Delay in the diagnosis of retinoblastoma in China

Abstract

Acta Ophthalmol. 2011: 89: e72–e74 Abstract. Purpose: Retinoblastoma is the most frequent primary intraocular tumour and is rapidly gaining importance in Asia. As the survival is markedly dependent on early diagnosis and as information on that is not available from East Asia, we assessed the time interval between symptoms detection and therapy of children treated in the Beijing TongRen Eye Hospital. Methods: The retrospective study consisted of all patients who were treated in the study period from January 1987 to November 2006 in the Beijing TongRen Hospital and for whom the data on delay in diagnosis, age, clinical appearance and histological tumour features were available. Results: The inclusion criteria were met by 572 patients (326 boys) with a mean age of 2.6 ± 1.8. Mean interval between first detection of symptoms and clinical diagnosis and therapy was 4.1 ± 5.9 months (range: 3–36 months). A diagnostic delay of 2 months or >6 months was found for 337 (59%) children and 98 (17%) children, respectively. Diagnostic delay was significantly (p < 0.001) the longest in the 2‐ to 4‐year‐old group (5.5 ± 7.4 months). It decreased from the study period 1987–1991 to the period 2002–2006 (p < 0.001). It was significantly associated with the clinical appearance (p = 0.001) and histological finding (p = 0.008). Conclusions: Delay in the diagnosis of retinoblastoma depended on the age of the children, study period, and clinical and histological stage. Because the prognosis is markedly influenced by tumour stage, further improvements in the alertness of parents, family doctors and paediatricians and in the medical infrastructure in China may be addressed.

A systematic review of time to diagnosis in children and young adults with cancer

“…The time between symptom recognition and a definitive diagnosis were described as: TTD,11 29 delay to diagnosis,16 20 23 32 pre-diagnostic interval,22 25 26 31 lag-time14 15 17–19 21 33 and duration of symptoms 13 24 34 37 40 41. The term ‘symptom-interval’ was used to describe the time between symptom onset and overall TTD 30 38 39…”

“…However, the inter-quartile ranges were rarely cited. Furthermore, only four of 32 papers presented the mean, median, range and SD in combination 14 15 32 34…”

Strategies to manage retinoblastoma in developing countries

“…Delayed diagnosis accounts for the increased prevalence of advanced retinoblastoma in developing countries and explains why retinoblastoma is diagnosed at a later age in these countries [9,10,26,27]. Brazilian investigators were the first to report the importance of lag time (i.e., the interval between the onset of symptoms and diagnosis) in determining outcome [9].…”

Clinical presentation and group classification of newly diagnosed intraocular retinoblastoma in China

“…The delay in the clinical diagnosis may depend on the medical infrastructure of the country and on the alertness of the parents as well as of the paediatricians. Almost no information has been available so far on the clinical presentation and clinical signs and diagnosis of retinoblastomas of children in China, except of a recent retrospective ophthalmic histopathological investigation 9 10. China, however, is the nation with the worldwide largest population, with an estimated number of 1100 new cases of retinoblastoma each year (using the published Chinese birth rate11 and prevalence figures from Western countries) 1.…”