Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi’s sarcoma in five countries across sub-Saharan Africa

BMC Cancer

Research Article

Naftali Busakhala¹  Kathryn Anastos²  David Bangsberg³  Esther Freeman⁴  Antoine Jaquet⁵  Francois Dabis⁵  Constantin Yiannoutsos⁶  Kara Wools-Kaloustian⁷  F. Chite Asirwa⁸  Aggrey Semeere⁹  Elima Jedy-Agba^1,10  Emmanuel Oga^1,10  Sam Phiri^1,11  Mwebesa Bwana^1,12  Kenneth Iregbu^1,13  Habakkuk Azinyui Yumo^1,14  Jean Claude Dusingize^1,15  Vivian Kwaghe^1,16  Matthias Egger^1,17  Julia Bohlius^1,17  Megan Wenger^1,18  Jeffrey Martin^1,18 

[1] AMPATH, Moi University, Eldoret, Kenya;Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA;Center for Global Health, Massachusetts General Hospital, Boston, MA, USA;Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, 02114, Boston, MA, USA;INSERM U897 & ISPED, Université Bordeaux, Bordeaux, France;Indiana University Fairbanks School of Public Health, Indianapolis, USA;Indiana University School of Medicine, Indianapolis, IN, USA;Indiana University School of Medicine, Indianapolis, IN, USA;AMPATH, Moi University, Eldoret, Kenya;Infectious Diseases Institute, Makerere University, Kampala, Uganda;University of California, San Francisco, USA;Institute of Human Virology, Abuja, Nigeria;Lighthouse Trust Clinic, Lilongwe, Malawi;Mbarara University of Science and Technology, Mbarara, Uganda;National Hospital of Abuja, Abuja, Nigeria;R4D International, Yaounde, Cameroon;Regional Alliance for Sustainable Development, Kigali, Rwanda;University of Abuja Teaching Hospital, Abuja, Nigeria;University of Bern, Bern, Switzerland;University of California, San Francisco, USA;

关键词: Survival;    Mortality;    Kaposi’s sarcoma;    HIV/AIDS;    Cancer;    Resource-limited settings;    Africa;    Loss to follow-up;    Cohort;   

DOI  :  10.1186/s12885-016-2080-0

 received in 2015-06-09, accepted in 2016-01-21,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundSurvival after diagnosis is a fundamental concern in cancer epidemiology. In resource-rich settings, ambient clinical databases, municipal data and cancer registries make survival estimation in real-world populations relatively straightforward. In resource-poor settings, given the deficiencies in a variety of health-related data systems, it is less clear how well we can determine cancer survival from ambient data.MethodsWe addressed this issue in sub-Saharan Africa for Kaposi’s sarcoma (KS), a cancer for which incidence has exploded with the HIV epidemic but for which survival in the region may be changing with the recent advent of antiretroviral therapy (ART). From 33 primary care HIV Clinics in Kenya, Uganda, Malawi, Nigeria and Cameroon participating in the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortia in 2009–2012, we identified 1328 adults with newly diagnosed KS. Patients were evaluated from KS diagnosis until death, transfer to another facility or database closure.ResultsNominally, 22 % of patients were estimated to be dead by 2 years, but this estimate was clouded by 45 % cumulative lost to follow-up with unknown vital status by 2 years. After adjustment for site and CD4 count, age <30 years and male sex were independently associated with becoming lost.ConclusionsIn this community-based sample of patients diagnosed with KS in sub-Saharan Africa, almost half became lost to follow-up by 2 years. This precluded accurate estimation of survival. Until we either generally strengthen data systems or implement cancer-specific enhancements (e.g., tracking of the lost) in the region, insights from cancer epidemiology will be limited.

【 授权许可】

CC BY   
© Freeman et al. 2016