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Ophthalmology
Research
Lag time for retinoblastoma in the UK revisited: a retrospective analysis
  1. Marcus Posner1,
  2. Adil Jaulim1,2,
  3. Marina Vasalaki1,3,
  4. Khadija Rantell4,
  5. Mandeep S Sagoo1,5,6,
  6. M Ashwin Reddy1,5
  1. 1 Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
  2. 2 Cancer Research UK Cambridge Institute, University of Cambridge, London, UK
  3. 3 The Western Eye Hospital, Marylebone, UK
  4. 4 Education Unit, UCL Institute of Neurology, Queen Square, UK
  5. 5 Moorfields Eye Hospital, London, UK
  6. 6 UCL Institute of Ophthalmology, London, UK
  1. Correspondence to Dr M Ashwin Reddy; mashwinreddy{at}hotmail.com

Abstract

Objectives To explore current delays in diagnosis of retinoblastoma (Rb) and effect on outcome with comparison to a study from the 1990s.

Setting Primary, secondary, tertiary care: majority from South of England.

Participants A retrospective analysis of 93 new referrals of sporadic (non-familial) Rb to a specialist Rb unit in London, UK from January 2006 to February 2014.

Primary and secondary outcomes International Intraocular Retinoblastoma Classification, lag times including parental delay and healthcare professional delay, patients requiring enucleation and requirement of adjuvant chemotherapy postenucleation (high-risk Rb).

Results During the study period, 29% presented via accident and emergency (A&E). The median referral time from symptom onset to visiting primary care (PC) was 28 days and PC to ophthalmologist 3 days (range 0–181 days). The median time from local ophthalmologist to the Rb Unit was 6 days (0–33). No significant correlation was found between delay and International Classification of Retinoblastoma grade (p>0.05) or between postenucleation adjuvant chemotherapy and enucleation groups (p>0.05). Less enucleations (60%) are being performed compared with the previous study (81%) (p=0.0015).

Conclusions Parents are attending A&E more compared with the 1990s and this may reflect the effect of public awareness campaigns. More eyes are being salvaged despite a similar number of children requiring adjuvant chemotherapy. High-risk Rb and Group E eyes do not correlate with increased lag time in the UK. Other determinants such as tumour biology may be more relevant.

  • retinoblastoma
  • lag time
  • ocular oncology
  • paediatric ophthalmology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015625

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    Footnotes

    • Contributors Research design: MP, AJ, MV, KR, MSS, MAR. Data acquisition and/or research execution: MP, AJ, MV, MAR. Data analysis and/or interpretation: MP, MV, KR, MSS, MAR. Manuscript preparation: MP, AJ, MV, KR, MSS, MAR.

    • Competing interests None declared.

    • Ethics approval Queen Mary University of London.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement MAR has access to all data.