Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda

Background: Cervical cancer is among the most common cancers affecting women globally. Where treatment is available in low- and middle-income countries, many women become lost to follow-up (LTFU) at various points of care. Objective: This study assessed predictors of LTFU among cervical cancer patie...

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Autores principales:	Placide Habinshuti, Marc Hagenimana, Cam Nguyen, Paul H. Park, Tharcisse Mpunga, Lawrence N. Shulman, Alexandra Fehr, Gilbert Rukundo, Jean Bosco Bigirimana, Stephanie Teeple, Catherine Kigonya, Gilles Francois Ndayisaba, Francois Uwinkindi, Thomas Randall, Ann C. Miller
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2020
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/8b497ada38e74c17b47a6d893fa447ad
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spelling	oai:doaj.org-article:8b497ada38e74c17b47a6d893fa447ad2021-12-02T11:35:32ZFactors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda2214-999610.5334/aogh.2722https://doaj.org/article/8b497ada38e74c17b47a6d893fa447ad2020-09-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/2722https://doaj.org/toc/2214-9996Background: Cervical cancer is among the most common cancers affecting women globally. Where treatment is available in low- and middle-income countries, many women become lost to follow-up (LTFU) at various points of care. Objective: This study assessed predictors of LTFU among cervical cancer patients in rural Rwanda. Methods: We conducted a retrospective study of cervical cancer patients enrolled at Butaro Cancer Center of Excellence (BCCOE) between 2012 and 2017 who were either alive and in care or LTFU at 12 months after enrollment. Patients are considered early LTFU if they did not return to clinic after the first visit and late LTFU if they did not return to clinic after the second visit. We conducted two multivariable logistic regressions to determine predictors of early and late LTFU. Findings: Of 652 patients in the program, 312 women met inclusion criteria, of whom 47 (15.1%) were early LTFU, 78 (25.0%) were late LTFU and 187 (59.9%) were alive and in care. In adjusted analyses, patients with no documented disease stage at presentation were more likely to be early LTFU vs. patients with stage 1 and 2 when controlling for other factors (aOR: 14.93, 95% CI 6.12–36.43). Patients who travel long distances (aOR: 2.25, 95% CI 1.11, 4.53), with palliative care as type of treatment received (aOR: 6.65, CI 2.28, 19.40) and patients with missing treatment (aOR: 7.99, CI 3.56, 17.97) were more likely to be late LTFU when controlling for other factors. Patients with ECOG status of 2 and higher were less likely to be late LTFU (aOR: 0.26, 95% CI 0.08, 0.85). Conclusion: Different factors were associated with early and later LTFU. Enhanced patient education, mechanisms to facilitate diagnosis at early stages of disease, and strategies that improve patient tracking and follow-up may reduce LTFU and improve patient retention.Placide HabinshutiMarc HagenimanaCam NguyenPaul H. ParkTharcisse MpungaLawrence N. ShulmanAlexandra FehrGilbert RukundoJean Bosco BigirimanaStephanie TeepleCatherine KigonyaGilles Francois NdayisabaFrancois UwinkindiThomas RandallAnn C. MillerUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 86, Iss 1 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Placide Habinshuti Marc Hagenimana Cam Nguyen Paul H. Park Tharcisse Mpunga Lawrence N. Shulman Alexandra Fehr Gilbert Rukundo Jean Bosco Bigirimana Stephanie Teeple Catherine Kigonya Gilles Francois Ndayisaba Francois Uwinkindi Thomas Randall Ann C. Miller Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda
description	Background: Cervical cancer is among the most common cancers affecting women globally. Where treatment is available in low- and middle-income countries, many women become lost to follow-up (LTFU) at various points of care. Objective: This study assessed predictors of LTFU among cervical cancer patients in rural Rwanda. Methods: We conducted a retrospective study of cervical cancer patients enrolled at Butaro Cancer Center of Excellence (BCCOE) between 2012 and 2017 who were either alive and in care or LTFU at 12 months after enrollment. Patients are considered early LTFU if they did not return to clinic after the first visit and late LTFU if they did not return to clinic after the second visit. We conducted two multivariable logistic regressions to determine predictors of early and late LTFU. Findings: Of 652 patients in the program, 312 women met inclusion criteria, of whom 47 (15.1%) were early LTFU, 78 (25.0%) were late LTFU and 187 (59.9%) were alive and in care. In adjusted analyses, patients with no documented disease stage at presentation were more likely to be early LTFU vs. patients with stage 1 and 2 when controlling for other factors (aOR: 14.93, 95% CI 6.12–36.43). Patients who travel long distances (aOR: 2.25, 95% CI 1.11, 4.53), with palliative care as type of treatment received (aOR: 6.65, CI 2.28, 19.40) and patients with missing treatment (aOR: 7.99, CI 3.56, 17.97) were more likely to be late LTFU when controlling for other factors. Patients with ECOG status of 2 and higher were less likely to be late LTFU (aOR: 0.26, 95% CI 0.08, 0.85). Conclusion: Different factors were associated with early and later LTFU. Enhanced patient education, mechanisms to facilitate diagnosis at early stages of disease, and strategies that improve patient tracking and follow-up may reduce LTFU and improve patient retention.
format	article
author	Placide Habinshuti Marc Hagenimana Cam Nguyen Paul H. Park Tharcisse Mpunga Lawrence N. Shulman Alexandra Fehr Gilbert Rukundo Jean Bosco Bigirimana Stephanie Teeple Catherine Kigonya Gilles Francois Ndayisaba Francois Uwinkindi Thomas Randall Ann C. Miller
author_facet	Placide Habinshuti Marc Hagenimana Cam Nguyen Paul H. Park Tharcisse Mpunga Lawrence N. Shulman Alexandra Fehr Gilbert Rukundo Jean Bosco Bigirimana Stephanie Teeple Catherine Kigonya Gilles Francois Ndayisaba Francois Uwinkindi Thomas Randall Ann C. Miller
author_sort	Placide Habinshuti
title	Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda
title_short	Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda
title_full	Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda
title_fullStr	Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda
title_full_unstemmed	Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda
title_sort	factors associated with loss to follow-up among cervical cancer patients in rwanda
publisher	Ubiquity Press
publishDate	2020
url	https://doaj.org/article/8b497ada38e74c17b47a6d893fa447ad
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Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda

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