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17-04-2012 | Surgery | Article

Missed, misdiagnosed tumors lead to long treatment delays in uveal cancer


Free abstract

MedWire News: Many patients in the UK with uveal melanoma experience long delays in treatment because their tumor is missed or misdiagnosed, show study findings.

"As a result, many patients have preventable morbidity and, possibly, mortality," say Erika Damato (Bristol Eye Hospital, UK) and Bertil Damato (Liverpool Ocular Oncology Center, UK).

As reported in Ophthalmology, the researchers prospectively analyzed data on 2384 patients diagnosed with uveal melanoma at the Liverpool Ocular Oncology Center between 1996 and 2011. Patients were a median age of 62.1 years when their tumor was detected or the referral process was initiated.

The referral process was started by an optometrist in 1621 (68.0%) patients, a family doctor in 435 (18.2%), and an ophthalmologist in 328 (13.8%) patients.

Almost all patients (97.5%) whose referral was initiated by a family doctor were symptomatic, compared with 63.8% of those referred by an optometrist or ophthalmologist.

In total, 551 (23.1%) patients reported that their tumor had initially been missed by the practitioner they first consulted. Only 45.3% of patients who had attended a family doctor said that their tumor had been detected. The tumor was reported to be missed by 22.2% of symptomatic patients attending an optometrist and 14.0% of those attending an ophthalmologist.

The median time from referral to treatment was 49 days, exceeding 6 months in 19.8% of patients. The time to treatment was significantly longer in patients who reported that their tumor had been missed (median 92 vs 40 days).

Patients initially seen by an optometrist waited longer to see an ophthalmologist if they were referred via a family doctor instead of directly (median 44 vs 10 days). Conversely, patients whose referral was initiated by a family doctor experienced longer delays if referred to an optometrist instead of an ophthalmologist (median 19 vs 3 days).

Once seen by an ophthalmologist, 65.8% of patients were referred to the oncology center promptly (letter, fax, phone call received within 2 weeks). However, 252 (10.9%) experienced a delay exceeding 6 months.

Primary enucleation was performed in 33.3% of patients, and was more likely in patients who reported that their tumor was missed (44.8 vs 29.8%). "Such patients experienced a longer delay before treatment… so that during this time the tumor may have become larger, more extensive, and thus more likely [to] involve optic disc or extend extraocularly," suggest the authors.

"A better understanding of the factors that influence detection and time to treatment of uveal melanoma in different healthcare systems should enhance opportunities for conserving the eye and vision and may also prevent metastatic spread in some patients," conclude the researchers.

"Publication of minimum standards of care may improve outcomes," they add.

By Nikki Withers

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