How Telemedicine and Centralized Care Changed the Natural History of Retinoblastoma in a Developing Country: Analysis of 478 Patients.
PURPOSE
To evaluate the efficacy of integrating a telemedicine-based twinning partnership and centralized care for retinoblastoma on survival and eye salvage.


DESIGN
Four hundred seventy-eight retinoblastoma patients treated at a tertiary referral cancer center (King Hussein Cancer Centre [KHCC]) from 2003 through 2019.


PARTICIPANTS
Four hundred seventy-eight retinoblastoma patients treated at KHCC after implementing a telemedicine-based program with St. Jude Children's Research Hospital.


METHODS
We reviewed the outcomes of retinoblastoma patients who were treated at KHCC after implementing a telemedicine-based eye salvage program with St. Jude Children's Research Hospital, and we compared that with outcomes for retinoblastoma patients who were treated before implementing a telemedicine-based retinoblastoma service at KHCC.


MAIN OUTCOME MEASURES
We analyzed patient demographics, clinical characteristics, treatments received, consultation type and duration, and long-term patient outcomes before and after implementing the twinning program.


RESULTS
Over 17 years, 813 eyes from 478 children with retinoblastoma were treated at KHCC. Three hundred thirty-five patients (70%) had bilateral disease. Six patients (4%) with unilateral disease and 66 patients (20%) with bilateral disease had a family history of retinoblastoma. After the twinning program was established in 2003, the mortality rate decreased from 38% to 5% (P < 0.0001), and the overall eye salvage rate increased from 4% to 61% (98% for group A, 93% for group B, 81% for group C, and 48% for group D; P < 0.0001). Initially, all cases were discussed via telemedicine, but as knowledge transfer increased, the proportion of cases that required discussion decreased to less than 3% 10 years later. Similarly, treatment changes based on consultations decreased from 70% to 7% after 10 years. Both survival and eye-salvage rates were comparable at the early and later stages of implementing the twinning program. At a median follow-up of 120 months, 5% of patients had died of metastases or secondary neoplasms, 81% were alive, and 14% were lost to follow-up.


CONCLUSIONS
Centralization of care at a single center in developing countries can achieve patient outcomes comparable with those of developed countries via twinning and telemedicine. This benefit can extend to a large region because two thirds of patients treated at KHCC were non-Jordanians.
['Yousef|Yacoub A|YA|', 'Al-Nawaiseh|Ibrahim|I|', 'Mehyar|Mustafa|M|', 'Sultan|Iyad|I|', 'Al-Hussaini|Maysa|M|', 'Jaradat|Imad|I|', 'Mohammad|Mona|M|', 'AlJabari|Reem|R|', 'Abu-Yaghi|Nakhleh|N|', 'Rodriguez-Galindo|Carlos|C|', 'Qaddoumi|Ibrahim|I|', 'Wilson|Matthew|M|']
D002675:Child, Preschool D003131:Combined Modality Therapy D003906:Developing Countries D019468:Disease Management D005260:Female D005500:Follow-Up Studies D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D012017:Referral and Consultation D019572:Retinal Neoplasms D012175:Retinoblastoma D012189:Retrospective Studies D017216:Telemedicine D013997:Time Factors
Telemedicine Retinoblastoma Survival