Few Losses to Follow-up in a Sub-Saharan African Cancer Cohort via Active Mobile Health Follow-up: The African Breast Cancer—Disparities in Outcomes Study

Accurate survival estimates are needed for guiding cancer control efforts in sub-Saharan Africa, but previous studies have been hampered by unknown biases due to excessive loss to follow-up (LTFU). In the African Breast Cancer—Disparities in Outcomes Study, a prospective breast cancer cohort study,...

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Published in:American journal of epidemiology 2020-10, Vol.189 (10), p.1185-1196
Main Authors: Foerster, Milena, Anele, Angelica, Adisa, Charles, Moses Galukande, Groesbeck Parham, Zietsman, Annelle, Christopher Sule Oyamienlen, Iwuoha, Kingsley Chukwunyere, Ezeigbo, Esther, Bakengesa, Evelyn, Kaggwa, Agnes, Allen Naamala, Nteziryayo, Anne, Nakazibwe, Teopista, Pinder, Leeya F, Walubita, Emily, Pontac, Johanna, Anderson, Benjamin O, McKenzie, Fiona, Schüz, Joachim, Isabel dos Santos Silva, McCormack, Valerie
Format: Article
Language:English
Subjects:
Breast cancer
Cancer
Cell phones
Practice of Epidemiology
Survival
Womens health
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Summary:Accurate survival estimates are needed for guiding cancer control efforts in sub-Saharan Africa, but previous studies have been hampered by unknown biases due to excessive loss to follow-up (LTFU). In the African Breast Cancer—Disparities in Outcomes Study, a prospective breast cancer cohort study, we implemented active mobile health follow-up, telephoning each woman or her next-of-kin (NOK) trimonthly on her mobile phone to update information on her vital status. Dates of every contact with women/NOK were analyzed from diagnosis in 2014–2017 to the earliest of September 1, 2018, death, or 3 years postdiagnosis. The cumulative incidence of being LTFU was calculated considering deaths as competing events. In all, 1,490 women were followed for a median of 24.2 (interquartile range (IQR), 14.2–34.5) months, corresponding to 8,529 successful contacts (77% of total contacts) with the women/NOK. Median time between successful contacts was 3.0 (IQR, 3.0–3.7) months. In all, 71 women (5.3%) were LTFU at 3 years: 0.8% in Nigeria, 2.2% in Namibia, and 5.6% in Uganda. Because of temporary discontinuity of active follow-up, 20.3% of women were LTFU after 2 years in Zambia. The median time to study notification of a death was 9.1 (IQR, 3.9–14.0) weeks. Although the present study was not a randomized controlled trial, in this cancer cohort with active mobile health follow-up, LTFU was much lower than in previous studies and enabled estimation of up-to-date and reliable cancer survival.
ISSN:0002-9262
1476-6256
DOI:10.1093/aje/kwaa070