Health care timeline for patients with retinoblastoma seen in Southern Philippines Medical Center: Policy notes

ABSTRACT

@#Retinoblastoma (RB), the most common intraocular malignancy in infants and young children,1 2 may lead to the loss of one or two eyes, central nervous system involvement, or even death, if treatment is delayed.3 However, if RB is diagnosed and treated early, patients with the malignancy have a survival rate of almost 100%.4 Delay in diagnosis of RB affects treatment outcomes and prognosis of patients with the disease. With the significant number of RB referrals that result in delays in receiving specialized care in low- and middle-income countries (LMICs)5—where most cases occur—global disparities in the outcomes of RB are evident, such that children with RB in LMICs often have poor prognosis.6 Difficulty of caregivers and primary health care providers in recognizing the earliest presenting signs of RB also contributes to the delay and can increase the risk of local tumor invasion.7 At present, the Department of Health (DOH) has included in its Philippine Cancer Control Program the Cancer in Children Awareness Month, as one of its health advocacies aimed to increase the public’s knowledge and understanding of childhood cancer.8 In September 2021, the first ever DOH-WHO Cancer Control Stakeholders Virtual Summit was held, with special focus given on childhood cancer.9 The DOH program has given emphasis on eight childhood cancers, including RB, that are common in Filipino children.10 In 2011, the Southern Philippines Medical Center (SPMC) and the National University Hospital in Singapore, in collaboration with the Dana Farber Children’s Hospital Cancer Center in Boston and St. Jude Children’s Research Hospital in Memphis, joined together to establish the RB Early Detection Campaign Program. This collaborative project started to educate the public on the early signs of RB, established a referral system across Davao City and other regions in Mindanao (Tagum City, General Santos City, Zamboanga City, and Cagayan de Oro City), and developed a multidisciplinary RB management team at SPMC.11 With the opening of a dedicated RB center at SPMC in 2012 as part of the program, the hospital’s RB census increased, and the majority of the cases detected were still at the early (intraocular) stage.12 However, despite the stringent implementation of the program in SPMC, the time interval between onset of symptoms and initiation of therapy among patients with RB has remained protracted.13 The aim of this article is to recommend health care policies based on the results of a study on the clinical profile and health care timeline of patients seen in a tertiary hospital in Davao City.