A multidisciplinary approach to improving the care and outcomes of patients with retinoblastoma at a pediatric cancer hospital in Egypt

ABSTRACT

Background: Retinoblastoma poses a substantial burden in developing countries. We conducted this study to assess the effect of implementing a multidisciplinary approach and standardized protocols for treating pediatric patients with retinoblastoma at the Children’s Cancer Hospital Egypt (CCHE).

Materials and Methods: In January 2011, the CCHE implemented standardized protocols for the diagnosis, treatment, and reporting of retinoblastoma cases. The hospital also introduced a new retinoblastoma management algorithm and data analysis system. In this study, we compared the pathologic features, tumor invasiveness, reporting, and survival of 276 pediatric patients who underwent enucleations of 290 eyes before or after the implementation of the retinoblastoma protocols.

Results: Time to enucleation (indicating time needed for decision taking) decreased significantly within the neoadjuvant chemotherapy group for intraocular disease after January 2011 (68.7 ± 48 weeks vs. 47.3 ± 28.3 weeks; p < 0.05). Mean optic nerve stump length increased from 5.6 mm in the earlier period to 7.2 mm in the later period (p = 0.004). The overall quality of pathology reporting also improved during the later period. The probability of 3-year survival was significantly higher for patients during the later period (94.2% vs. 79.2%; p = 0.018).

Conclusions: The implementation of standardized protocols and a multidisciplinary approach improved reporting; discrepancies in disease classification and the amount of missing data were reduced; and quality measures and prognostic capabilities of the team were substantially improved. Such established data-driven practice supports faster decision making to enucleate diseased eyes and save patients’ lives through providing measurable indicators.

KEYWORDS:

• Chemotherapy
• developing countries
• pediatric oncology
• retinoblastoma
• surgical pathology

Acknowledgments

The authors thank Dr. Hoda Z. Amer for revising some pathology reports, Dr. Mohamed-Ismail Y. Rakha for revising the article, and Rokayya Konsowa for helping with data collection. The authors thank Drs. Carlos Rodriguez-Galindo (St. Jude Children’s Research Hospital, Memphis, TN, USA), Célia B. G. Antoneli (Pediatric Oncology Department, Centro de Tratamento e Pesquisa Hospital do Câncer A C Camargo, São Paulo, Brazil), Brenda Galli, and Helen Dimaras (both of The Hospital for Sick Children, Toronto, ON, Canada) for their support during the establishment of the retinoblastoma research program at CCHE. The authors also thank Dr. Vani Shanker and Dr. Angela McArthur for editing the manuscript.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

ASA was funded by a scholarship from The German Academic Exchange Service (DAAD) numbers 50015318 and 57147166.

Supplemental data

Supplemental data for this article can be accessed on the publisher’s website at http://dx.doi.org/10.1080/13816810.2016.1227995.

Additional information

Funding

ASA was funded by a scholarship from The German Academic Exchange Service (DAAD) numbers 50015318 and 57147166.