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

Abstract

Introduction Cervical cancer is among the most common cancers and is the fourth most common cause of cancer death in women worldwide [1]. Women in low-and middle-income countries (LMICs) disproportionately bear the burden of cervical cancer; 85% of cervical cancer morbidity and 88% of cervical cancer mortality occur in this region [2-4]. In East Africa, among all types of cancers in women, cervical cancer is the leading cause of morbidity and mortality with 52,633 new cases and 37,017 deaths estimated in 2018 [5]. Without adequate investment in cervical cancer control, these rates are only expected to rise [2]. Treatment for cervical cancer is critical for control and secondary disease prevention in LMICs [2]. However, most LMICs have limited infrastructure and human resource capacity to support surgical screening and subsequent treatment with radiotherapy, evidenced by the lack of trained health personnel and inadequate availability of treatment equipment [2]. Where services are available, the cost of treatment often prohibits access [6, 7]. Further, issues such as late presentation at diagnosis, low pretreatment performance status, which indicates a patient's ability to tolerate chemotherapy, lack of adherence to treatment or post-treatment follow-up, and low quality of care worsen patient outcomes [2, 8-11]. Among important programmatic and patient-related aspects of cervical cancer treatment is post-treatment follow-up. Women receiving therapy for invasive cancer

The Experiences of Cervical Cancer Patients During Follow-Up Care in Ethiopia: A Qualitative Study

“…[30][31][32] Habinshuti et al indicated that such side effects and complications need proper care and follow-up. 33 This indicates that cervical cancer not only affects patients' physical health but also the psychological and social health aspects. Thus, the follow-up treatment needs to focus on restoring the overall health of patients.…”

Cervical cancer treatment in Rwanda: Resource-driven adaptations, quality indicators, and patient outcomes

“…Intervals from diagnosis to surgery (median 7.7 weeks) and from last neoadjuvant chemotherapy to surgery (median 5.9 weeks) were acceptable, and rates of chemotherapy and CRT adherence and timely completion were high, once started. Key remaining challenges include delays to CRT due to resource limitations and high loss to follow up rates, which are both priority targets for improvement initiatives in our program [36][37][38]. Loss to follow up is a well-documented challenge in cancer care in low resource settings, attributable to direct and indirect costs to patients (e.g., transportation costs, lost income), distance and travel burden, competing priorities, preference for alternative treatment, social stigma, loss of phone access to receive calls, and unclear benefits of clinical follow up from patients' perspective.…”

Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the “treat all” era: a retrospective cohort study from rural Rwanda

“…The Butaro district hospital, located in Burera, is Rwanda's main cancer referral hospital and provides treatment for many cancers associated with HIV, such as HPV-related cancers or Hodgkin's lymphoma [25]. For example, previous research in Butaro revealed that over 30% of cervical cancer patients had HIV as comorbidity [26]. We hypothesize that the higher prevalence of patients with advanced HIV in Burera may indicate that many patients who develop HIV-related cancers as a result of living with advanced HIV are referred to Burera for cancer treatment and subsequently diagnosed with HIV.…”