Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan.
Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan.
Ophthalmology. 2021 Jan;128(1):130-137. doi: 10.1016/j.ophtha.2020.07.026. Epub 2020 Jul 16.
To evaluate the efficacy of integrating a telemedicine-based twinning partnership and centralized care for retinoblastoma on survival and eye salvage.
Four hundred seventy-eight retinoblastoma patients treated at a tertiary referral cancer center (King Hussein Cancer Centre [KHCC]) from 2003 through 2019.
Four hundred seventy-eight retinoblastoma patients treated at KHCC after implementing a telemedicine-based program with St. Jude Children's Research Hospital.
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.
We analyzed patient demographics, clinical characteristics, treatments received, consultation type and duration, and long-term patient outcomes before and after implementing the twinning program.
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.
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.
评估将基于远程医疗的结对合作和集中护理整合用于视网膜母细胞瘤治疗的效果，以提高患者生存率和保留眼球。
2003 年至 2019 年间，在三级转诊癌症中心（侯赛因国王癌症中心[KHCC]）接受治疗的 478 例视网膜母细胞瘤患者。
KHCC 实施了与圣裘德儿童研究医院（St. Jude Children's Research Hospital）的基于远程医疗的项目后，在此接受治疗的 478 例视网膜母细胞瘤患者。
我们回顾了在 KHCC 实施基于远程医疗的眼保存项目后接受治疗的视网膜母细胞瘤患者的结局，并将其与在 KHCC 实施基于远程医疗的视网膜母细胞瘤服务之前接受治疗的患者的结局进行比较。
分析患者的人口统计学特征、临床特征、接受的治疗、咨询类型和持续时间，以及在实施双胞胎计划前后的长期患者结局。
17 年间，478 名患有视网膜母细胞瘤的儿童的 813 只眼在 KHCC 接受了治疗。335 名患者（70%）患有双眼疾病。6 名（4%）患有单侧疾病，66 名（20%）患有双侧疾病的患者有视网膜母细胞瘤家族史。2003 年建立双胞胎计划后，死亡率从 38%降至 5%（P<0.0001），总眼球保存率从 4%增至 61%（A 组为 98%，B 组为 93%，C 组为 81%，D 组为 48%；P<0.0001）。最初，所有病例均通过远程医疗进行讨论，但随着知识转移的增加，需要讨论的病例比例在 10 年后降至 3%以下。同样，基于咨询的治疗变更在 10 年后从 70%降至 7%。双胞胎计划实施的早期和后期，生存率和眼球保存率相当。在中位随访 120 个月时，5%的患者死于转移或继发肿瘤，81%的患者存活，14%的患者失访。
发展中国家的单一中心集中护理可以通过结对和远程医疗实现与发达国家相当的患者结局。由于 KHCC 治疗的三分之二的患者是非约旦人，这种益处可以扩展到更大的地区。
