Incidence rate and predictors of loss to follow-up of newly diagnosed adult cancer patients at uganda cancer institute.

Abstract

Introduction: Loss to follow-up (LTFU) in cancer patients is a serious problem, yet there is little data on its incidence and on the underlying reasons. General objective: The study aimed to determine the incidence rate, predictors of loss to follow-up among KS and breast cancer patients and reasons for loss to follow-up, at the Uganda Cancer Institute (UCI) between January 1 and December 31, 2018. Methods: The study employed a retrospective cohort study design and it used both qualitative and quantitative methods of data collection. This was a retrospective review of patient files of 155 adult histologically confirmed Breast and Kaposi sarcoma (KS) patients seen at UCI between January 1 and December 31, 2018 and systematic sampling was used to select study participants. Demographic (age, gender and education) and clinical factors (stage, performance status, type of tumor and BMI) were abstracted from the UCI patient file. Kaplan-Meier method was used to compare the incidence rate of LTFU between breast and KS patients. Extended Cox proportional hazards model was used to determine the predictors of loss to follow up. Variables with p-value of ≤0.2 at bivariate analysis were considered for the multivariate analysis and those with a p-value of ≤0.05 were considered statistically significant. In-depth phone interviews were used to explore the underlying reasons for LTFU of 14 study participants and open code software was used in this analysis. Results: The incidence rate of loss to follow up was 10.3 per 1000 person weeks. Lack of funds for transport, drug stock outs and lack of money to buy the expensive drugs were the major reasons for loss to follow up and most of the participants were not knowledgeable about cancer before coming to UCI. In the multivariate analysis, Male sex (HR= 0.30; 95% CI: 0.3-0.3); residing in Western Uganda (HR=0.0; 95% CI: 0.0-0.0) and body mass index (BMI) (HR=0.86; 95% CI: 0.84-0.88) predicted loss to follow up of both adult KS and breast cancer patients in Uganda. Conclusion: The Incidence rate of LTFU in Uganda is quite high and lack of funds for transport, drug stock outs and lack of money to buy the expensive drugs contribute significantly to this cause. Health education and setting up of regional cancer centers may reduce LTFU among cancer patients.