Delay in diagnosis of retinoblastoma: risk factors and treatment outcome
Andrea G Goddarda, Judith E Kingstona, John L Hungerfordb
a Department of
Paediatric Oncology, St Bartholomew's Hospital, London, b Department of
Ocular Oncology
Correspondence to: Dr Andrea Goddard, Department of Paediatrics, St Mary's Hospital, Praed Street, London W2 1NY
Accepted for publication 18 August 1999
BACKGROUND
Delay in
diagnosis of retinoblastoma causes considerable parental distress;
however, the primary healthcare professional (PHP) may have difficulty
detecting the most common presenting symptomleucocoria. Alternatively, the PHP may not appreciate that retinoblastoma is the
pathology underlying more common ocular symptoms in infants and young children.
METHODThe parents of
100 recently diagnosed patients with retinoblastoma were interviewed to
establish the extent of diagnostic delay, ascertain any associated risk
factors, and to determine whether or not delay influenced treatment outcome.
RESULTSAlthough
nearly 50% of patients were referred to an ophthalmologist within 1 week of first consulting a PHP, one quarter waited more than 8 weeks.
There was a significantly increased risk of diagnostic delay in younger
patients, those presenting with squint rather than leucocoria, and
those first presenting to a health visitor rather than to a general
practitioner. The risk of local tumour invasion was significantly
increased by diagnostic delay. Treatment with primary enucleation was
not increased by diagnostic delay. There were no deaths during the
study period.
CONCLUSIONPrimary
healthcare professionals require education about the importance of
ocular symptoms, especially squint, in paediatric patients.
© 1999 by British Journal of Ophthalmology
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