Challenges in the management of retinoblastoma during nationwide lockdown: an observational study from a retinoblastoma center in South India

ABSTRACT

Introduction: The nationwide lockdown due to coronavirus disease 2019 led to travel restrictions resulting in a delay in diagnosis, treatment, and follow-up of children with retinoblastoma (RB). Objectives: We audited the impact and challenges of lockdown among RB children over 1-year period (May 2020-2021). Materials and Methods: It is a cross-sectional study of 104 children with RB, who presented within the 1-year study period. The demographic details, clinical presentations, and outcome of treatment due to lockdown were studied. Results: Of the 152 eyes of 104 children, unilateral RB was observed in 52% and bilateral in 48%, in which four children had metastatic disease and one child had trilateral RB. International classification groups D (n = 64 eyes, 42%) and E (n = 38 eyes, 25%) were in majority. Almost, half of the children (n = 53, 51%) underwent enucleation. Overall, the vision was preserved in 32% of the children and globe preservation in 49% of children. Eleven children (10.5%) succumbed due to disease progression. But, only five children were affected with severe acute respiratory syndrome coronavirus 2 infection. The majority of children (n = 72, 69%) had to travel more than or equal to 1,000 km for treatment. About 57% (n = 60) patients were newly diagnosed during the lockdown period and due to the travel restrictions, they had a mean delay of 2.2 months (range 0-15 months) in starting treatment and 27% (n = 29) of children on treatment had an interruption of treatment. Conclusion: Multidisciplinary team management with strategies to support the RB families during locked down crisis is essential to continue care without interruptions.