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Lemmen J, Mageto S, Njuguna F, Midiwo N, Vik TA, Kaspers G, Mostert S. A caregivers' perspective on social reintegration and stigma of childhood cancer survivors in Kenya. Psychooncology 2024; 33:e6345. [PMID: 38708858 DOI: 10.1002/pon.6345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 04/10/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Childhood cancer survivors' social reintegration may be hampered in low and middle-income countries. The nature and extent of social challenges and prejudices that survivors encounter in such settings are largely unknown. This study explores caregivers' perspectives on social reintegration and stigmatization of Kenyan childhood cancer survivors. METHODS Caretakers of childhood cancer survivors (<18 years) were interviewed using mixed-methods questionnaires during home or clinic visits between 2021 and 2022. Stigma was assessed with an adjusted Social Impact Scale and risk factors were investigated. RESULTS Caretakers of 54 survivors (median age 11 years) were interviewed. Families' income (93%) decreased since start of treatment. Caretakers (44%) often lost their jobs. Financial struggles (88%) were a burden that provoked conflicts within communities (31%). School fees for siblings became unaffordable (52%). Families received negative responses (26%) and were left or avoided (13%) by community members after cancer disclosure. Survivors and families were discriminated against because the child was perceived fragile, and cancer was considered fatal, contagious, or witchcraft. Survivors repeated school levels (58%) and were excluded from school activities (19%) or bullied (13%). Performance limitations of daily activities (p = 0.019), male sex (p = 0.032), solid tumors (p = 0.056) and a short time since treatment completion (p = 0.047) were associated with increased stigma. Caretakers recommended educational programs in schools and communities to raise awareness about cancer treatment and curability. CONCLUSIONS Childhood cancer survivors and their families experienced difficulties with re-entry and stigmatization in society. Increasing cancer and survivorship awareness in schools and communities should facilitate social reintegration and prevent stigmatization.
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Affiliation(s)
- Jesse Lemmen
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Susan Mageto
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Pharmacology, School of Health Sciences, Kisii University, Kisii, Kenya
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Nancy Midiwo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Terry A Vik
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gertjan Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Lukamba RM, Budiongo AN, Monga BB, Yao A, Bey P, Chenge GB, Desjardins L, Doz F, Mwembo AT, Kabesha TA, Luboya ON. Treatment adherence in retinoblastoma: A retro-prospective cohort study in Ivory Coast and the Democratic Republic of Congo. Cancer Rep (Hoboken) 2023; 7:e1949. [PMID: 38146612 PMCID: PMC10849925 DOI: 10.1002/cnr2.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/11/2023] [Accepted: 11/12/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND In high-income countries, retinoblastoma is curable in more than 95% of cases, whereas in low-income countries, mortality remains high, especially when the diagnosis is made late or the treatment is discontinued. AIMS To determine the factors associated with adherence to the treatment of retinoblastoma in the Ivory Coast and the Democratic Republic of Congo (DRC). METHODS AND RESULTS A retro-prospective cohort study was carried out. Data were collected from patient folders and follow-up records of parents. RESULTS A total of 175 children with retinoblastoma were registered from January 2013 to December 2015. Seventy-six children (43%) were 5 years old and above. Care costs were covered by families in 86.9% of cases. Chemotherapy refusal was recorded in 39 cases (22.3%), and enucleation refusal was recorded in 79 cases (45.1%). After 36 months of follow-up, we recorded 16.6% deaths, 27.4% treatment dropouts, and 18.3% loss to follow-up after treatment. The commonest cause for enucleation refusal was fear of infirmity, while chemotherapy refusal and absconding treatment were due to financial constraints. CONCLUSION Poor adherence to retinoblastoma management was due to financial constraints, and a lack of knowledge of the disease and its treatment. Family psychosocial support is needed to improve this condition.
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Affiliation(s)
- Robert Mbuli Lukamba
- Department of Pediatrics (Pediatric Oncology Unit)University of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | - Aléine Nzazi Budiongo
- Department of Pediatrics (Pediatric Oncology Unit)University of KinshasaKinshasaDemocratic Republic of the Congo (DRC)
| | - Ben Bondo Monga
- Faculty of Medicine and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | - Atteby Yao
- Pediatric Oncology UnitUniversity Teaching Hospital of TreichvilleAbidjanIvory Coast
| | - Pierre Bey
- Advisor to the President of Institut CurieUniversity of Lorraine and AMCCParisFrance
| | | | | | - François Doz
- SIREDO Oncology Center (Care, Innovation, Research in Child Oncology, Adolescent and Young Adult) Institut Curie and University Paris CitéParisFrance
| | - Albert Tambwe Mwembo
- Faculty of Medicine and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
| | | | - Oscar Numbi Luboya
- Department of Pediatrics and School of Public HealthUniversity of LubumbashiLubumbashiDemocratic Republic of the Congo (DRC)
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Joseph A, Balogun O, Akinsete A, Habeebu M, Jimoh M, Lasebikan N, Oyeyinka K, Akindele K, Awofeso O. Early detection of paediatric cancer: Equipping primary health-care workers in Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_123_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kabre RS, Kamble KM. Retinoblastoma: A retrospective analysis of 141 patients from 1983 to 2013 at a tertiary care hospital in Nagpur, India. South Asian J Cancer 2020; 8:195-197. [PMID: 31489299 PMCID: PMC6699240 DOI: 10.4103/sajc.sajc_314_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: There is scarcity of data regarding clinical presentation and outcome of retinoblastoma patients in India. Objectives: The objective of this study was to assess the clinical profile of retinoblastoma patients in a tertiary care hospital in India from 1983 to 2013. Subjects and Methods: A retrospective analysis of clinical records of 141 patients with retinoblastoma registered from 1983 to 2013 at Government Medical College, Nagpur, India, was conducted. Demographics, clinical features, modes of treatment, and outcome of the patients were assessed. Results: Majority of patients (81 [57.45%]) presented in the age group of 1–3 years and were males. One hundred and fourteen patients (80.85%) had unilateral disease, while rare presentations of trilateral/quadrilateral retinoblastoma were also noted. Proptosis was seen in 81 (57.45%) patients as presenting symptom. Eighty-nine patients (63.12%) had locally invasive disease-involving sites. Forty-four patients (31.19%) developed distant metastasis. Surgical management and external beam radiotherapy were followed in majority of patients. Trend of increased usage of chemotherapy was seen from the mid-1990s. One hundred and twelve patients (79.43%) died with the disease. Conclusions: Data from this study show late diagnosis, leading to poor outcome for patients with advanced retinoblastoma, which is in accordance with data from other developing countries. Even though management of patients changed in accordance with changing standard of care over the decade, mortality remained high.
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Affiliation(s)
- Rohit S Kabre
- Department of Radiation Oncology, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - Krishna M Kamble
- Department of Radiation Therapy and Oncology, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Ekenze SO, Jac-Okereke CA, Nwankwo EP. Funding paediatric surgery procedures in sub-Saharan Africa. Malawi Med J 2020; 31:233-240. [PMID: 31839896 PMCID: PMC6895386 DOI: 10.4314/mmj.v31i3.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background In sub-Saharan Africa, there is a growing awareness of the burden of paediatric surgical diseases. This has highlighted the large discrepancy between the capacity to treat and the ability to afford treatment, and the effect of this problem on access to care. This review focuses on the sources and challenges of funding paediatric surgical procedures in sub-Saharan Africa. Methods We undertook a search for studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review and data abstraction were completed and resulting data were analysed using Statistical Package for Social Sciences (SPSS) software. Results Thirty-five studies met our inclusion criteria and were reviewed. The countries that were predominantly emphasized in the publications reviewed were Nigeria, South Africa, Kenya, Ghana and Uganda. The paediatric surgical procedures involved general paediatric surgery/urology, cardiac surgery, neurosurgery, oncology, plastics, ophthalmology, orthopaedics and otorhinolaryngology. The mean cost of these procedures ranged from 60 to 21,140 United States Dollars (USD). The source of funding for these procedures was mostly out-of-pocket payments (OOPs) by the patient's family in 32 studies, (91.4%) and medical mission/non-governmental organizations (NGOs) in 21 (60%) studies. This pattern did not differ appreciably between the articles published in the initial and latter 5 years of the study period, although there was a trend towards a reduction in OOP funding. Improvements in healthcare funding by individual countries supported by international organizations and charities were the predominant suggested solutions to challenges in funding. Conclusion While considering the potential limitations created by diversity in study design, the reviewed publications indicate that funding for paediatric surgical procedures in sub-Saharan Africa is mostly by OOPs made by families of the patients. This may result in limited access to some procedures. Coordinated efforts, and collaboration between individual countries and international agencies, may help to reduce OOP funding and thus improve access to critical procedures.
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Affiliation(s)
- Sebastian O Ekenze
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
| | - Chukwunonso A Jac-Okereke
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
| | - Elochukwu P Nwankwo
- Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
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Berhane A, Hailu T, Mulugeta A. Determinants of delayed diagnosis among pediatric cancer patients from Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia. BMC Pediatr 2019; 19:478. [PMID: 31810453 PMCID: PMC6896776 DOI: 10.1186/s12887-019-1848-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background Despite advances in the field of pediatric oncology, cancer remains a leading cause of death in children. The delays in cancer diagnosis may occur throughout the diagnostic pathway. Diagnosis of childhood cancer as early as possible is crucial to reduce mortality. The aim of this study was to identify determinants of delayed diagnosis among pediatric cancer patients in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Method Facility based cross-sectional study was conducted among pediatric cancer patients aged less than 18 years. Data collection was done by interviewer-administered structured questionnaire from the volunteer primary caregiver from 1st September 2017 to 30th August 2018. The data was checked and cleaned by principal investigator on daily basis during data collection for completeness, consistencies, then coded, entered and analyzed using SPSS version 21 software. Diagnosis delay was considered significant when it is above the 3rd quartile. Binary logistic regression analysis was used to test associations between each of the determinant factors and the dependent variable. Variables with P-value < 0.25 during bivariate analysis were fed to the multivariate logistic regression model. Finally, variables with P-value < 0.05 were considered as determinants of delayed diagnosis. Results From a total of 102 patients, 71(69.6%) had delayed diagnosis. Children older than 10 years of age were four (AOR = 4.01; 95%CI = 1.55–12, P < 0.001) times more likely to get delayed compared to under five children. Rural residence (AOR = 3.3; 95%CI = 1.24–10.24, P < 0.001), uneducated parents (AOR = 3.4; 95%CI = 1.91–13.25, P = 0.009), parents with monthly income less than 1000 ETB (AOR = 6.1; 95%CI = 1.76–7.23, P < 0.001), absence of health insurance (AOR = 2.4; 95%CI = 1.50–3.50, P = 0.02), visit to holy water (AOR = 3.4;95%CI = 1.6–7.2) and those who think cancer is incurable (AOR = 2.7;95%CI = 1.3–14,P = 0.004) were also likely to be delayed. Conclusion Delayed diagnosis of childhood cancer was a major issue and most influenced by the child’s age, residency, family’s socioeconomic status, parental education, health insurance, use of holy water and caregivers perception on curability of cancer. Thus; every effort should be made to promote public and parental awareness of childhood cancer and promoting health insurance.
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Affiliation(s)
- Alemseged Berhane
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Tadele Hailu
- Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- School of Public Health, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Hu H, Zhang W, Wang Y, Huang D, Shi J, Li B, Zhang Y, Zhou Y. Characterization, treatment and prognosis of retinoblastoma with central nervous system metastasis. BMC Ophthalmol 2018; 18:107. [PMID: 29685116 PMCID: PMC5914066 DOI: 10.1186/s12886-018-0772-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retinoblastoma is the most common primary intraocular tumor and more and more attention has been paid to the developing countries. This study was aimed to evaluate the clinical features, treatment, and prognosis of retinoblastoma patients with central nervous system (CNS) metastasis in Beijing Tongren Hospital, one of the largest tertiary eye centers in China. METHODS Clinical data of 31 consecutive retinoblastoma patients with CNS metastases, who were diagnosed at the Department of Pediatrics in Beijing Tongren Hospital between September 2005 and December 2015, were retrospective analyzed. RESULTS The median age at presentation was 29 months (range from 5 to 108 months). Magnetic resonance imaging (MRI) results indicated that 16 patients (56.6%, 16/31) presented with meningeal involvement, 12 (38.7%, 12/31) presented with intracranial mass, 11 (35.5%, 11/31) presented with thickened optic nerve, and 5 (16.1%, 5/31) presented with concurrent meningeal and spinal cord membrane involvement. Retinoblastoma cells were detected in the cerebrospinal fluid (CSF) of 12 patients (44.4%, 12/27). Laboratory examinations on the blood and CSF were performed for 11 patients who had received six cycles of systemic chemotherapy, indicated that the serum level of neurone-specific enolase (NSE) after chemotherapy was significantly lower than that before chemotherapy (P < 0.05). At the end of the follow-up, 25 patients were dead with a median survival time of 6 months (1 d - 21 months), and 6 cases were alive and continued to receive treatment. CONCLUSION Our results were basically consistent with previous reports in the developing countries, and it could be guidance for clinical treatment, prognosis and prevention of CNS metastases in retinoblastoma.
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Affiliation(s)
- Huimin Hu
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Weiling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Yizhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Dongsheng Huang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China.
| | - Jitong Shi
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Bin Li
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Yan Zhou
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
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Goolam S, Kana H, Welsh N, Wainwright L, Poole J, Mayet I. A 20-Year Retrospective Review of Retinoblastoma at Two Tertiary Academic Hospitals in Johannesburg, South Africa. Ocul Oncol Pathol 2017; 4:170-175. [PMID: 29765949 DOI: 10.1159/000481508] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/13/2017] [Indexed: 11/19/2022] Open
Abstract
Aim This paper presents a 20-year review of retinoblastoma in Johannesburg, South Africa, aiming to better characterize the disease in this sub-Saharan setting. Methods The study represents a retrospective case series of retinoblastoma patients presenting to Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital between January 1, 1992, and December 31, 2011. Results The total number of cases identified was 282, with 245 meeting the study inclusion criteria. Retinoblastoma comprised 6.9% of the total pediatric oncology presentations; 65.3% were unilateral, 34.3% bilateral, and 0.4% trilateral. The overall male-to-female ratio was 1.08. The mean age at presentation overall was 32.6 months (median 28.0), in the unilateral group 39.4 months (median 33.0), and in the bilateral group 19.7 months (median 17.0). The mean delay to presentation overall was 7.0 months (median 4.0). The most frequent presenting symptoms were leukocoria (37.1%) and proptosis (34.7%). The distribution of disease stages at presentation (International Retinoblastoma Staging System) was 1.6% stage 0, 24.1% stage I, 27.8% stage II, 16.3% stage III, and 25.3% stage IV. 26.5% defaulted care. The 5-year Kaplan-Meier survival estimate was 57.7% overall. Conclusion This study shows that delayed presentation and refusal of therapy remains a significant barrier to effective treatment in this African setting.
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Affiliation(s)
- Saadiah Goolam
- Division of Ophthalmology, Department of Neurosciences, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Hemant Kana
- Division of Ophthalmology, Department of Neurosciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicky Welsh
- Division of Ophthalmology, Department of Neurosciences, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Wainwright
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Janet Poole
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Ismail Mayet
- Division of Ophthalmology, Department of Neurosciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Singh G, Daniels AB. Disparities in Retinoblastoma Presentation, Treatment, and Outcomes in Developed and Less-Developed Countries. Semin Ophthalmol 2016; 31:310-6. [PMID: 27127937 DOI: 10.3109/08820538.2016.1154177] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Retinoblastoma (RB) is the most common intraocular malignancy in children. In the past century, RB survival rates in developed countries (DCs) have improved from <5% to as high as 99%. In contrast, in less developed countries (LDCs) where the tumor burden is greatest, survival rates remain poor, with some countries reporting survival rates as low as 0-5%. In addition, there are disparities between DCs and LDCs in RB presentation, treatment modalities, and prognosis. These disparities are due to many underlying causes, including delays in diagnosis, access to medical care, patient and physician familiarity with the disease, availability and cost of treatment, and patient acceptance of enucleation. It is our belief that attempts to extend the improvements in prognosis achieved in DCs to various LDCs must be culturally sensitive and tailored to each country's specific challenges, and thus, a "one-size-fits-all" approach to improving patient outcomes in LDCs is unlikely to work well. We discuss several culturally sensitive approaches that have been successfully implemented in various LDCs, including those that make use of telemedicine and "twinning" with centers of excellence around the world.
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Affiliation(s)
- Gobind Singh
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Anthony B Daniels
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Radiation Oncology , Vanderbilt University Medical Center , Nashville , TN , USA.,c Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center , Nashville , TN , USA.,d Department of Cancer Biology , Vanderbilt University , Nashville , TN , USA
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Weaver MS, Heminger CL, Lam CG. Integrating stages of change models to cast new vision on interventions to improve global retinoblastoma and childhood cancer outcomes. BMC Public Health 2014; 14:944. [PMID: 25213666 PMCID: PMC4165911 DOI: 10.1186/1471-2458-14-944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 09/09/2014] [Indexed: 01/24/2023] Open
Abstract
Background Retinoblastoma, the most common intraocular tumor globally, represents a curable cancer when diagnosed early and treated promptly. Delay to diagnosis, lag time prior to treatment initiation, and abandonment of treatment including upfront treatment refusal, represent stark causes of high retinoblastoma mortality rates in low- and middle- income settings, particularly regions in Africa. While a health delivery-based approach has been a historic focus of retinoblastoma treatments globally and is essential to quality care, this is necessary but not adequate. Retinoblastoma is a compelling disease model to illustrate the potential insights afforded in theory-informed approaches to improve outcomes that integrate public health and oncology perspectives, prioritizing both health service delivery and social efficacy for cure. Discussion Given that barriers to appropriate and timely diagnosis and treatment represent main contributors to mortality in children with retinoblastoma in resource-limited settings such as certain areas in Africa, an important priority is to overcome barriers to cure that may be predominantly socially influenced, alongside health delivery-based improvements. While Stages of Change models have been effectively utilized in cancer screening programs within settings of economic and cultural barriers, this application of health behavior theory has been limited to cancer screening rather than a comprehensive framework for treatment completion. Using retinoblastoma as a case example, we propose applying stage-based intervention models in critical stages of care, such as the Precaution Adoption Process Model to decrease delay to diagnosis and a Transtheoretical Model to increase treatment completion rates in resource-limited settings. Summary Stage-based theories recognize that improved cure and survival outcomes will require supportive strategies to progress households, communities, and social and economic institutions from being unaware and unengaged to committed and sustained in their respective roles. Applying a stage-based model lens to programmatic interventions in resource-limited settings has potential for visible improvement in outcomes for children with retinoblastoma and other cancers.
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Affiliation(s)
- Meaghann S Weaver
- Department of Oncology, St, Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA.
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Abstract
BACKGROUND Enucleation (eye removal) is often the only curative treatment for the childhood eye cancer retinoblastoma, yet parental refusal of enucleation commonly contributes to treatment delay and poor survival globally. METHODS Physicians who treat retinoblastoma were surveyed to glean underlying reasons for treatment refusal. RESULTS Refusal rates were higher when less time was spent with parents explaining retinoblastoma/enucleation, and where fewer support services were available. Reasons for refusal included parental belief in alternative treatments, culture, and social stigma. CONCLUSIONS We suggest strategies to increase parental compliance with enucleation and save the lives of children with retinoblastoma.
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Affiliation(s)
| | - Helen Dimaras
- b Department of Ophthalmology and Vision Science , University of Toronto .,c The Division of Visual Science , Toronto Western Research Institute , and.,d The Department of Ophthalmology & Vision Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada
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Study on Clinical Therapeutic Effect Including Symptoms, Eye Preservation Rate, and Follow-up of 684 Children with Retinoblastoma. Eur J Ophthalmol 2013; 23:532-8. [PMID: 23483499 DOI: 10.5301/ejo.5000245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2012] [Indexed: 11/20/2022]
Abstract
Purpose Retinoblastoma is the most common type of primary malignant intraocular tumor in children. The purpose of this study is to summarize the clinical experience of diagnosis and treatment for retinoblastoma, aiming to provide appropriate knowledge for surveillance and therapy for retinoblastoma. Methods We performed retrospective analysis of 684 children (885 eyes) with advanced retinoblastoma diagnosed in the department of Pediatrics in Tongren Hospital, Beijing, China, between September 2005 and May 2010. Results The average age at first diagnosis was 2.2 ± 1.7 years with overall median age 1.91 years. Leucocoria was the most common sign at the initial diagnosis (70.47%, 482/684). A total of 21 cases (3.06%) had positive family history. According to International Retinoblastoma Classification, 551 cases (80.57%, 723 eyes) were A-E stage and 81.47% (589/723) were D-E stages of retinoblastoma; extraocular stage was present in 101 cases (120 eyes, 14.76%); metastatic stage was present in 32 cases (44 eyes, 4.67%). Pathology diagnosis was performed in 494 cases of unilateral or bilateral enucleation; 91 cases were grade I, 260 cases were grade II, 94 cases were grade III, 49 cases were grade IV. The median follow-up time was 27 months until June 2010. Total survival rate was 95.13%. A total of 34 cases were lost to follow-up and 34 cases were abandoned. Conclusions Children developed retinoblastoma at a young age. Early diagnosis is difficult. Key factors of clinical treatment and long survival rate were diagnosis and treatment at the early stage with multidisciplinary methods.
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Lim FPM, Soh SY, Iyer JV, Tan AM, Swati H, Quah BL. Clinical profile, management, and outcome of retinoblastoma in singapore. J Pediatr Ophthalmol Strabismus 2013; 50:106-12. [PMID: 23244241 DOI: 10.3928/01913913-20121211-01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/15/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the clinical manifestations and treatment outcomes for patients with retinoblastoma in Singapore from 1997 to 2010. METHODS Medical records of 51 patients (67 eyes) diagnosed as having retinoblastoma were analyzed. Data on laterality, genetics, presentation, disease severity, treatment, and prognosis were collected. RESULTS The mean age of presentation was 25.7 ± 19.9 months. Sixteen (31.4%) of the patients had bilateral disease, of whom 2 had an associated pineal tumor. Leukocoria was the most common sign. Two had metastasis at diagnosis. Only 3 patients (5.9%) had a family history. Using the International Intraocular Retinoblastoma Classification, 6.0% were Group A, 6.0% were Group B, 3.0% were Group C, 38.8% were Group D, and 49.2% were Group E. Chemotherapy and focal therapy were administered for 4 of 35 (12.9%) patients with unilateral retinoblastoma (50% had successful globe preservation) and 13 of 16 (81.3%) patients with bilateral retinoblastoma (42.3% had successful globe preservation). Overall, globe preservation was achieved in 100% of Groups A, B, and C, and 23.1% of Group D cases. The 5-year survival rate overall, for unilateral retinoblastoma, and for bilateral retinoblastoma was 91%, 97%, and 76% respectively. CONCLUSION The overall 5-year survival rate is comparable to international data in most developed countries. However, most patients presented with advanced disease, making the rate of globe preservation lower than in some developed countries. Better education of the public and healthcare professionals may increase awareness and enable early detection of the disease.
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Affiliation(s)
- Fiona Pin Miao Lim
- Singapore National Eye Centre and Department of Paediatric Haematology/Oncology,, K.K. Women and Children’s Hospital, Singapore
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Carrim ZI, Kajaige J, Bowman RJ, Lavy TE, Scanlan P. First-year experience of chemotherapy for advanced retinoblastoma in Tanzania: disease profile, outcomes, and challenges in 2008. J Pediatr Ophthalmol Strabismus 2012; 49:176-83. [PMID: 21838214 DOI: 10.3928/01913913-20110809-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/30/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the profile of retinoblastoma in a national tertiary referral center in Tanzania and to report first-year outcomes of its treatment using chemotherapy. METHODS All patients with retinoblastoma referred in 2008 were included. Disease was classified on clinical grounds as ocular, orbital, or metastatic. Those with ocular and orbital disease received chemotherapy. Remission was the main outcome measure and defined as absence of disease at the end of treatment. RESULTS In 2008, 37 patients (20 males and 17 females) with retinoblastoma were referred to Ocean Road Cancer Institute. The mean delay from the first sign of disease to presentation at hospital was 10.4 ± 8.7 months. Disease was ocular in 32% (12 of 37), orbital in 57% (21 of 37), and metastatic in 11% (4 of 37). Of those with ocular disease, 67% (8 of 12) completed chemotherapy and all (8 of 8) achieved remission. In contrast, 48% (10 of 21) with orbital disease completed chemotherapy and only 50% (5 of 10) achieved remission. The difference in outcome between the groups was statistically significant (P = .001, Fisher exact test). CONCLUSION The profile of retinoblastoma in Tanzania is skewed toward severe invasive disease. Despite the introduction of chemotherapy, further improvements in mortality and morbidity can only be achieved through emphasis on early detection.
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Affiliation(s)
- Zia I Carrim
- Dept. of Ophthalmology, St. James’s University Hospital, Leeds, United Kingdom.
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Retinoblastoma in the democratic republic of congo: 20-year review from a tertiary hospital in kinshasa. J Cancer Epidemiol 2012; 2012:920468. [PMID: 22619679 PMCID: PMC3350961 DOI: 10.1155/2012/920468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/02/2012] [Accepted: 03/05/2012] [Indexed: 11/17/2022] Open
Abstract
Background. To determine clinical profile and management of retinoblastoma among children at Kinshasa in Democratic Republic of Congo. Patients and methods. The medical records of patients with a diagnosis of retinoblastoma seen at the University Hospital of Kinshasa from January 1985 till December 2005 were retrospectively reviewed. Demographic profile, clinical data, modes of treatment and outcome were analysed. Results. A total of 49 children, of whom 40 had adequate data on record were identified as retinoblastoma (28 males and 12 females). Nine cases had bilateral disease. The median age at the first symptoms was 9 months (range, 1 month to 6 years) for unilateral retinoblastoma and 18 months (range, 1 month to 3.5 years) for bilateral retinoblastoma. The median age at the first oncology consultation was 2.4 years (range, 6 months to 6 years) for unilateral retinoblastoma and 2.4years (range, 9 months to 4 years) for bilateral disease. Leukokoria was present in 67.5% of subjects. Seventy-five percent abandoned the treatment. The mortality was 92.5%. Conclusion. In Democratic Republic of Congo, retinoblastoma remains a life threatening disease characterized by late referral to a specialized unit and affordability of chemotherapy; all leading to an extension of the disease and high mortality.
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Naseripour M. "Retinoblastoma survival disparity": The expanding horizon in developing countries. Saudi J Ophthalmol 2012; 26:157-61. [PMID: 23960987 PMCID: PMC3729846 DOI: 10.1016/j.sjopt.2012.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 02/03/2012] [Accepted: 02/05/2012] [Indexed: 11/28/2022] Open
Abstract
The patients' survival for the most common intraocular tumor in children, retinoblastoma, has a wide spectrum among the world countries. This study was conducted to provide an overview of the retinoblastoma survival disparity worldwide by discussing the trends of patients' survival, as well as recent advances in the management of retinoblastoma. The design of this study was literature review and commentary. Selected articles from PubMed (except one) including both developing and developed countries regarding the patients' survival in retinoblastoma were considered and reviewed critically. An analysis of 47 articles was performed. In conclusion, in spite of an obvious contrast of retinoblastoma survival disparity in the world, the expanding horizons in developing countries are promising and continuing on all fronts and results are hope-inspiring.
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Affiliation(s)
- Masood Naseripour
- Eye Research Center, Rassoul Akram Hospital, Tehran University of Medical Sciences, Niayesh Avenue, Sattar-khan Street, Tehran, Iran
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Ali AAE, Elsheikh SMA, Elhaj A, Osman N, Abuidris D, Eltayeb EA, Mahgoub M, Hamdoun A, Babiker MM, Mohamedani AA, Elwali NEMA, Qaddoumi I. Clinical presentation and outcome of retinoblastoma among children treated at the National Cancer Institute (NCI) in Gezira, Sudan: a single Institution experience. Ophthalmic Genet 2011; 32:122-5. [PMID: 21366428 DOI: 10.3109/13816810.2010.546822] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Retinoblastoma (RB) is a rare and unique cancer that affects the eyes of very young children. There are few reports on RB in Sudan. MATERIALS AND METHODS We performed a retrospective study of data from patients diagnosed with retinoblastoma between January 1999 and December 2009 at the National Cancer Institute in Gezira (NCI-Gezira). RESULTS Of the 519 cases of childhood cancer treated at NCI-Gezira during the study period, 25 (4.8%) were retinoblastoma. Of these 25 patients with retinoblastoma, there were 13 boys and 19 cases were unilateral. The median age at diagnosis was 36 months (range, 8-60 months). The disease was localized in 9 patients, regional in 5 patients, and metastatic in 11 patients. The most frequent symptoms were enlarged eye (n = 14) and leukocoria (n = 8). Nine patients (36%) have been lost to follow-up; 9 were alive at last follow-up (7 in remission, 2 progressed); and 7 have died (5 from disease and 2 from unrelated causes). Twenty-two eyes were enucleated in 16 patients (6 bilateral and 10 unilateral). Pathologic examination of the enucleated eyes could only be completed in 11 patients. Diagnostic imaging in the form of computerized tomography scans or ultrasonography of the brain and orbit was done for 10 patients (40%). CONCLUSIONS Although these findings are not surprising, and similar to reports from other developing countries, we hope our work will provide a foundation for strategies to improve outcome for retinoblastoma in our center such as proper training, public awareness, team approach, and twinning.
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Affiliation(s)
- Amel A E Ali
- Department of Oncology, National Cancer Institute-University of Gezira, Wad- Sudan.
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Chantada GL, Qaddoumi I, Canturk S, Khetan V, Ma Z, Kimani K, Yeniad B, Sultan I, Sitorus RS, Tacyildiz N, Abramson DH. Strategies to manage retinoblastoma in developing countries. Pediatr Blood Cancer 2011; 56:341-8. [PMID: 21225909 DOI: 10.1002/pbc.22843] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 08/30/2010] [Indexed: 11/06/2022]
Abstract
Survival of retinoblastoma is >90% in developed countries but there are significant differences with developing countries in stage at presentation, available treatment options, family compliance, and survival. In low-income countries (LICs), children present with advanced disease, and the reasons are socioeconomic and cultural. In middle-income countries (MICs), survival rates are better (>70%), but there is a high prevalence of microscopically disseminated extraocular disease. Programs for eye preservation have been developed, but toxicity-related mortality is higher. Although effective treatment of microscopically extraocular disease improved the outcome, worldwide survival will be increased only by earlier diagnosis and better treatment adherence.
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Current World Literature. Curr Opin Ophthalmol 2010; 21:239-46. [DOI: 10.1097/icu.0b013e32833983a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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