title: Causes, outcome and prevention of abandonment in retinoblastoma in India.
abstract: BACKGROUND
  The high-cure rates of 90% in retinoblastoma are not replicated in developing countries due to late presentation and poor compliance to treatment. The present study takes a closer look at causes of abandonment of therapy and effectiveness of counselling in reducing abandonment.
  
  
  METHODS
  A retrospective study of children with retinoblastoma registered at our centre from March 2008 through August 2011.
  
  
  RESULTS
  Fifty (49.50%) of 101 children registered for treatment abandoned therapy. Abandonment rates were significantly higher in rural as compared to urban children (P = 0.02). There was no significant difference in rate of abandonment between stages or laterality of disease and other socio-demographic factors. Telephone calls were more effective than letters in tracing patients (31.2% vs. 2.4%). Major reasons cited behind abandonment were financial problems (30%) and unwillingness to enucleate (20%). Of the 12 children who returned and were retreated 6 (50%) died of progressive disease. Nineteen (73%) of those who did not return died at home. Abandonment rates steadily declined from 71.42% in 2008 to 16.66% in 2011 (P = 0.01) due to effective pre-abandonment counselling by a support team under the National Retinoblastoma Registry of India from 2009.
  
  
  CONCLUSIONS
  Abandonment rates for children with retinoblastoma continue to be unacceptably high. Rural background, financial constraints and hesitancy to enucleate were important causes behind abandonment. Outcome of patients who abandoned treatment was uniformly dismal. Inclusion of support team and intensified initial counselling helped in improving compliance.
authors.affiliation: Division of Paediatric Haematology-Oncology, Department of Paediatrics, King George's Medical University Lucknow, Uttar Pradesh, India. archanakumar53@yahoo.co.in
authors.forename: Archana
authors.initials: A
authors.lastname: Kumar
authors.forename: Nirmalya Roy
authors.initials: NR
authors.lastname: Moulik
authors.forename: Ravi Krishna
authors.initials: RK
authors.lastname: Mishra
authors.forename: Dipak
authors.initials: D
authors.lastname: Kumar
mesh_terms: D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003906:Developing Countries; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D019572:Retinal Neoplasms / Q000628:therapy*; D012175:Retinoblastoma / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D016312:Treatment Refusal