Saving Lives, Saving Vision
Retinoblastoma, the most common malignant eye cancer in children, has a high incidence in the Philippines (17.8 per million children 0-4 years). In a country of 92 million people of which 10-13 % are children aged 4 years and below, the expected number of cases is 210 per year. Retinoblastoma is a highly curable cancer if detected early. However, majority of Filipinos present late with extra-ocular extension. There are multiple causes for diagnosis delay and financial constraints, inaccessibility to care and misdiagnosis play a major role. In Southern Philippines
Medical Center (SPMC), the tertiary referral center for the island of Mindanao, 93 % of patients present with extra-ocular disease and the survival rate is less than 20 %. The number of children seen and diagnosed is also a fraction of the expected 35 to 40 cases per year for the island.
Hence in 2011, KTP-NUCMI funded a program for early detection of retinoblastoma in Davao city and other key cities in Mindanao Island. This is a joint project between Southern Philippines Medical Center led by Dr. Mae Dolendo, and National University Hospital in collaboration with Dana Farber Children’s Hospital Cancer Center and St. Jude Children’s Research Hospital. The program involves education on the early warning signs of retinoblastoma; establishment of a referral system in the city; and development of a multi-disciplinary team at the Southern Philippines Medical Center. Specifically, the educational campaign involves distribution of posters and pamphlets on “early warning signs of retinoblastoma” in local health centers targeted at the public; as well as a symposium for barangay health workers (BHW), general medical practitioners, paediatricians and ophthalmologists on retinoblastoma, available resources for diagnosis and treatment, and the local referral pathway for suspected cases. The campaign will run in 5 major cities around Mindanao Island: Davao City, Tagum, General Santos City, Zamboanga City and Cagayan de Oro. To develop SPMC as a retinoblastoma center of excellence, monthly on-line multi-disciplinary tumor board meetings are held with the NUH team and world experts, Dr. Carlos Rodriguez-Galindo and Dr. Matthew Wilson, to discuss all cases for opinion and management guidance. A retinoblastoma protocol and treatment plan appropriate for SPMC was established and a comprehensive database was set up to monitor care. Review of pathology specimens and CT scans for second opinion are done in NUH. Moreover, a dedicated retinoblastoma center in SPMC was opened in 2012.
Since program implementation, the number of retinoblastoma cases seen in SPMC has doubled and 20 % of the cases are early stage or intra-ocular. Following the success of this initiative, the retinoblastoma detection programmme will be replicated and serve as a model for other key cities and provinces in Mindanao island, and in the Philippines national capital region, Metro Manila.
For children suffering from eye cancer in Mindanao, this project has brought them and their families hope, ensured better survival rates and quality of life, and given them access to specialist cancer care.
Activities under the programme:
- Educational campaigns
- Distribution of posters and pamphlets in hospitals and local health centers to educate the public
- Retinoblastoma symposium for medical professionals and health workers
- Data management system and registry of retinoblastoma patient are established to monitor care for patients
- Mentorship programmes and Care4Kids teleconferences to impart knowledge and technology transfer
- Multi-disciplinary meetings and clinical reviews are implemented to improve care for patients
- Patients receive psychosocial support to help them cope with their illness