Associação entre fatores socioeconômicos e a sobrevida de pacientes com retinoblastoma em um centro terciário de tratamento oncológico

Abstract

Retinoblastoma (RB) is the most common intraocular cancer of childhood. Structure of health systems, socioeconomic factors and family indicators affects patient survival, despite biological predictors and availability of updated treatment practices. These characteristics make RB more sensitive to factors related to the socioeconomic status (SES) of each individual patient and knowledge of the determining factors of SES is of paramount importance in understanding disparities in outcomes. This study aims to describe 5-year overall survival of patients with RB enrolled at the National Cancer Institute (INCA) between 2000 and 2016; determine influence exerted by socioeconomic factors on survival; determine time to diagnosis of and its association with staging, death and enucleation, determine time to diagnosis and age at diagnosis of patients with RB from countries in Latin America and its association with sociodemographic factors. A retrospective revision of medical records of all patients diagnosed or suspected of RB were carried out. A structured questionnaire was designed to guide data collection performed between March and October 2017. A systematic bibliographic review of studies published between 1997 and 2017 that contained information on time to diagnosis and age at diagnosis of patients with RB was also carried out. Our sample included 160 patients with retinoblastoma with a mean age at diagnosis equal to 22.85 months (SD±14.29). Five-years Overall Survival (OS) was 78,8% (CI 95%: 72.4%-85.9%). In final multivariate model, patients whose fathers had more than nine years of study had a lower risk of death compared to those with lower educational level (HR:0.11; 95% CI 0.03-0.38). Patients from families having more than one child under five years at home had a 213% higher risk of death compared to patients living in families with no other small child (HR: 3.13; 95% CI 1.51-6.51). Treatment abandonment also had a profound effect on the risk of death (HR:7.00; 95% CI 3.17-15.49). As compared to intraocular disease at diagnosis, patients with metastatic or extraocular stage had also a significant increase in the risk of death (HR:9.40; 95% CI 4.52-19.58). In the systematic review, nine studies were selected, encompassing data from 1560 patients, from Argentina, Brazil, Chile, Honduras, Mexico and Peru. The median time to diagnosis ranged from 3 to 5months and the median age at diagnosis ranged from 16.5 to 22.2months. A prolonged time to diagnosis was observed and was associated to damaging results on retinoblastoma outcomes, particularly increasing extraocular disease, and mortality rates. The systematic review showed a prolonged time to diagnosis in Latin America, leading to a negative influence on RB outcomes, causing higher rates of extraocular disease and consequently higher mortality. Results also suggest heterogeneity in RB survival and association with some sociodemographic factors such as; paternal education, number of children under 5 years old at home and treatment abandonment. The improvement in disparities must occur not only in large-scale settings, such as improving care for the national health system and reducing poverty, but also in more personalized actions that can mitigate these inequalities in individuals with low SES.