University of Twente Student Theses


Individualized breast cancer follow-up : cost-effectiveness for various follow-up scenarios

Elteren, Jesse J. van (2008) Individualized breast cancer follow-up : cost-effectiveness for various follow-up scenarios.

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Abstract:This study investigates the follow-up of breast cancer and took place from September 2007 until February 2008. One of the main goals of follow-up is to improve the survival of patients. Follow-up influences survival by detecting local recurrences and second primary tumors in an early stage, thereby reducing the risk of metastases. Breast cancer occurs in about one in eight women in the Netherlands. Every year, 11000 new cases are registered and about 3500 women die of breast cancer. Prognosis after primary treatment for patients with breast cancer is improving. This leads to an increased number of patients in follow-up, which leads to increased workload. All patients are currently assigned the same follow-up: five years long, with a frequency of two consults per year, as national guidelines prescribe. This study wants to determine a more individualized follow-up in order to give women the follow-up they need and reduce workload in hospitals. We classify various patient groups, according to age, tumor size and lymph node status. We choose follow-up scenarios based on their type of consult (surgeon face-to-face, nurse practitioner face-toface, nurse practitioner telephone), frequency (once, twice per year) and length (one, three, five years), and determine the most appropriate follow-up scenario for each patient group. To investigate the cost-effectiveness scenarios, we model the process of breast cancer in a discreteevent state-transition model and measure the cost-effectiveness of all scenarios for all patient groups. Primary recommendations flowing from the research are the following: This study illustrates the possibility and potential for individualized follow-up in various types of cancer. Implementing individualized follow-up can lead to savings of up to 89% of the number of consults needed. We have come to the insight that in general, patients younger than 50 require a more intensive follow-up than patients older than 70. Older patients have a lower life expectancy, and therefore there are less QALYs to be gained and the effectiveness of follow-up is lower. Specific results are: o Patients older than 70 and with favorable tumor characteristics) are served best with a minimal follow-up of one year. o Patients younger than 40 and patients with unfavorable tumor characteristics (>3 lymph nodes, tumor size > 2.0 cm) can benefit from a more intensive follow-up of five or possibly ten years. o Patients with age older than 40 but younger than 70 sometimes benefit from a more intensive follow-up, e.g. when younger than 50 and tumor size >2,0 cm.
Item Type:Essay (Master)
Medisch Spectrum Twente, Centre for Mammacare ; Integraal Kankercentrum Stedendriehoek Twente
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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