Abstract P1-10-02: A Novel Attempt To Improve Long-Term Patient Follow-Up in a Low Resource Urban Setting
Authors: Alexander A , Kaluve RS , Manjunath S , Shastry S , Raju R , Tirumalai SS. 
Published: April 2011

Abstract
The lack of either a nationalized health care structure or widespread health insurance in most developing nations is at the root of many of our health care challenges. Amongst them is the loss to follow-up of a majority of patients treated at tertiary care centers. As a consequence, outcomes data from such countries are notoriously non representative. While there have been numerous published reports of treatment outcomes of cancers from India, the reported numbers as a proportion of originally treated patients are probably less than half. We have attempted a simple solution to this problem, made possible primarily by the revolution of low cost mobile cell phones and almost universal access.
Methods.
St. John's Medical College Hospital is a tertiary care centre located in Bangalore, India. We established a patient support group called Aadhara (“Support” in Sanskrit). Aadhara has employed two women with training in counseling and clinical research. Both were provided with cell phones. At the time of initial breast cancer diagnosis, patients are enrolled in a long term follow-up study. Cell phone numbers, address and other contact details of patients and/or next of kin are obtained. The patients and their family are informed about the psycho-social support available at Aadhara that include counseling, psycho-education, talks on psycho-social aspects of the disease, nutrition, news letters, meeting long-term survivors and community breast cancer awareness programs. They are provided phone numbers and email ids to get in touch with the counselors as needed. The patients or their family are contacted by the counselors on a monthly basis. However the patients are free to get in touch with the counselors by just making a “missed call” to the cell phone numbers.
Results
Aadhara has been operational for close to two years. During this period we have enrolled 121 patients into our longitudinal observational study. There have been 11 deaths in our cohort. The most gratifying outcome has been the loss of only 2 patients to follow-up. This represents a greater than 95% follow-up. The costs of this entire program have been made available by a philanthropic organization and are approximately USD 2000 per month. Represented as per patient cost, this is less than USD 20/patient per month and could probably be halved as the enrollments grow. Discussion
The rapid and deep penetration of mobile phone services in India present opportunities for obtaining better metrics of the consequences of medical treatment. This model has the advantage of scalability and diminishing per patient costs as the numbers grow. It is also portable to other clinical conditions where long-term outcomes are needed to guide health care interventions. This is “proof-of-concept” that improved outcome measures can be obtained in low resource settings at costs that are a fraction of the cost of treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-02.