International Outreach: Improving Global Retinoblastoma Outcomes

RB is the most common primary intraocular malignancy of childhood, and > 8,000 children are diagnosed each year worldwide.1,2 In high-resource settings with infrastructure and support, the survival of children with RB can be nearly 100%.3,4 In contrast, in low- and middle-resource countries, eye cancer specialists and support are lacking, leading to survival rates approximating 10%.3-5 In that more than 80% of the children diagnosed with pediatric cancer live in low- and middle-resource countries, many more children are dying of RB than surviving.6-11 Given this disparity, it is important to identify what can be done to save the lives of RB children in low- and middle-resource countries.
That said, the World Health Organization (WHO) has identified RB as one of the most curable pediatric index cancers, stating a goal of at least 60% survival by 2030.12 This will require cooperation between ophthalmic and pediatric oncology. Governments and nongovernmental organizations will need to work towards allocating highly specific resources, education/training, and infrastructure. Thus, RB can serve as a model for other pediatric cancers by implementing effective education, training, and capacity-building initiatives that are scalable and adaptable. Many strategies are already known to be effective: multidisciplinary care teams, well-defined referral networks, resource-adapted treatment guidelines, as well as early programs to promote early detection and awareness.

Towards Holistic Ophthalmic Oncology Care

Despite the advances in the clinical management of ocular and periocular tumors that have significantly improved life expectancy and visual prognosis, many barriers to care delivery remain.1-3 Structural separations between the ocular oncologist, oculoplastics specialist, pathologist, radiation oncologist, medical oncologist, and other stakeholders may contribute to inconsistent referral practices, poor communication, inappropriate or delayed referrals, duplication of efforts, and interruptions in the continuity of care. These disruptions may lead to a fragmented and stressful experience for both patient and caregiver. Improved integration between caregivers, services, and institutions at all stages of the clinical encounter can provide a holistic experience that improves patient outcomes and quality of life while advancing knowledge in ophthalmic oncology (Mind map 10-1).