Optimization of follow-up scenarios following breast cancer

Purpose: Breast cancer occurs in about 1 in 9 women in the Netherlands. Every year, 11,000 new cases are registered and about 3,500 women die of breast cancer. Prognosis after primary treatment is improving, leading to an increased number of follow-up visits and increasing workload to physicians. National guidelines currently assign all these patients the same follow-up program: twice a year for 5 years. The present study was undertaken to determine an individualized follow-up program that gives women the follow-up they need and reduces physician workload. Method: Breast cancer patients were classified according to different risk groups for recurrence based on age, tumor size and lymph node status. We chose follow-up programs with different frequency and length. To determine the most appropriate follow-up program for each patient group we modeled the process of breast cancer in a state transition model, and used discrete event simulation to investigate the effectiveness of various follow-up programs. Follow-up programs are compared based on the number of visits and quality adjusted life expectancy. We simulated 150,000 patients per patient group and follow-up program. Result: For patients older than 70 years and patients with favorable tumor characteristics follow-up could be minimized to 1 visit. Patients younger than 40 years and patients with unfavorable tumor characteristics can benefit from a more intensive follow-up of twice a year for 5 years. Overall a reduction of 70% of needed follow-up visits can be quickly achieved. Conclusion: The present study illustrates the potential for individualized follow-up in breast cancer patients. Implementing individualized follow-up can lead to a reduction of number of follow-up visits needed.