Welcome to PracticeUpdate! We hope you are enjoying temporary access to this content.
Please register today for a free account and gain full access
to all of our expert-selected content.
Already Have An Account? Log in Now
Factors Other Than Travel Burden Impact the Clinical Presentation of Retinoblastoma in Africa
TAKE-HOME MESSAGE
-
Analysis of treatment-naïve patients with retinoblastoma revealed a capture rate of 42.2% of expected patients in African countries and 108.8% in European countries. African patients were more likely than European patients to present with advanced disease, including extraocular retinoblastoma and distant metastasis. The average distance traveled to reach a retinoblastoma center was 421.8 km in Europe versus 185.7 km in Africa. Factors associated with advanced disease were lower national income level, African residence, and older age.
- There are barriers to access other than travel distance that impact the presentation of patients in Africa with retinoblastoma. Further health education is required in Africa to increase the capture rate and encourage early referral.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.
METHODS
A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.
RESULTS
Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease.
CONCLUSIONS
Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.
Additional Info
Travel Burden and Clinical Presentation of Retinoblastoma: Analysis of 1024 Patients From 43 African Countries and 518 Patients From 40 European Countries
Br J Ophthalmol 2020 Sep 15;[EPub Ahead of Print], ID Fabian, AW Stacey, A Foster, TT Kivelä, FL Munier, N Keren-Froim, N Gomel, N Cassoux, MS Sagoo, MA Reddy, LA Harby, M Zondervan, C Bascaran, E Abdallah, SU Abdullahi, SA Boubacar, DS Ademola-Popoola, A Adio, AE Aghaji, SA Portabella, AI Alfa Bio, AM Ali, DB Alia, C All-Eriksson, AA Almeida, KM Alsawidi, R Antonino, NJ Astbury, R Atsiaya, J Balaguer, W Balwierz, H Barranco, MB Popovic, S Benmiloud, NB Guebessi, RC Berete, SJ Biddulph, EM Biewald, S Blum, N Bobrova, M Boehme, N Bornfeld, GC Bouda, H Bouguila, A Boumedane, BG Brichard, MC L, G Castela, J Català-Mora, GL Chantada, VS Chernodrinska, FS Chiwanga, K Cieslik, C Comsa, MG Correa Llano, M Csóka, IV Da Gama, A Davidson, P Potter, L Desjardins, MD Dragomir, MD Bruyn, AE Kettani, AM Elbahi, D Elgalaly, AM Elhaddad, MM Ali Elhassan, MM Elzembely, VA Essuman, TGA Evina, O Fasina, A Fernández-Teijeiro, M Gandiwa, DG Aldana, JA Geel, Z Gizachew, PA Gregersen, KM Guedenon, T Hadjistilianou, S Hassan, S Hederova, L Hessissen, DF Hordofa, M Hummlen, K Husakova, R Ida, VR Ilic, H Jenkinson, TB Amani Kabesha, RL Kabore, A Kalinaki, N Kapelushnik, T Kardava, PK Kemilev, T Kepak, Z Khotenashvili, A Klett, JE Kosh Komba Palet, D Krivaitiene, M Kruger, A Kyara, ES Lachmann, S Latinović, K Lecuona, RM Lukamba, L Lumbroso, L Lysytsia, E Maka, M Makan, C Manda, NM Begue, IO Matende, M Matua, I Mayet, FB Mbumba, AA Mengesha, E Midena, FG Mndeme, AA Mohamedani, AC Moll, C Moreira, MS Msina, G Msukwa, KI Muma, G Murgoi, KO Musa, H Mustak, OM Muyen, G Naidu, L Naumenko, PA Ndoye Roth, V Neroev, M Nikitovic, ED Nkanga, H Nkumbe, M Nyaywa, G Obono-Obiang, NC Oguego, A Olechowski, AH Oscar, P Osei-Bonsu, SL Painter, V Paintsil, L Paiva, R Papyan, R Parrozzani, M Parulekar, K Pawinska-Wasikowska, S Perić, R Philbert, P Pochop, VG Polyakov, MT Pompe, JJ Pons, L Raobela, LA Renner, D Reynders, D Ribadu, MM Riheia, P Ritter-Sovinz, S Saakyan, AM Said, SS Román Pacheco, TA Scanlan, J Schoeman, S Seregard, ST Sherief, SS Cheikh, S Silva, T Sorochynska, G Ssali, C Stathopoulos, BS Kranjc, DK Stones, K Svojgr, F Sylla, G Tamamyan, A Tandili, B Tateshi, T Theophile, F Traoré, H Tyau-Tyau, AB Umar, SF Urbak, TL Ushakova, S Valeina, MV Hoefen Wijsard, NV Veleva-Krasteva, M Viksnins, W Wackernagel, K Waddell, PD Wade, AH Wali Nigeria, AD Wime, CW Dod, JM Yanga, VA Yarovaya, AA Yarovoy, E Zein, S Sharabi, K Zhilyaeva, OA Ziko, R BowmanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.