Purpose: Breast cancer occurs in about one in nine 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 programme: twice a year for five years. The present study was undertaken to determine an individualised follow-up programme that gives women the follow-up they need and reduces physician workload.
Methods: Breast cancer patients were classified according to different risk groups for recurrence based on age, tumour size and lymph node status. We chose follow-up programmes with different frequency and length. To determine the most appropriate follow-up programme for each patient group we modelled the process of breast cancer in a state transition model, and used discrete event simulation to investigate the effectiveness of various follow-up programmes. Follow-up programmes are compared based on the number of visits and quality adjusted life expectancy. We simulated 150,000 patients per patient group and follow-up programme.
Result: For patients older than 70 years and patients with favourable tumour characteristics follow-up could be minimised to one visit. Patients younger than 40 years and patients with unfavourable tumour characteristics can benefit from a more intensive follow-up of twice a year for five years. Overall a reduction of 70% of needed follow-up visits can be quickly achieved.
Conclusion: The present study illustrates the potential for individualised follow-up in breast cancer patients. Implementing individualised follow-up can lead to a reduction of number of follow-up visits needed.