Abstract
Abstract: :
Purpose: Socioeconomic determinants of outcomes in patients with heritable retinoblastoma have not been examined. In this study, we examined the influence of socioeconomic factors on visual and survival outcomes in these patients. Methods: We performed retrospective review of medical records and conducted interviews of parents of 61 consecutive hereditary retinoblastoma patients treated at UCSF between 1988 and 2004. Clinical data collected included disease presentation, time of diagnostic delay, stage at diagnosis, treatments, visual outcomes, and survival outcomes. Socioeconomic data collected, including insurance status, primary language, ethnicity, place of residence, citizenship, parental education, parental age, parental employment status, and parental income. Results: Several socioeconomic factors including non–Caucasian ethnicity (p=0.013), Asian and African American ethnicity (p=0.012), low income (p=0.049), and Medicaid or lack of insurance (p=0.006) were significantly correlated with mortality due to retinoblastoma, trilateral retinoblastoma, or second primary tumors. In terms of overall visual and survival outcomes, only Asian ethnicity was significantly associated with poorer outcome (p=0.036). This assoication was significant even after controling for diagnostic delay and stage of disease at presentation. Conclusions: This study suggests that socioeconomic factors may play a role in prognosis in hereditary retinoblastoma. Genetic background and modifier genes may also play a role in determining disease phenotype. The understanding of these relationships may serve to guide early detection efforts, risk stratification and treatment protocols.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • retinoblastoma • clinical (human) or epidemiologic studies: risk factor assessment