Retinoblastoma in children: profound inequities still exist

Despite global treatment outcomes for retinoblastoma over the past four decades, there are still widening disparities in overall survival and outcomes.  Two recent studies have demonstrated the significance of these disparities, as well as some of the associated factors.

Retinoblastoma is an aggressive eye cancer of infancy and childhood, and the most common cause of death from eye cancer worldwide. Early diagnosis and prompt treatment can save a child’s life and the eye globe.

Research, led by the International Centre for Eye Health (ICEH) at the London School of Hygiene & Tropical Medicine (LSHTM), found stark differences in survival for children with retinoblastoma, between high-income and low-income countries. In high-income countries, retinoblastoma is considered a curable disease, and nearly 100% of children survive. But in low-income countries, just over 50% of children with retinoblastoma remain alive 3 years after diagnosis.[1]

A second study funded by the Hong Kong Health and Medical Research Fund and the Children Cancer’s Foundation (Hong Kong) looked at trends in global retinoblastoma survival and globe preservation over the past 40 years. The factors associated with higher survival were education level of the population, the percentage of the population living in rural areas, government investment in health care, and disparity in wealth distribution (i.e. Gini index).[2]  The factors associated with overall globe salvage rate were cataract surgery rate, eye care worker density, education and poverty gaps.

A new dashboard displays modelled survival statistics and allows users to compare selected countries. https://cuhkdovs.shinyapps.io/RB_Data_Studio/

These studies demonstrate the great need to advocate for access to quality eye care services. Many of those challenges can be addressed by implementing the World Health Assembly resolution 73.4 on Integrated People-centred Eye Care, which urges member states to make eye care an integral part of Universal Health Coverage.

Publications:

1         Global Retinoblastoma Study Group. The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries. Articles Lancet Glob Health 2022;10:1128–68. doi:10.1016/S2214-109X(22)00250-9

2         Wong ES, Choy RW, Zhang Y, et al. Global retinoblastoma survival and globe preservation: a systematic review and meta-analysis of associations with socioeconomic and health-care factors. Lancet Glob Health 2022;10:e380–9. doi:10.1016/S2214-109X(21)00555-6

Image on top: Retinoblastoma patient, Ruharo Eye Centre, Mbarara, Uganda by Terry Cooper