Time to treatment of uveal melanoma in the United Kingdom

Abstract

To measure delay before treatment of uveal melanoma. A retrospective study was carried out of patients referred for diagnosis and treatment of uveal melanoma at the Liverpool Ocular Oncology Centre (LOOC), a tertiary adult ocular oncology service. Participants were patients with uveal melanoma presenting to an optometrist or general practitioner in the United Kingdom between 1997 and 2000. Main outcome measures were delay at each stage of the referral process according to route of referral and tumour size. Delays greater than 2 weeks occurred (1) between presentation to the optometrist or general practitioner and the ophthalmologist's examination in 50% of patients; (2) between the ophthalmologist's examination and receipt of the referral at the ocular oncology centre in 34%; (3) between receipt of referral at the oncology centre and first assessment at that centre in 16%; and (4) between first assessment at the oncology centre and treatment in 8%. The waiting time for the ophthalmologist's examination was greater if the optometrist referred the patient via the general practitioner instead of directly. The median overall delays between presentation and treatment were 129 days for small tumours, 50 days for medium-sized tumours and 34 days for large tumours. Many patients with uveal melanoma experience long delays before treatment. Patients wait longer to see an ophthalmologist if their tumour is small or if they are referred by the optometrist to the general practitioner instead of directly to the ophthalmologist. Several patients also experience long delays after seeing the ophthalmologist, some having a large tumour by the time of teatment.