Reasons for missed chemotherapy appointments in retinoblastoma patients undergoing chemotherapy: A report from a Tertiary Care Hospital from India

BACKGROUND: Delays in chemotherapy due to missed‐appointments can lead to sub‐optimal outcomes in any cancer. Missed appointments or delayed follow up are an important concern in the treatment of pediatric cancers as it compromises the patient's health and overall outcomes. AIM: This study was conducted to understand the reasons responsible for missed‐appointments in Retinoblastoma (RB) patients scheduled for daycare based chemotherapy. METHODS: We prospectively recorded the causes for missed‐appointments in RB patients from February 2018 to September 2018. A delay of more than 48‐hours from the pre‐scheduled date of chemotherapy was categorized as a “missed‐appointment.” RESULTS: Out of 870 scheduled visits of patients with RB for chemotherapy to our center, there were 122 (14%) instances of missed‐appointments during the study period. There were 40 instances (4.6%) where the patient had missed‐appointments (possibly avoidable reasons). These 40 instances occurred in 33 patients who had a median age of 29 months (IQR 22.5‐51.5 m) with 22 males. Six patients lived within 100 km of the treating center, 12 lived between 100 and 500 km, and 15 patients lived beyond 500 km. The median length of delay was 13.75 days (IQR‐7‐20.75 days). Twenty‐seven patients used a train as a means of transport, and 10 used the state‐bus. The main cause of delay was the illness of other family members (52.5%) followed by financial issues (27.5%), transport‐related problems (10%), and absence of an adult to accompany (10%). CONCLUSION: Causes for missed‐appointments for chemotherapy in RB patients were multifactorial and included the illness of other family members, financial issues, distance/transport‐related problems, and no caregiver to accompany. The future study with a large sample size with a multicenter design is needed to confirm the results of the current study and to know the deficiency in the improvement of the follow‐up RB patients.