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. 2024 Jun;205(2):313-322.
doi: 10.1007/s10549-024-07246-5. Epub 2024 Feb 26.

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Madelon M Voets  1   2 , Noa S Hassink  1 , Jeroen Veltman  3   4 , Cornelis H Slump  5 , Hendrik Koffijberg  1 , Sabine Siesling  6   7
Affiliations

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Madelon M Voets et al. Breast Cancer Res Treat. 2024 Jun.

Abstract

Purpose: Follow-up guidelines barely diverge from a one-size-fits-all approach, even though the risk of recurrence differs per patient. However, the personalization of breast cancer care improves outcomes for patients. This study explores the variation in follow-up pathways in the Netherlands using real-world data to determine guideline adherence and the gap between daily practice and risk-based surveillance, to demonstrate the benefits of personalized risk-based surveillance compared with usual care.

Methods: Patients with stage I-III invasive breast cancer who received surgical treatment in a general hospital between 2005 and 2020 were selected from the Netherlands Cancer Registry and included all imaging activities during follow-up from hospital-based electronic health records. Process analysis techniques were used to map patients and activities to investigate the real-world utilisation of resources and identify the opportunities for improvement. The INFLUENCE 2.0 nomogram was used for risk prediction of recurrence.

Results: In the period between 2005 and 2020, 3478 patients were included with a mean follow-up of 4.9 years. In the first 12 months following treatment, patients visited the hospital between 1 and 5 times (mean 1.3, IQR 1-1) and received between 1 and 9 imaging activities (mean 1.7, IQR 1-2). Mammogram was the prevailing imaging modality, accounting for 70% of imaging activities. Patients with a low predicted risk of recurrence visited the hospital more often.

Conclusions: Deviations from the guideline were not in line with the risk of recurrence and revealed a large gap, indicating that it is hard for clinicians to accurately estimate this risk and therefore objective risk predictions could bridge this gap.

Keywords: Breast cancer; Follow-up; Process mining; Real-world data; Resource utilisation; Risk of recurrence.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Patient inclusion based on the selection of the NCR and linkage to the EHR between 2005 and 2020
Fig. 2
Fig. 2
Annual (left) and cumulative (right) LRR risk predicted by the INFLUENCE 2.0 nomogram for all included patients
Fig. 3
Fig. 3
Sequential process map of follow-up. The numbers between brackets are the absolute number of activity instance executions, the percentages represent the proportion of patients in which the activity was executed. R-Mammogram, repeat mammogram within 40 days; R-Ultrasound, repeat ultrasound within 40 days; R-MRI, repeat MRI within 40 days
Fig. 4
Fig. 4
Sankey flow diagram describing the sequence of follow-up activities for all patients (n = 3478) during six years of follow-up and the repeat (interval) diagnostics between annual visits. FUP follow-up
See this image and copyright information in PMC

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