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

Esther Freeman, Aggrey Semeere, Megan Wenger, Mwebesa Bwana, F. Chite Asirwa, Naftali Busakhala, Emmanuel Oga, Elima Jedy-Agba, Vivian Kwaghe, Kenneth Iregbu, Antoine Jaquet, Francois Dabis, Habakkuk Azinyui Yumo, Jean Claude Dusingize, David Bangsberg, Kathryn Anastos, Sam Phiri, Julia Bohlius, Matthias Egger, Constantin YiannoutsosKara Wools-Kaloustian, Jeffrey Martin

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Survival 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. Methods: We 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. Results: Nominally, 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

Original languageEnglish (US)
Article number65
JournalBMC Cancer
Volume16
Issue number1
DOIs
StatePublished - Feb 6 2016

Fingerprint

Africa South of the Sahara
Kaposi's Sarcoma
Epidemiology
Survival
Databases
Neoplasms
HIV
Malawi
Cameroon
Uganda
Kenya
Lost to Follow-Up
CD4 Lymphocyte Count
Nigeria
Information Systems
Registries
Primary Health Care
Acquired Immunodeficiency Syndrome
Incidence
Health

Keywords

  • Africa
  • Cancer
  • Cohort
  • HIV/AIDS
  • Kaposi's sarcoma
  • Loss to follow-up
  • Mortality
  • Resource-limited settings
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Genetics

Cite this

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. / Freeman, Esther; Semeere, Aggrey; Wenger, Megan; Bwana, Mwebesa; Asirwa, F. Chite; Busakhala, Naftali; Oga, Emmanuel; Jedy-Agba, Elima; Kwaghe, Vivian; Iregbu, Kenneth; Jaquet, Antoine; Dabis, Francois; Yumo, Habakkuk Azinyui; Dusingize, Jean Claude; Bangsberg, David; Anastos, Kathryn; Phiri, Sam; Bohlius, Julia; Egger, Matthias; Yiannoutsos, Constantin; Wools-Kaloustian, Kara; Martin, Jeffrey.

In: BMC Cancer, Vol. 16, No. 1, 65, 06.02.2016.

Research output: Contribution to journalArticle

Freeman, E, Semeere, A, Wenger, M, Bwana, M, Asirwa, FC, Busakhala, N, Oga, E, Jedy-Agba, E, Kwaghe, V, Iregbu, K, Jaquet, A, Dabis, F, Yumo, HA, Dusingize, JC, Bangsberg, D, Anastos, K, Phiri, S, Bohlius, J, Egger, M, Yiannoutsos, C, Wools-Kaloustian, K & Martin, J 2016, '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, vol. 16, no. 1, 65. https://doi.org/10.1186/s12885-016-2080-0
Freeman, Esther ; Semeere, Aggrey ; Wenger, Megan ; Bwana, Mwebesa ; Asirwa, F. Chite ; Busakhala, Naftali ; Oga, Emmanuel ; Jedy-Agba, Elima ; Kwaghe, Vivian ; Iregbu, Kenneth ; Jaquet, Antoine ; Dabis, Francois ; Yumo, Habakkuk Azinyui ; Dusingize, Jean Claude ; Bangsberg, David ; Anastos, Kathryn ; Phiri, Sam ; Bohlius, Julia ; Egger, Matthias ; Yiannoutsos, Constantin ; Wools-Kaloustian, Kara ; Martin, Jeffrey. / 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. In: BMC Cancer. 2016 ; Vol. 16, No. 1.
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AU - Asirwa, F. Chite

AU - Busakhala, Naftali

AU - Oga, Emmanuel

AU - Jedy-Agba, Elima

AU - Kwaghe, Vivian

AU - Iregbu, Kenneth

AU - Jaquet, Antoine

AU - Dabis, Francois

AU - Yumo, Habakkuk Azinyui

AU - Dusingize, Jean Claude

AU - Bangsberg, David

AU - Anastos, Kathryn

AU - Phiri, Sam

AU - Bohlius, Julia

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AU - Martin, Jeffrey

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