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Rabelo BS, de Alvarenga KAF, Fernando Lopes L, Guimarães Ribeiro A, de Sá Rodrigues KE. Strategies to improve diagnosis and access to treatment of retinoblastoma in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2024; 71:e30987. [PMID: 38594882 DOI: 10.1002/pbc.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
Retinoblastoma, the most common intraocular tumor in childhood, still faces challenges in diagnosis and treatment, particularly in low- and middle-income countries. Identifying strategies to improve the time to diagnosis and access to treatment is crucial to enhance survival rates and preserve ocular health. We conducted a systematic review to identify interventions that have demonstrated potential in addressing these challenges. We performed a comprehensive search across databases until March 2023. Out of the studies reviewed, 21 met the inclusion criteria and were categorized into five main areas: surveillance strategies, genetic counseling, education, public assistance, and international partnership. Despite the obstacles faced, the initiatives identified in this review present acts toward improving the time to diagnosis and access to treatment for retinoblastoma. Based on the extracted data, we propose a comprehensive chain of initiatives. We firmly believe that implementing this chain of initiatives can lead to improved clinical outcomes for retinoblastoma patients.
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Affiliation(s)
- Bruna Salgado Rabelo
- Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
| | - Kevin Augusto Farias de Alvarenga
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
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Bilbeisi T, Almasry R, Obeidat M, Mohammad M, Jaradat I, Halalsheh H, Alni’mat A, Ahmad DK, Alsaket N, Mehyar M, Al-Nawaiseh I, Yousef YA. Causes of death and survival analysis for patients with retinoblastoma in Jordan. Front Med (Lausanne) 2023; 10:1244308. [PMID: 37731722 PMCID: PMC10507250 DOI: 10.3389/fmed.2023.1244308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
Purpose To analyze causes and prognostic factors for death among Retinoblastoma (Rb) patients treated at a single specialized tertiary cancer center in Jordan. Methods We reviewed the mortality causes for all Rb patients who have been treated at the King Hussein Cancer Center between 2003 and 2019 and were followed for at least 3 years after diagnosis. The main outcome measures included demographics, laterality, tumor stage, treatment modalities, metastasis, survival, and causes of death. Results Twenty-four (5%) of the 478 patients died from retinoblastoma and 5-year survival was 94%. The mean age at diagnosis was 15 months (median, 18 months; range, 4-38 months); eight (33%) received diagnoses within the first year of life. Eleven (46%) were boys, 16 (67%) had bilateral disease, and 3 (13%) had a positive family history. The stage for the worst eye was C for 1 (4%) patient, D in 6 (25%) patients, and E (T3) in 15 (63%) patients. Two patients had extraocular Rb at diagnosis, and four of the patients who had intraocular Rb at diagnosis refused treatment and then came back with extraocular Rb. In total, extraocular disease was encountered in six eyes (six patients). After a 120-month median follow-up period, 24 patients (5%) died of second neoplasms (n = 3) or metastases (n = 21). Significant predictive factors for metastasis and death included advanced IIRC tumor stage (p < 0.0001), the presence of high-risk pathological features in the enucleated eyes (p = 0.013), parental refusal of the recommended primary treatment plan (p < 0.0001), and extraocular extension (p < 0.0001). Conclusion The 5-year survival rates of Rb patients in Jordan are as high as those in high-income countries. However, 5% are still dying from metastatic disease, prompting the need for awareness campaigns to educate the public about the high cure rates and to prevent treatment abandonment.
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Affiliation(s)
- Tharwa Bilbeisi
- FedEx Institute of Technology, University of Memphis, Memphis, TN, United States
- St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Razaq Almasry
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mariam Obeidat
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Hadeel Halalsheh
- Department of Pediatrics Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ayat Alni’mat
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Danah Kanj Ahmad
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Nour Alsaket
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center (KHCC), Amman, Jordan
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Yousef YA, Abu Salim QF, Mohammad M, Jaradat I, Mehyar M, AlJabari R, Al-Habahbeh O, Saboubeh K, Halalsheh H, Khzouz J, Shawagfeh M, Sultan I, AlMasri M, Al-Nawaiseh I, Al-Hussaini M, Mansour A. Presentation and management outcomes of Retinoblastoma among Syrian refugees in Jordan. Front Oncol 2023; 12:1056963. [PMID: 36713556 PMCID: PMC9880551 DOI: 10.3389/fonc.2022.1056963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose The humanitarian crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management outcomes of Syrian patients with Retinoblastoma (Rb) treated at a single tertiary cancer center in Jordan. Methods and Materials This is a retrospective comparative study of Syrian refugees and Jordanian citizens who had Rb between 2011 and 2020. Collected data included patient demographics, presentation, tumor stage, treatment modalities, eye salvage rate, metastasis, and mortality. Results Thirty Syrian refugees (16 (53%) had bilateral disease) and 124 Jordanian citizens (51(41%) had bilateral disease) were diagnosed with Rb during this period. The median age at diagnosis for refugees was 10 and 32 months for patients with bilateral and unilateral Rb consecutively, compared to 6 and 28 months for citizens. The median lag time between signs of disease and initiation of treatment was 3 months for refugees, compared to 1 month for citizens.Refugees were more likely to present with a more advanced stage (p=0.046). Out of 46 affected eyes in refugees; 32 (70%) eyes were group D or E, while out of 175 affected eyes among citizens; 98 (56%) eyes were group D or E. Therefore, refugees with Rb were more likely to mandate primary enucleation (48%) compared to citizens (25%) (p=0.003). However, out of 24 eyes among refugees who received conservative therapy, 15 (62%) eyes were successfully salvaged, while out of 131 affected eyes among citizens who received conservative therapy, 105 (80%) eyes were successfully salvaged (p=0.06). Two (7%) of the refugees and four (3.2%) of the citizens with Rb died from metastasis. Conclusion Syrian refugees with Rb presented with more advanced disease due to delay in diagnosis and referral that increased the treatment burden by decreasing the chance for eye globe salvage. However, patients who received the timely intervention had a similar outcome to citizens with Rb; probably a reflection of the management of all patients at a single specialized center. We advocate for the timely referral of refugees with this rare life-threatening tumor to a specialized cancer center for the best possible outcome.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan,*Correspondence: Yacoub A. Yousef,
| | | | - Mona Mohammad
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Omar Al-Habahbeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Khalid Saboubeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Hadeel Halalsheh
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Jakub Khzouz
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Munir Shawagfeh
- Department Anesthesia, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mahmoud AlMasri
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | | | - Maysa Al-Hussaini
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Asem Mansour
- Department Diagnostic Radiology, King Hussein Cancer Centre (KHCC), Amman, Jordan
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Elshafie MA, Abd-elkader MM, Sr AM, el-Ansarey HS, Waly MA, Mohamed MA. Efficacy of ophthalmological curriculum in Kafrelsheikh University: awareness of retinoblastoma among medical students and fresh graduates.. [DOI: 10.21203/rs.3.rs-2148750/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
Background: retinoblastoma (RB) is a rare inherited eye disease. Leukocoria is the first presenting sign of this disease. Early diagnosis is important to gain better life outcomes. We aim to assess Kafr Elsheikh university medical students' knowledge about retinoblastoma.
Methodology: A cross-sectional study was performed using a web-based questionnaire to collect data. We analyzed the data using the SPSS program.
Results: we survived 235 medical students and graduates at Kafr Elsheikh university. Most participants (n=131, 55.7%) had sufficient knowledge about retinoblastoma, while 78 (33.2%) had poor knowledge. Only 26 (11.1%) had a proficient level. Almost all participants (99.6%) detected that the abnormal eye was due to disease. Nearly two-thirds (63%) thought that it was a life-threatening leukocoria. While (96.6%) knew that an ophthalmologist referral was the right thing to do. We found no significant differences between academic grades and test results (H= 1.093, P=.779). As well, no correlation was found between academic grades and results (r=.033, p=.086).
Conclusion: Retinoblastoma is a fatal disease that needs attention in developing countries. Early detection of RB is the key to successful management with a higher survival rate. All healthcare providers, particularly those who have direct contact with children, should receive comprehensive education to improve their clinical screening skills.
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Yousef YA, Al-Nawaiseh I, Mehyar M, Sultan I, Al-Hussaini M, Jaradat I, Mohammad M, AlJabari R, Abu-Yaghi N, Rodriguez-Galindo C, Qaddoumi I, Wilson M. How Telemedicine and Centralized Care Changed the Natural History of Retinoblastoma in a Developing Country: Analysis of 478 Patients. Ophthalmology 2020; 128:130-137. [PMID: 32682835 DOI: 10.1016/j.ophtha.2020.07.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the efficacy of integrating a telemedicine-based twinning partnership and centralized care for retinoblastoma on survival and eye salvage. DESIGN Four hundred seventy-eight retinoblastoma patients treated at a tertiary referral cancer center (King Hussein Cancer Centre [KHCC]) from 2003 through 2019. PARTICIPANTS Four hundred seventy-eight retinoblastoma patients treated at KHCC after implementing a telemedicine-based program with St. Jude Children's Research Hospital. METHODS We reviewed the outcomes of retinoblastoma patients who were treated at KHCC after implementing a telemedicine-based eye salvage program with St. Jude Children's Research Hospital, and we compared that with outcomes for retinoblastoma patients who were treated before implementing a telemedicine-based retinoblastoma service at KHCC. MAIN OUTCOME MEASURES We analyzed patient demographics, clinical characteristics, treatments received, consultation type and duration, and long-term patient outcomes before and after implementing the twinning program. RESULTS Over 17 years, 813 eyes from 478 children with retinoblastoma were treated at KHCC. Three hundred thirty-five patients (70%) had bilateral disease. Six patients (4%) with unilateral disease and 66 patients (20%) with bilateral disease had a family history of retinoblastoma. After the twinning program was established in 2003, the mortality rate decreased from 38% to 5% (P < 0.0001), and the overall eye salvage rate increased from 4% to 61% (98% for group A, 93% for group B, 81% for group C, and 48% for group D; P < 0.0001). Initially, all cases were discussed via telemedicine, but as knowledge transfer increased, the proportion of cases that required discussion decreased to less than 3% 10 years later. Similarly, treatment changes based on consultations decreased from 70% to 7% after 10 years. Both survival and eye-salvage rates were comparable at the early and later stages of implementing the twinning program. At a median follow-up of 120 months, 5% of patients had died of metastases or secondary neoplasms, 81% were alive, and 14% were lost to follow-up. CONCLUSIONS Centralization of care at a single center in developing countries can achieve patient outcomes comparable with those of developed countries via twinning and telemedicine. This benefit can extend to a large region because two thirds of patients treated at KHCC were non-Jordanians.
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Affiliation(s)
- Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan.
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Iyad Sultan
- Pediatric Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | | | | | | | - Matthew Wilson
- St. Jude Children's Research Hospital, Memphis, Tennessee; Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee
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