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Poor retinoblastoma outcomes associated with racial, socioeconomic factors
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Significant racial, ethnic and socioeconomic disparities appeared to exist in the care and outcome of pediatric patients with retinoblastoma, according to the results of a population study.
Specifically, lower socioeconomic status appeared negatively associated with disease extent and ocular outcomes, and Hispanic children appeared to have higher rates of advanced disease and enucleation, according to the researchers.
Carlos Rodriguez-Galindo
The majority of U.S. children diagnosed with retinoblastoma have a large intraocular tumor burden that requires intensive ocular-salvage treatment or enucleation, according to study background.
“Early diagnosis and referral and prompt initiation of therapy are key to successful outcomes,” Carlos Rodriguez-Galindo, MD, professor of pediatrics at Harvard Medical School, and colleagues wrote. “Ocular survival, preservation of vision, and patient survival correlate directly with the time of diagnosis. … Early diagnosis and successful outcomes for children with retinoblastoma are tightly related to the strength of the health care system; vulnerable, socioeconomically deprived populations are at risk for delayed diagnosis and adverse outcomes.”
Rodriguez-Galindo and colleagues conducted a population study by reviewing 18 SEER databases. They identified 830 cases of retinoblastoma in children up to age 9 years between January 2000 and December 2010.
The researchers used county-based socioeconomic variables to analyze poverty level, educational attainment, language isolation, crowding, unemployment, and percentage of immigrants among the study population.
Extent of disease, ocular outcome and survival served as primary outcomes.
Boys comprised 54.8% (n = 455) of the study population. Seventy-three percent (n = 606) of children included in the study were white, whereas Hispanics comprised nearly one-third (n = 262) of the population.
The researchers observed that a greater proportion of Hispanic children had extraocular disease (33% vs. 20%; OR = 1.97; 95% CI, 1.38-2.79).
Further, a higher percentage of extraocular disease occurred in counties with certain low socioeconomic status indicators, including higher vs. lower poverty status (27.8% vs. 20.4%; OR = 1.51; 95% CI, 1.06-2.14), lower vs. higher educational attainment (28.7% vs. 19.7%; OR = 1.65; 95% CI, 1.16-2.34), higher vs. lower crowding levels (31.2% vs. 17.2%; OR = 2.18; 95% CI, 1.53-3.13), higher vs. lower unemployment (28.9% vs. 19.2%; OR = 1.72; 95% CI, 1.21-2.45), higher vs. lower language isolation (30.2% vs. 18.5%; OR = 1.89; 95% CI, 1.34-2.7) and higher vs. lower immigrant population (28.2% vs. 20.5%; OR = 1.52; 95% CI, 1.08-2.16).
Higher enucleation rates appeared associated with low educational attainment (66.1% vs. 73.4%; OR = 1.42; 95% CI, 1.04-1.93), higher crowding levels (76% vs. 63.5%; OR = 1.81; 95% CI, 1.32-2.48), and Hispanic race (74.5%; OR = 1.41; 95% CI, 1.01-1.98).
A significantly smaller proportion of black children achieved 5-year relative survival than non-Hispanic white children (92.7% vs. 99.2%; P < .001).
The researchers acknowledged the use of SEER and census data to extrapolate area-based indicators for racial and socioeconomic status as a study limitation.
“The unique features of retinoblastoma have provided a scenario for the analysis of the impact of racial, ethnic and socioeconomic factors and have led to the identification of populations at risk for disparate outcomes in childhood cancer,” Rodriguez-Galindo and colleagues said. “Identifying and addressing such disparities is critical, given the known morbidity and the long-term psychosocial, financial, and medical burden that these children and their families have to endure.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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