University of Twente Student Theses

Analyzing daily practice follow-up of breast cancer patients compared to their risk of local regional recurrence using the INFLUENCE- nomogram.

Hassink, N.S. (2022) Analyzing daily practice follow-up of breast cancer patients compared to their risk of local regional recurrence using the INFLUENCE- nomogram.

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Embargo date:	3 August 2024
Abstract:	Background and aim Every year almost 15.000 women in the Netherlands are diagnosed with invasive breast cancer. The incidence has doubled and survival has increased since 1989. This results in an increase in patients in need of follow-up care. Current guidelines are mainly age-based. Contradicting to the guidelines, does research show that the age cut-offs are suboptimal. Follow-up that is designed for patients’ individual risk profile could lead to more efficient follow-up care. The aim of this study is to find out which variations in costs and frequency of visits during follow-up could be seen for patients with different risks of 5-year local regional recurrence (LRR). Using data of patients treated at Ziekenhuisgroep Twente (ZGT). Methods Data originates from the Netherlands Cancer Registry (NCR) and ZGT. Data on patient & tumour characteristics and recurrences were obtained through the NCR (N=6968). The INFLUENCE-nomogram was used to estimate the 5-year LRR. Datasets from the NCR and ZGT were linked using pseudonym patient identifiers. Follow-up in this study is defined as all medical interventions performed up to a possible recurrence or the end of follow-up. The follow-up period was divided into the first year of follow-up, 2-5 years period of follow-up and after 5 years of follow-up. Package BuparR of Rstudio was used to make event logs and process maps of the follow-up. An event log is a figure showing a sequence of medical interventions in a chronological order for an individual patient. Process maps show the follow-up care pathways of the patients. Results After the exclusion of patients due to missing data and/or exclusion criteria was a study population left of 3797 patients. In the first year of follow-up is the average 5-year LRR risk of 0,033 percentile, 2-5 years period of follow-up 0,034 percentile and after 5 years is the average risk 0,032 percentile. Event logs show the biggest difference between the follow-up care pathway in the first year of follow-up and the remaining time of follow-up. Results show that patients with a lower 5-year LRR risk have more follow-up visits than higher-risk patients during follow-up. Patients who have a lower risk of recurrence are more costly than higher-risk patients. Discussion & conclusion We would have excepted that higher risk patients would be more costly than lower risk patients. In addition to this it was unexpected that after five years of follow-up the average risk was the lowest. This shows that current guidelines do not properly determine the risk of recurrence for individual patients. we do think that the individualization of follow-up could benefit from a recurrence risk calculation tool, like the INFLUENCE-nomogram.
Item Type:	Essay (Master)
Faculty:	TNW: Science and Technology
Subject:	44 medicine, 85 business administration, organizational science
Programme:	Health Sciences MSc (66851)
Link to this item:	https://purl.utwente.nl/essays/92202
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