title: Socioeconomic and psychological impact of treatment for unilateral intraocular retinoblastoma.
abstract: OBJECTIVE
  To identify the socioeconomic and psychosocial impacts of clinical treatment decisions for advanced unilateral intraocular retinoblastoma.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  
  
  
  METHODS
  institutional study at Alexandria Main University Hospital.
  
  
  METHODS
  records of 66 unilateral retinoblastoma cases treated from May 2005 to May 2013 were retrospectively reviewed. Sixty cases were eligible (International Intraocular Retinoblastoma Classification [IIRC] group C, D or E).
  
  
  METHODS
  two treatment groups were compared: enucleation vs. salvage treatment. Salvage treatment eyes were further subdivided based on IIRC group. Six socioeconomic parameters (financial burden, financial impact, psychological, social, medical and tumor impacts) were scored. Parameter scores ranged from 0 to 3, for overall score range 0 (no adverse impact) to 18 (severe adverse impact).
  
  
  METHODS
  derived Socioeconomic scores were correlated with treatment and outcomes.
  
  
  RESULTS
  The enucleation group (28 eyes) had a median overall Socioeconomic score of 4/18, significantly lower than the salvage treatment group (32 eyes), median score 11/18 (P<0.01). Socioeconomic score varied with IIRC group. Attempted eye salvage failed in 25 children, due to uncontrolled tumor (44%) and socioeconomic impact of cumulative therapies (56%). Treatment duration and Socioeconomic score were higher for the 5 children in the salvage treatment group who developed metastatic disease compared to those without metastasis (P<0.01).
  
  
  CONCLUSIONS
  The socioeconomic and psychosocial impacts of attempted ocular salvage for unilateral intraocular retinoblastoma are severe, in comparison to primary enucleation. Primary enucleation is a good treatment for unilateral retinoblastoma.
authors.affiliation: Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada. Electronic address: samehelsayedsoliman@yahoo.com.
authors.forename: S E
authors.initials: SE
authors.lastname: Soliman
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada; Division of Visual Science, Toronto Western Research Institute, Toronto, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Dimaras
authors.affiliation: Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: A A
authors.initials: AA
authors.lastname: Souka
authors.affiliation: Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: M H
authors.initials: MH
authors.lastname: Ashry
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada; Division of Visual Science, Toronto Western Research Institute, Toronto, Canada; Department of Ophthalmology & Visual Science, Hospital for Sick Children, Toronto, Canada; Princess Margaret Cancer Centre, Toronto, Canada; Departments of Ophthalmology & Visual Sciences, Medical Biophysics and Molecular Genetics, University of Toronto, Toronto, Canada.
authors.forename: B L
authors.initials: BL
authors.lastname: Gallie
mesh_terms: D000223:Adaptation, Psychological; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000523:psychology; D017281:Cost of Illness; D018450:Disease Progression; D004534:Egypt; D015353:Eye Enucleation / Q000523:psychology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009926:Organ Preservation / Q000523:psychology; D019572:Retinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology* / Q000628:therapy*; D012175:Retinoblastoma / Q000401:mortality / Q000473:pathology / Q000523:psychology* / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000523:psychology; D012917:Social Adjustment; D012959:Socioeconomic Factors; D015996:Survival Rate
keywords: Cancer; Developing country; Enucleation; Le cancer; Pays en développement; Retinoblastoma; Rétinoblastome; Socioeconomic; Socioéconomique; Unilateral; Unilatérale; Énucléation