title: Quantifying bias in survival estimates resulting from loss to follow-up among children with lymphoma in Malawi.
abstract: Pediatric lymphoma is common in sub-Saharan Africa, where survival estimates are often based on limited follow-up with incomplete retention, introducing potential for bias. We compared follow-up and overall survival (OS) between passive and active tracing within a prospective cohort of children with lymphoma in Malawi. Median follow-up times were 4.4 months (interquartile range [IQR] 2.0-9.4) and 10.8 months (IQR 6.2-20.6) in passive and active follow-up, respectively. Twelve-month overall survival (OS) was 69% (95% confidence interval [CI] 54-80) in passive and 44% (95% CI 34-54) in active follow-up. Passive follow-up significantly overestimated the OS and underestimated the mortality. Efforts to improve retention in regional studies are needed.
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Stanley
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Kate D
authors.initials: KD
authors.lastname: Westmoreland
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Salama
authors.initials: S
authors.lastname: Itimu
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Ande
authors.initials: A
authors.lastname: Salima
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Toon
authors.initials: T
authors.lastname: van der Gronde
authors.affiliation: Texas Children's Hospital, Houston, Texas.|Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Peter
authors.initials: P
authors.lastname: Wasswa
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Idah
authors.initials: I
authors.lastname: Mtete
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Mercy
authors.initials: M
authors.lastname: Butia
authors.affiliation: Texas Children's Hospital, Houston, Texas.
authors.forename: Nader K
authors.initials: NK
authors.lastname: El-Mallawany
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|University of North Carolina, Chapel Hill, North Carolina.|University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
mesh_terms: D000293:Adolescent; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008223:Lymphoma / Q000401:mortality* / Q000628:therapy; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate
keywords: Malawi; loss to follow-up; lymphoma; pediatric cancer; sub-Saharan Africa