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dc.contributor.authorFreeman, Estheren_US
dc.contributor.authorSemeere, Aggreyen_US
dc.contributor.authorWenger, Meganen_US
dc.contributor.authorBwana, Mwebesaen_US
dc.contributor.authorAsirwa, F. Chiteen_US
dc.contributor.authorBusakhala, Naftalien_US
dc.contributor.authorOga, Emmanuelen_US
dc.contributor.authorJedy-Agba, Elimaen_US
dc.contributor.authorKwaghe, Vivianen_US
dc.contributor.authorIregbu, Kennethen_US
dc.contributor.authorJaquet, Antoineen_US
dc.contributor.authorDabis, Francoisen_US
dc.contributor.authorYumo, Habakkuk Azinyuien_US
dc.contributor.authorDusingize, Jean Claudeen_US
dc.contributor.authorBangsberg, Daviden_US
dc.contributor.authorAnastos, Kathrynen_US
dc.contributor.authorPhiri, Samen_US
dc.contributor.authorBohlius, Juliaen_US
dc.contributor.authorEgger, Matthiasen_US
dc.contributor.authorYiannoutsos, Constantinen_US
dc.contributor.authorWools-Kaloustian, Karaen_US
dc.contributor.authorMartin, Jeffreyen_US
dc.date.accessioned2016-03-01T19:51:15Z
dc.date.issued2016en_US
dc.identifier.citationFreeman, E., A. Semeere, M. Wenger, M. Bwana, F. C. Asirwa, N. Busakhala, E. Oga, et al. 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 16 (1): 65. doi:10.1186/s12885-016-2080-0. http://dx.doi.org/10.1186/s12885-016-2080-0.en
dc.identifier.issn1471-2407en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:25658543
dc.description.abstractBackground: 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 <30 years and male sex were independently associated with becoming lost. Conclusions: In 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.en
dc.language.isoen_USen
dc.publisherBioMed Centralen
dc.relation.isversionofdoi:10.1186/s12885-016-2080-0en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744447/pdf/en
dash.licenseLAAen_US
dc.subjectSurvivalen
dc.subjectMortalityen
dc.subjectKaposi’s sarcomaen
dc.subjectHIV/AIDSen
dc.subjectCanceren
dc.subjectResource-limited settingsen
dc.subjectAfricaen
dc.subjectLoss to follow-upen
dc.subjectCohorten
dc.titlePitfalls 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 Africaen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalBMC Canceren
dash.depositing.authorFreeman, Estheren_US
dc.date.available2016-03-01T19:51:15Z
dc.identifier.doi10.1186/s12885-016-2080-0*
dash.authorsorderedfalse
dash.contributor.affiliatedFreeman, Esther
dash.contributor.affiliatedBangsberg, David R.


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