-risk of TxA was most frequently reported when prognosis clearly worsened (i.e. lack of response to therapy, relapse), or conversely when the patient appeared improved (i.e. induction completed, mass removed), as well as before aggressive/mutilating surgery. Provider responses allowed development of an expanded conceptual model of determinants of TxA; one which illustrates established and emerging individual, family, center, and context specific factors to be considered in order to tackle this problem. Emerging factors included vulnerability, family dynamics, perceptions, center capacity, public awareness, and governmental healthcare financing, among others. CONCLUSION TxA is a complex and multifactorial phenomenon. With increased recognition of the role of TxA on global pediatric cancer outcomes, factors beyond social/economic status and beliefs have emerged. Our results provide insights regarding the role of established determinants of TxA in different geographical and economic contexts, allow probing of key determinants by deliberating their mechanisms, and allow building an expanded conceptual model of established and emerging determinants TxA.
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Ospina-Romero M, Portilla CA, Bravo LE, Ramirez O. Caregivers' Self-Reported Absence of Social Support Networks is Related to Treatment Abandonment in Children With Cancer. Pediatr Blood Cancer 2016; 63:825-31. [PMID: 26871640 DOI: 10.1002/pbc.25919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/21/2015] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment abandonment (TxA) is a primary cause of therapy failure in children with cancer in low-/middle-income countries. We explored the absence of social support network (SSN), among other predictive factors, and TxA in children with cancer in Cali, Colombia. PROCEDURE In this prospective cohort study, we included children diagnosed with cancer at a public university hospital. A social worker and a psychologist administered semistructured questionnaires to patients' caregivers. We extracted information from the questionnaires about social, economic, and psychological conditions of the patients' families. Outcomes were death, relapse, and TxA. Failure either to start or to continue the planned course of curative treatment for 4 weeks or more was defined as TxA. We identified events with Cali's childhood cancer outcomes surveillance system (VIGICANCER). We adjusted the hazard ratios (HRs) for potential confounders using multivariate Cox regression analyses. RESULTS Among 188 patients diagnosed from January 2011 to June 2013, 99 interviews were conducted. Median age was 5 years old (range: 0.3, 14.9), 53% were male, 17% were of Colombian-Indian ethnicity, and 68% lived in rural areas. The 2-year cumulative incidence of TxA was 21% (95% confidence interval [CI]: 13, 35) and the annual proportion was 14%. The adjusted HR for the absence of SSN was 4.9 (95% CI: 1.6, 15.3). CONCLUSIONS We found a strong association between the absence of SSN and TxA that was independent of other covariates, including surrogate measures of wealth. Our findings highlight the imperative understanding of social ties and support surrounding children's families for planning strategies to prevent TxA.
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Affiliation(s)
| | - Carlos Andrés Portilla
- School of Medicine, Universidad del Valle, Cali, Colombia.,Valley Public University Hospital, Cali, Colombia.,POHEMA Foundation, Cali, Colombia
| | - Luis Eduardo Bravo
- School of Medicine, Universidad del Valle, Cali, Colombia.,Population Based Cali Cancer Registry, Colombia
| | - Oscar Ramirez
- POHEMA Foundation, Cali, Colombia.,Imbanaco Medical Center, Cali, Colombia.,Population Based Cali Cancer Registry, Colombia
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Arora RS, Bakhshi S. Indian Pediatric Oncology Group (InPOG) – Collaborative research in India comes of age. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2016.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, Abramson DH, Shields CL, Chantada GL, Njuguna F, Gallie BL. Retinoblastoma. Nat Rev Dis Primers 2015; 1:15021. [PMID: 27189421 PMCID: PMC5744255 DOI: 10.1038/nrdp.2015.21] [Citation(s) in RCA: 342] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retinoblastoma is a rare cancer of the infant retina that is diagnosed in approximately 8,000 children each year worldwide. It forms when both retinoblastoma gene (RB1) alleles are mutated in a susceptible retinal cell, probably a cone photoreceptor precursor. Loss of the tumour-suppressive functions of the retinoblastoma protein (pRB) leads to uncontrolled cell division and recurrent genomic changes during tumour progression. Although pRB is expressed in almost all tissues, cone precursors have biochemical and molecular features that may sensitize them to RB1 loss and enable tumorigenesis. Patient survival is >95% in high-income countries but <30% globally. However, outcomes are improving owing to increased disease awareness for earlier diagnosis, application of new guidelines and sharing of expertise. Intra-arterial and intravitreal chemotherapy have emerged as promising methods to salvage eyes that with conventional treatment might have been lost. Ongoing international collaborations will replace the multiple different classifications of eye involvement with standardized definitions to consistently assess the eligibility, efficacy and safety of treatment options. Life-long follow-up is warranted, as survivors of heritable retinoblastoma are at risk for developing second cancers. Defining the molecular consequences of RB1 loss in diverse tissues may open new avenues for treatment and prevention of retinoblastoma, as well as second cancers, in patients with germline RB1 mutations.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, Toronto, Canada
| | - Timothy W. Corson
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Cobrinik
- The Vision Center, Children’s Hospital Los Angeles & USC Eye Institute, University of Southern California, Los Angeles, CA USA
| | | | - Junyang Zhao
- Department of Ophthalmology, Beijing Children’s Hospital, Capital Medial University, Beijing, China
| | - Francis L. Munier
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - David H. Abramson
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Festus Njuguna
- Department of Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Brenda L. Gallie
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, 555 University Ave, Toronto, Ontario M5G1X8, Canada
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Abstract
BACKGROUND There are no standardized diagnostic or treatment guidelines for patients with advanced unilateral retinoblastoma. MATERIALS AND METHODS Patients with advanced unilateral retinoblastoma were prospectively treated after enucleation using a risk-based protocol. Patients were assigned to low risk (LR), intermediate risk (IR), or high risk (HR) based on pathology. LR patients underwent observation. IR patients received 4 courses of chemotherapy with vincristine, doxorubicin, and cyclophosphamide (VDC). In the HR group, patients received 3 courses of VDC alternating with 3 courses of vincristine, carboplatin, and etoposide (VCE) and irradiation when indicated. RESULTS Fifty patients with advanced unilateral retinoblastoma were treated (LR, n=36; IR, n=7; HR, n=7). All eyes were Reese-Ellsworth group V. All bone scans (n=81), lumbar punctures (n=16), and bone marrow aspirates (n=16) were negative. Chemotherapy was well tolerated. Grades 3/4 hematologic toxicities were seen in all patients; grades 3/4 nonhematologic toxicities were seen in half the patients. Only one patient in the HR group received radiation therapy. All patients were alive at the time of analysis with no signs of disease recurrence. Median follow-up was 3.4 years (range, 0.8 to 6.4 y). CONCLUSIONS Patients with nonmetastatic unilateral retinoblastoma undergoing primary enucleation can be cured with a graduated intensity approach based on pathology.
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da Rocha-Bastos R, Araújo J, Silva R, Gil-da-Costa M, Brandão E, Farinha N, Falcão-Reis F, Dinah-Bragança T. Retinoblastoma: experience of a referral center in the North Region of Portugal. Clin Ophthalmol 2014; 8:993-7. [PMID: 24899796 PMCID: PMC4039395 DOI: 10.2147/opth.s59601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe the experience of the Ophthalmology Department of Hospital São João (HSJ), a tertiary health care center in North Region, Portugal, in terms of the diagnosis, treatment, and follow-up of retinoblastoma. Methods This was a retrospective study of patients diagnosed with retinoblastoma in Hospital São João, between 1978 and 2012. Results Fifty patients with retinoblastoma were evaluated in our institution between 1978 and 2012. Four patients were excluded due to loss of follow-up. Among the 46 retinoblastoma cases, 33 (71.7%) were unilateral and 13 (28.3%) bilateral, with a mean age at diagnosis of 22.19 months and 6.92 months, respectively (P<0.001). Leukocoria was the most common presenting sign (36.9%), followed by strabismus (19.6%), a combination of leukocoria and strabismus (8.7%), and buphthalmia (2.2%). Between 1978 and 1992, nine retinoblastoma cases were referred to our hospital, all of them unilateral, and, in each case, enucleation was performed, with or without salvage therapy. Between 1993 and 2012, 18 eyes with retinoblastoma were successfully managed with conservative treatment. Conclusion Demographic results were generally coincident with previous reports. It is crucial to screen leukocoria in pediatric practice, even in asymptomatic children. The outcome of retinoblastoma treatment in our hospital is similar to other series in developed countries.
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Affiliation(s)
| | - Jr Araújo
- Department of Ophthalmology, Hospital São João, Porto, Portugal
| | - Rs Silva
- Hematology and Oncology Unit, Pediatric Hospital, Hospital São João, Porto, Portugal
| | - Mj Gil-da-Costa
- Hematology and Oncology Unit, Pediatric Hospital, Hospital São João, Porto, Portugal
| | - E Brandão
- Department of Ophthalmology, Hospital São João, Porto, Portugal
| | - Nj Farinha
- Hematology and Oncology Unit, Pediatric Hospital, Hospital São João, Porto, Portugal ; Pediatrics Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Falcão-Reis
- Department of Ophthalmology, Hospital São João, Porto, Portugal ; Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal
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Dean M, Bendfeldt G, Lou H, Giron V, Garrido C, Valverde P, Barnoya M, Castellanos M, Jiménez-Morales S, Luna-Fineman S. Increased incidence and disparity of diagnosis of retinoblastoma patients in Guatemala. Cancer Lett 2014; 351:59-63. [PMID: 24814393 DOI: 10.1016/j.canlet.2014.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/23/2014] [Accepted: 04/27/2014] [Indexed: 11/17/2022]
Abstract
Analysis of 327 consecutive cases at a pediatric referral hospital of Guatemala reveals that retinoblastoma accounts for 9.4% of all cancers and the estimated incidence is 7.0 cases/million children, higher than the United States or Europe. The number of familial cases is low, and there is a striking disparity in indigenous children due to late diagnosis, advanced disease, rapid progression and elevated mortality. Nine germline mutations in 18 patients were found; two known and five new mutations. Hypermethylation of RB1 was identified in 13% of the tumors. An early diagnosis program could identify cases at an earlier age and improve outcome of retinoblastoma in this diverse population.
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Affiliation(s)
- Michael Dean
- Laboratory of Experimental Immunology, Cancer and Inflammation Program, National Cancer Institute at Frederick, Frederick, MD 21702, USA
| | - Giovana Bendfeldt
- Laboratory of Experimental Immunology, Cancer and Inflammation Program, National Cancer Institute at Frederick, Frederick, MD 21702, USA; Universidad de San Carlos Medical School, Guatemala City, Guatemala
| | - Hong Lou
- Leidos Biomedical Research Corporation, Frederick, MD 21702, USA
| | - Veronica Giron
- Stanford University, Stanford, CA 94305, USA; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Claudia Garrido
- Stanford University, Stanford, CA 94305, USA; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Patricia Valverde
- Stanford University, Stanford, CA 94305, USA; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Margarita Barnoya
- Stanford University, Stanford, CA 94305, USA; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Mauricio Castellanos
- Stanford University, Stanford, CA 94305, USA; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Silvia Jiménez-Morales
- Laboratory of Experimental Immunology, Cancer and Inflammation Program, National Cancer Institute at Frederick, Frederick, MD 21702, USA; Laboratory of Immunogenomic and Metabolic Diseases, National Institute of Genomic Medicine, Mexico City, Mexico
| | - Sandra Luna-Fineman
- Stanford University, Stanford, CA 94305, USA; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala; Pediatric Hematology/Oncology/SCT/Cancer Bio, Stanford University School of Medicine, Stanford, CA 94305, USA
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Valery PC, Moore SP, Meiklejohn J, Bray F. International variations in childhood cancer in indigenous populations: a systematic review. Lancet Oncol 2014; 15:e90-e103. [PMID: 24480559 DOI: 10.1016/s1470-2045(13)70553-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although the cancer burden in indigenous children has been reported in some countries, up to now, no international comparison has been made. We therefore aimed to assess the available evidence of the burden of childhood cancer in indigenous populations. We did a systematic review of reports on cancer incidence, mortality, and survival in indigenous children worldwide. Our findings highlight the paucity of accessible information and advocate the pressing need for data by indigenous status in countries where population-based cancer registries are established. The true extent of disparities between the burden in the indigenous community needs to be measured so that targeted programmes for cancer control can be planned and implemented.
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Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
| | - Suzanne P Moore
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
| | - Judith Meiklejohn
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Freddie Bray
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
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30
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Abdolvahabi A, Taylor BW, Holden RL, Shaw EV, Kentsis A, Rodriguez-Galindo C, Mukai S, Shaw BF. Colorimetric and longitudinal analysis of leukocoria in recreational photographs of children with retinoblastoma. PLoS One 2013; 8:e76677. [PMID: 24204654 PMCID: PMC3813630 DOI: 10.1371/journal.pone.0076677] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/02/2013] [Indexed: 11/18/2022] Open
Abstract
Retinoblastoma is the most common primary intraocular tumor in children. The first sign that is often reported by parents is the appearance of recurrent leukocoria (i.e., "white eye") in recreational photographs. A quantitative definition or scale of leukocoria--as it appears during recreational photography--has not been established, and the amount of clinical information contained in a leukocoric image (collected by a parent) remains unknown. Moreover, the hypothesis that photographic leukocoria can be a sign of early stage retinoblastoma has not been tested for even a single patient. This study used commercially available software (Adobe Photoshop®) and standard color space conversion algorithms (operable in Microsoft Excel®) to quantify leukocoria in actual "baby pictures" of 9 children with retinoblastoma (that were collected by parents during recreational activities i.e., in nonclinical settings). One particular patient with bilateral retinoblastoma ("Patient Zero") was photographed >7, 000 times by his parents (who are authors of this study) over three years: from birth, through diagnosis, treatment, and remission. This large set of photographs allowed us to determine the longitudinal and lateral frequency of leukocoria throughout the patient's life. This study establishes: (i) that leukocoria can emerge at a low frequency in early-stage retinoblastoma and increase in frequency during disease progression, but decrease upon disease regression, (ii) that Hue, Saturation and Value (i.e., HSV color space) are suitable metrics for quantifying the intensity of retinoblastoma-linked leukocoria; (iii) that different sets of intraocular retinoblastoma tumors can produce distinct leukocoric reflections; and (iv) the Saturation-Value plane of HSV color space represents a convenient scale for quantifying and classifying pupillary reflections as they appear during recreational photography.
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Affiliation(s)
- Alireza Abdolvahabi
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Brandon W. Taylor
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Rebecca L. Holden
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Elizabeth V. Shaw
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Alex Kentsis
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Shizuo Mukai
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - Bryan F. Shaw
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
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31
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Friedrich P, Ortiz R, Fuentes S, Gamboa Y, Ah Chu-Sanchez MS, Arambú IC, Montero M, Báez F, Rodríguez-Galindo C, Antillón-Klussmann F. Barriers to effective treatment of pediatric solid tumors in middle-income countries: can we make sense of the spectrum of nonbiologic factors that influence outcomes? Cancer 2013; 120:112-25. [PMID: 24132910 DOI: 10.1002/cncr.28339] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/15/2013] [Accepted: 07/24/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The delivery of effective treatment for pediatric solid tumors poses a particular challenge to centers in middle-income countries (MICs) that already are vigorously addressing pediatric cancer. The objective of this study was to improve the current understanding of barriers to effective treatment of pediatric solid tumors in MICs. METHODS An ecologic model centered on pediatric sarcoma and expanded to country as the environment was used as a benchmark for studying the delivery of solid tumor care in MICs. Data on resources were gathered from 7 centers that were members of the Central American Association of Pediatric Hematologists and Oncologists (AHOPCA) using an infrastructure assessment tool. Pediatric sarcoma outcomes data were available, were retrieved from hospital-based cancer registries for 6 of the 7 centers, and were analyzed by country. Patients who were diagnosed from January 1, 2000 to December 31, 2009 with osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, and other soft tissue sarcomas were included in the analysis. To explore correlations between resources and outcomes, a pilot performance index was created. RESULTS The analyses identified specific deficits in human resources, communication, quality, and infrastructure. The treatment abandonment rate, the proportion of metastatic disease at diagnosis, the relapse rate, and the 4-year abandonment-sensitive overall survival (AOS) rate varied considerably by country, ranging from 1% to 38%, from 15% to 54%, from 24% to 52%, and from 21% to 51%, respectively. The treatment abandonment rate correlated inversely with health economic expenditure per capita (r = -0.86; P = .03) and life expectancy at birth (r = -0.93; P = .007). The 4-year AOS rate correlated inversely with the mortality rate among children aged <5 years (r = -0.80; P = 0.05) and correlated directly with the pilot performance index (r = 0.98; P = 0.005). CONCLUSIONS Initiatives to improve the effectiveness of treatment for pediatric solid tumors in MICs are warranted, particularly for pediatric sarcomas. Building capacity and infrastructure, improving supportive care and communication, and fostering comprehensive, multidisciplinary teams are identified as keystones in Central America. A measure that meaningfully describes performance in delivering pediatric cancer care is feasible and needed to advance comparative, prospective analysis of pediatric cancer care and to define resource clusters internationally.
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Affiliation(s)
- Paola Friedrich
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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White Y, Castle VP, Haig A. Pediatric oncology in developing countries: challenges and solutions. J Pediatr 2013; 162:1090-1, 1091.e1. [PMID: 23708414 DOI: 10.1016/j.jpeds.2013.02.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yasmine White
- University of Michigan Medical School, and Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA
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33
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Chantada G, Luna-Fineman S, Sitorus RS, Kruger M, Israels T, Leal-Leal C, Bakhshi S, Qaddoumi I, Abramson DH, Doz F. SIOP-PODC recommendations for graduated-intensity treatment of retinoblastoma in developing countries. Pediatr Blood Cancer 2013; 60:719-27. [PMID: 23335388 DOI: 10.1002/pbc.24468] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/13/2012] [Indexed: 11/12/2022]
Abstract
Retinoblastoma remains incurable in many regions of the world. The major obstacles to cure are delayed diagnosis, poor treatment compliance, and lack of evidence-based recommendations for clinical management. Although enucleation is curative for intraocular disease, in developing countries retinoblastoma is often diagnosed after the disease has disseminated beyond the eye. A SIOP-PODC committee generated guidelines for the clinical management of retinoblastoma in developing countries and developed a classification system based on the resources available in those settings. Recommendations are provided for staging and treatment of unilateral and bilateral retinoblastoma and counseling of families for whom compliance is an issue.
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Affiliation(s)
- Guillermo Chantada
- Hospital de Pediatria SAMIC Prof Dr Juan P Garrahan, Buenos Aires, Argentina.
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Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, Kebudi R, Macfarlane SD, Howard SC. Paediatric cancer in low-income and middle-income countries. Lancet Oncol 2013; 14:e104-16. [PMID: 23434340 DOI: 10.1016/s1470-2045(13)70008-1] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patterns of cancer incidence across the world have undergone substantial changes as a result of industrialisation and economic development. However, the economies of most countries remain at an early or intermediate stage of development-these stages are characterised by poverty, too few health-care providers, weak health systems, and poor access to education, modern technology, and health care because of scattered rural populations. Low-income and middle-income countries also have younger populations and therefore a larger proportion of children with cancer than high-income countries. Most of these children die from the disease. Chronic infections, which remain the most common causes of disease-related death in all except high-income countries, can also be major risk factors for childhood cancer in poorer regions. We discuss childhood cancer in relation to global development and propose strategies that could result in improved survival. Education of the public, more and better-trained health professionals, strengthened cancer services, locally relevant research, regional hospital networks, international collaboration, and health insurance are all essential components of an enhanced model of care.
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Affiliation(s)
- Ian Magrath
- International Network for Cancer Treatment and Research, Brussels, Belgium.
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35
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Abstract
PURPOSE OF REVIEW Reduction of child mortality is one of the Millennium Development Goals; as low-income and middle-income countries (LMICs) advance toward the achievement of this goal, initiatives aimed at reducing the burden of noncommunicable diseases, including childhood cancer, need to be developed. RECENT FINDINGS Approximately 200 000 children and adolescents are diagnosed with cancer every year worldwide; of those, 80% live in LMICs, which account for 90% of the deaths. Lack of quality population-based cancer registries in LMICs limits our knowledge of the epidemiology of pediatric cancer; however, available information showing variations in incidence may indicate unique interactions between environmental and genetic factors that could provide clues to cause. Outcome of children with cancer in LMICs is dictated by late presentation and underdiagnosis, high abandonment rates, high prevalence of malnutrition and other comorbidities, suboptimal supportive and palliative care, and limited access to curative therapies. Initiatives integrating program building with education of healthcare providers and research have proven to be successful in the development of regional capacity. Intensity-graduated treatments adjusted to the local capacity have been developed. SUMMARY Childhood cancer burden is shifted toward LMICs; global initiatives directed at pediatric cancer care and control are urgently needed. International partnerships facilitating stepwise processes that build capacity while incorporating epidemiology and health services research and implementing intensity-graduated treatments have been shown to be effective.
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