1. Impact of HIV on Loss to Follow-up and Survival among children with Lymphoma in Malawi
Christopher Chikhosi Stanley, MSc
Malawi Cancer Symposium August 2016

2. Introduction Lymphoma is the commonest pediatric cancer in Malawi.
Long-term survival greater than 90% is achievable in developed countries.
Outcomes in SSA including Malawi are significantly worse.

3. Introduction
Survival estimates are often based on limited follow-up with incomplete retention, thereby introducing potential for bias.
‘True survival rates’ which appropriately account (and reasons) for loss to follow-up (LTFU) remain unknown for lymphoma in SSA.

4. Objectives
Within an existing pediatric lymphoma cohort at KCH, we are tracing patients LTFU to achieve the following specific aims:
Aim 1: To explore reasons for LTFU among children with lymphoma, using semi structured interviews.
Aim 2: To quantify bias in survival estimates resulting from LTFU.
Aim 3: To asses risk factors for LTFU among the entire cohort.

5. Method Prospective cohort of patients with HL from KCH Lymphoma Study.
Enrollment and follow-up since June 2013.
Diagnosis confirmed after consensus teleconference review by US and Malawian pathologists.

6. Method
Follow-up after enrollment, active phone & physical tracing throughout treatment.
Transport reimbursement is provided to all patients to promote retention throughout care.

7. Results so far on…
121 children enrolled June 2013-march 2016; 100 BL, 21 HL.
Aim 2: Bias in survival estimates resulting from LTFU
Median follow-up time among those not known to be deceased:
4.4 months [IQR ] in passive follow-up.
10.8 months [IQR ] in active follow-up.

8. Bias in survival estimates resulting from LTFU
Table 1: Kaplan-Meier overall survival estimates stratified by Diagnosis and clinical stage with a) Passive follow up;
b) Active follow up at 12-months
a)Passive follow up
Overall BL HL n OS
95% CI
95%CI
121 69
( )
100 63
( ) 21 83
( )
Stage I/II 36 76
( ) 23 68
( ) 13 81
( )
Stage III 49 78
( ) 47
( ) 2
Stage IV 55
( ) 30 45
( ) 6
( )
b) Active follow up 44
( ) 38
( ) 74
( ) 59
( ) 51
( )
( ) 34
( )
( ) 40
( ) 31
( ) 67
( )

9. Bias in survival estimates resulting from LTFU
Figure1
Kaplan-Meier overall survival with passive versus active follow-up for Overall cohort, Hodgkin, and Burkitt.

10. Next steps
Finalizing paper on Bias in survival estimates resulting from LTFU.
Continue with;
qualitative work, semi structured interviews on reasons for LTFU.
Collecting social economic indicator.

11. Thank you!
Comments and questions!