INFLUENCE: individualized follow-up for breast cancer

Research output: ThesisPhD Thesis - Research UT, graduation UTAcademic

Abstract

In contrast to significant progress in precision medicine and the tailoring of therapeutic strategies, current follow-up after breast cancer is still consensus-based and not dependent on the risk of recurrence of the individual patient. Better and personalized follow-up based on individual risk can reduce the burden for both the patients and the health care capacity due to the increasing patient volume requiring follow-up. To determine the risk of recurrence, data from the nation-wide population-based Netherlands Cancer Registry (NCR) was used from the incidence years 2003-2006 (N=37 230). The risk of recurrence was modelled using different techniques using baseline clinical and pathological characteristics. A model for time-dependent risk of recurrence was implemented in the INFLUENCE nomogram (www.utwente.nl/influence). Also, insight in long-term risk and risk of subsequent recurrence was acquired. Using a retrospective cohort study, guideline adherence was determined. Results showed no personalization on known risk factors and lower risk patients were actually given more frequent follow-up compared to higher risk patients. Additionally, the age-based recommendations after five years of follow-up do not relate to the risk of recurrence. Multiple risk factors should be taken into account when estimating recurrence risk. Subsequently, a partially observable Markov decision process (POMDP) was developed that takes into account the risk, as well as benefits and harm of follow-up to provide optimized follow-up schedules. This will enable clinicians to make informed decisions and focus resources on patients with higher risk, while avoiding unnecessary and potentially harmful follow-up visits for women with very low risks.
Original languageEnglish
Awarding Institution
  • University of Twente
Supervisors/Advisors
  • IJzerman, Maarten J., Supervisor
  • Siesling, Sabine , Supervisor
  • Vliegen, Ingrid, Co-Supervisor
Award date2 Nov 2018
Place of PublicationEnschede
Publisher
Print ISBNs978-90-365-4640-9
DOIs
Publication statusPublished - 2 Nov 2018

Fingerprint

Breast Neoplasms
Recurrence
Guideline Adherence
Markov Chains
Nomograms
Precision Medicine
Netherlands
Registries
Patient Care
Appointments and Schedules
Cohort Studies
Retrospective Studies
Delivery of Health Care
Incidence

Cite this

Witteveen, Annemieke . / INFLUENCE : individualized follow-up for breast cancer. Enschede : University of Twente, 2018. 257 p.
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title = "INFLUENCE: individualized follow-up for breast cancer",
abstract = "In contrast to significant progress in precision medicine and the tailoring of therapeutic strategies, current follow-up after breast cancer is still consensus-based and not dependent on the risk of recurrence of the individual patient. Better and personalized follow-up based on individual risk can reduce the burden for both the patients and the health care capacity due to the increasing patient volume requiring follow-up. To determine the risk of recurrence, data from the nation-wide population-based Netherlands Cancer Registry (NCR) was used from the incidence years 2003-2006 (N=37 230). The risk of recurrence was modelled using different techniques using baseline clinical and pathological characteristics. A model for time-dependent risk of recurrence was implemented in the INFLUENCE nomogram (www.utwente.nl/influence). Also, insight in long-term risk and risk of subsequent recurrence was acquired. Using a retrospective cohort study, guideline adherence was determined. Results showed no personalization on known risk factors and lower risk patients were actually given more frequent follow-up compared to higher risk patients. Additionally, the age-based recommendations after five years of follow-up do not relate to the risk of recurrence. Multiple risk factors should be taken into account when estimating recurrence risk. Subsequently, a partially observable Markov decision process (POMDP) was developed that takes into account the risk, as well as benefits and harm of follow-up to provide optimized follow-up schedules. This will enable clinicians to make informed decisions and focus resources on patients with higher risk, while avoiding unnecessary and potentially harmful follow-up visits for women with very low risks.",
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INFLUENCE : individualized follow-up for breast cancer. / Witteveen, Annemieke .

Enschede : University of Twente, 2018. 257 p.

Research output: ThesisPhD Thesis - Research UT, graduation UTAcademic

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AB - In contrast to significant progress in precision medicine and the tailoring of therapeutic strategies, current follow-up after breast cancer is still consensus-based and not dependent on the risk of recurrence of the individual patient. Better and personalized follow-up based on individual risk can reduce the burden for both the patients and the health care capacity due to the increasing patient volume requiring follow-up. To determine the risk of recurrence, data from the nation-wide population-based Netherlands Cancer Registry (NCR) was used from the incidence years 2003-2006 (N=37 230). The risk of recurrence was modelled using different techniques using baseline clinical and pathological characteristics. A model for time-dependent risk of recurrence was implemented in the INFLUENCE nomogram (www.utwente.nl/influence). Also, insight in long-term risk and risk of subsequent recurrence was acquired. Using a retrospective cohort study, guideline adherence was determined. Results showed no personalization on known risk factors and lower risk patients were actually given more frequent follow-up compared to higher risk patients. Additionally, the age-based recommendations after five years of follow-up do not relate to the risk of recurrence. Multiple risk factors should be taken into account when estimating recurrence risk. Subsequently, a partially observable Markov decision process (POMDP) was developed that takes into account the risk, as well as benefits and harm of follow-up to provide optimized follow-up schedules. This will enable clinicians to make informed decisions and focus resources on patients with higher risk, while avoiding unnecessary and potentially harmful follow-up visits for women with very low risks.

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Witteveen A. INFLUENCE: individualized follow-up for breast cancer. Enschede: University of Twente, 2018. 257 p. (Health Sciences Series; HS 18-24). https://doi.org/10.3990/1.9789036546409