Oral abstract presentation times
11th Rapid Fire
11th Oral
Abstract ID: 26-518
Tiered Referral Pathways and Diagnostic Lag Time: Impact on Clinical Outcomes of Retinoblastoma Patients at a Tertiary Referral Center in Eastern Indonesia
Author: Andi Pratiwi Base Hospital / Institution: Wahidin Sudirohusodo Hospital/ Ophthalmology Department, Faculty of Medicine, Hasanuddin University Indonesia
Presentation Type: Oral Presentation Session: Orbit IIDate: 11th SeptemberTime: 16.45
Purpose
To evaluate the influence of tiered referral pathways and diagnostic lag time on clinical outcomes of retinoblastoma (RB) patients at Dr. Wahidin Sudirohusodo General Hospital (WS Hospital), the primary referral center in Eastern Indonesia.
Methods
A retrospective cohort study was conducted on 142 RB patients treated between 2016 and 2024. Lag time was stratified into three components: Lag 1 (symptom onset to first presentation at the referral center), Lag 2 (first visit to confirmed diagnosis), and Lag 3 (diagnosis to initiation of therapy). Referral pathways were categorized by the number of healthcare facilities visited prior to WS Hospital. Associations between lag time, referral patterns, and disease stage (intraocular [IO] vs. extraocular [EO]) were analyzed using the Mann–Whitney U test.
Results
Of 142 patients, 79.6% were referred through one prior facility, while only 2.8% presented directly to WS Hospital. Paradoxically, patients presenting directly had the longest overall lag time (19.25 ± 9.57 weeks), whereas those referred through three facilities had the shortest (11.50 ± 4.95 weeks). EO patients demonstrated significantly longer Lag 1, Lag 2, Lag 3, and overall lag time compared to IO patients (all p < 0.001). Over 40% of patients resided more than 500 km from the referral center.
Conclusion
Referral pathway complexity, geographic barriers, and advanced disease stage at presentation substantially contribute to diagnostic and treatment delays in RB. These delays correlate with worse clinical outcomes, particularly in EO disease. Strengthening early detection literacy, optimizing tiered referral systems, and expanding access to specialized care are essential strategies to improve retinoblastoma survival in low-middle income settings.