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Voets MM, Hassink NS, Veltman J, Slump CH, Koffijberg H, Siesling S. Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk. Breast Cancer Res Treat 2024; 205:313-322. [PMID: 38409613 PMCID: PMC11101519 DOI: 10.1007/s10549-024-07246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024]
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.
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Affiliation(s)
- Madelon M Voets
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Noa S Hassink
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Jeroen Veltman
- Multi-Modality Medical Imaging, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Radiology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 9609 PP, Almelo, The Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands.
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van Maaren MC, van Hoeve JC, Korevaar JC, van Hezewijk M, Siemerink EJM, Zeillemaker AM, Klaassen-Dekker A, van Uden DJP, Volders JH, Drossaert CHC, Siesling S. The effectiveness of personalised surveillance and aftercare in breast cancer follow-up: a systematic review. Support Care Cancer 2024; 32:323. [PMID: 38695938 PMCID: PMC11065941 DOI: 10.1007/s00520-024-08530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/27/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Breast cancer follow-up (surveillance and aftercare) varies from one-size-fits-all to more personalised approaches. A systematic review was performed to get insight in existing evidence on (cost-)effectiveness of personalised follow-up. METHODS PubMed, Scopus and Cochrane were searched between 01-01-2010 and 10-10-2022 (review registered in PROSPERO:CRD42022375770). The inclusion population comprised nonmetastatic breast cancer patients ≥ 18 years, after completing curative treatment. All intervention-control studies studying personalised surveillance and/or aftercare designed for use during the entire follow-up period were included. All review processes including risk of bias assessment were performed by two reviewers. Characteristics of included studies were described. RESULTS Overall, 3708 publications were identified, 64 full-text publications were read and 16 were included for data extraction. One study evaluated personalised surveillance. Various personalised aftercare interventions and outcomes were studied. Most common elements included in personalised aftercare plans were treatment summaries (75%), follow-up guidelines (56%), lists of available supportive care resources (38%) and PROs (25%). Control conditions mostly comprised usual care. Four out of seven (57%) studies reported improvements in quality of life following personalisation. Six studies (38%) found no personalisation effect, for multiple outcomes assessed (e.g. distress, satisfaction). One (6.3%) study was judged as low, four (25%) as high risk of bias and 11 (68.8%) as with concerns. CONCLUSION The included studies varied in interventions, measurement instruments and outcomes, making it impossible to draw conclusions on the effectiveness of personalised follow-up. There is a need for a definition of both personalised surveillance and aftercare, whereafter outcomes can be measured according to uniform standards.
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Affiliation(s)
- Marissa C van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Jolanda C van Hoeve
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
- The Hague University of Applied Sciences, The Hague, the Netherlands
| | | | | | | | - Anneleen Klaassen-Dekker
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | | | - José H Volders
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Constance H C Drossaert
- Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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Giannoula A, Comas M, Castells X, Estupiñán-Romero F, Bernal-Delgado E, Sanz F, Sala M. Exploring long-term breast cancer survivors' care trajectories using dynamic time warping-based unsupervised clustering. J Am Med Inform Assoc 2024; 31:820-831. [PMID: 38193340 PMCID: PMC10990519 DOI: 10.1093/jamia/ocad251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Long-term breast cancer survivors (BCS) constitute a complex group of patients, whose number is estimated to continue rising, such that, a dedicated long-term clinical follow-up is necessary. MATERIALS AND METHODS A dynamic time warping-based unsupervised clustering methodology is presented in this article for the identification of temporal patterns in the care trajectories of 6214 female BCS of a large longitudinal retrospective cohort of Spain. The extracted care-transition patterns are graphically represented using directed network diagrams with aggregated patient and time information. A control group consisting of 12 412 females without breast cancer is also used for comparison. RESULTS The use of radiology and hospital admission are explored as patterns of special interest. In the generated networks, a more intense and complex use of certain healthcare services (eg, radiology, outpatient care, hospital admission) is shown and quantified for the BCS. Higher mortality rates and numbers of comorbidities are observed in various transitions and compared with non-breast cancer. It is also demonstrated how a wealth of patient and time information can be revealed from individual service transitions. DISCUSSION The presented methodology permits the identification and descriptive visualization of temporal patterns of the usage of healthcare services by the BCS, that otherwise would remain hidden in the trajectories. CONCLUSION The results could provide the basis for better understanding the BCS' circulation through the health system, with a view to more efficiently predicting their forthcoming needs and thus designing more effective personalized survivorship care plans.
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Affiliation(s)
- Alexia Giannoula
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- Research Programme on Biomedical Informatics (GRIB), Department of Medicine and Life Sciences (MELIS), Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Mercè Comas
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Francisco Estupiñán-Romero
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences (IACS), Zaragoza, Aragon, 50009, Spain
| | - Enrique Bernal-Delgado
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences (IACS), Zaragoza, Aragon, 50009, Spain
| | - Ferran Sanz
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- Research Programme on Biomedical Informatics (GRIB), Department of Medicine and Life Sciences (MELIS), Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Sala
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
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Klaassen-Dekker A, Drossaert CHC, Van Maaren MC, Van Leeuwen-Stok AE, Retel VP, Korevaar JC, Siesling S. Personalized surveillance and aftercare for non-metastasized breast cancer: the NABOR study protocol of a multiple interrupted time series design. BMC Cancer 2023; 23:1112. [PMID: 37964214 PMCID: PMC10647159 DOI: 10.1186/s12885-023-11504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Follow-up of curatively treated primary breast cancer patients consists of surveillance and aftercare and is currently mostly the same for all patients. A more personalized approach, based on patients' individual risk of recurrence and personal needs and preferences, may reduce patient burden and reduce (healthcare) costs. The NABOR study will examine the (cost-)effectiveness of personalized surveillance (PSP) and personalized aftercare plans (PAP) on patient-reported cancer worry, self-rated and overall quality of life and (cost-)effectiveness. METHODS A prospective multicenter multiple interrupted time series (MITs) design is being used. In this design, 10 participating hospitals will be observed for a period of eighteen months, while they -stepwise- will transit from care as usual to PSPs and PAPs. The PSP contains decisions on the surveillance trajectory based on individual risks and needs, assessed with the 'Breast Cancer Surveillance Decision Aid' including the INFLUENCE prediction tool. The PAP contains decisions on the aftercare trajectory based on individual needs and preferences and available care resources, which decision-making is supported by a patient decision aid. Patients are non-metastasized female primary breast cancer patients (N = 1040) who are curatively treated and start follow-up care. Patient reported outcomes will be measured at five points in time during two years of follow-up care (starting about one year after treatment and every six months thereafter). In addition, data on diagnostics and hospital visits from patients' Electronical Health Records (EHR) will be gathered. Primary outcomes are patient-reported cancer worry (Cancer Worry Scale) and overall quality of life (as assessed with EQ-VAS score). Secondary outcomes include health care costs and resource use, health-related quality of life (as measured with EQ5D-5L/SF-12/EORTC-QLQ-C30), risk perception, shared decision-making, patient satisfaction, societal participation, and cost-effectiveness. Next, the uptake and appreciation of personalized plans and patients' experiences of their decision-making process will be evaluated. DISCUSSION This study will contribute to insight in the (cost-)effectiveness of personalized follow-up care and contributes to development of uniform evidence-based guidelines, stimulating sustainable implementation of personalized surveillance and aftercare plans. TRIAL REGISTRATION Study sponsor: ZonMw. Retrospectively registered at ClinicalTrials.gov (2023), ID: NCT05975437.
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Affiliation(s)
- A Klaassen-Dekker
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - C H C Drossaert
- Health & Technology Department, University of Twente, Enschede, The Netherlands
| | - M C Van Maaren
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - V P Retel
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - J C Korevaar
- Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - S Siesling
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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Routine and interval detection of locoregional breast cancer recurrences and risk of subsequent distant metastasis. Breast Cancer Res Treat 2023; 197:123-135. [PMID: 36315307 PMCID: PMC9823019 DOI: 10.1007/s10549-022-06757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Follow-up for breast cancer survivors consists of after care and surveillance. The benefits of routine surveillance visits remain debatable. In this study we compared the severity of locoregional recurrences (LRRs) and the subsequent risk of a distant metastasis (DM) between LRRs detected at routine and interval visits. METHODS Women diagnosed with early breast cancer between 2003 and 2008 in one of the 15 participating hospitals, and who developed a LRR as first event after primary treatment, were selected from the Netherlands Cancer Registry (Cohort A). Chi-squared tests were used to compare the severity of routine- and interval-detected local recurrences (LRs) and regional recurrences (RRs), using tumor size, tumor grade, and number of positive lymph nodes. Data on the development of a subsequent DM after a LRR were available for a subset of patients (Cohort B). Cohort B was used to estimate the association between way of LRR-detection and risk of a DM. RESULTS Cohort A consisted of 109 routine- and 113 interval-LRR patients. The severity of routine-detected LRs or RRs and interval-detected LRs or RRs did not significantly differ. Cohort B consisted of 66 routine- and 61 interval-LRR patients. Sixteen routine- (24%) and 17 (28%) interval-LRR patients developed a DM. After adjustment, way of LRR-detection was not significantly associated with the risk of a DM (hazard ratio: 1.22; 95% confidence interval: 0.49-3.06). CONCLUSION The current study showed that routine visits did not lead to less severe LRRs and did not decrease the risk of a subsequent DM.
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Draeger T, Voelkel V, Schreuder K, Veltman J, Dassen A, Strobbe L, Heijmans HJ, Koelemij R, Groothuis-Oudshoorn CGM, Siesling S. Adherence to the Dutch Breast Cancer Guidelines for Surveillance in Breast Cancer Survivors: Real-World Data from a Pooled Multicenter Analysis. Oncologist 2022; 27:e766-e773. [PMID: 35962739 PMCID: PMC9526487 DOI: 10.1093/oncolo/oyac126] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 05/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Regular follow-up after treatment for breast cancer is crucial to detect potential recurrences and second contralateral breast cancer in an early stage. However, information about follow-up patterns in the Netherlands is scarce. Patients and Methods Details concerning diagnostic procedures and policlinic visits in the first 5 years following a breast cancer diagnosis were gathered between 2009 and 2019 for 9916 patients from 4 large Dutch hospitals. This information was used to analyze the adherence of breast cancer surveillance to guidelines in the Netherlands. Multivariable logistic regression was used to relate the average number of a patient’s imaging procedures to their demographics, tumor–treatment characteristics, and individual locoregional recurrence risk (LRR), estimated by a risk-prediction tool, called INFLUENCE. Results The average number of policlinic contacts per patient decreased from 4.4 in the first to 2.0 in the fifth follow-up year. In each of the 5 follow-up years, the share of patients without imaging procedures was relatively high, ranging between 31.4% and 33.6%. Observed guidelines deviations were highly significant (P < .001). A higher age, lower UICC stage, and having undergone radio- or chemotherapy were significantly associated with a higher chance of receiving an imaging procedure. The estimated average LRR-risk was 3.5% in patients without any follow-up imaging compared with 2.3% in patients with the recommended number of 5 imagings. Conclusion Compared to guidelines, more policlinic visits were made, although at inadequate intervals, and fewer imaging procedures were performed. The frequency of imaging procedures did not correlate with the patients’ individual risk profiles for LRR.
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Affiliation(s)
- Teresa Draeger
- Tumor Center Regensburg/University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Vinzenz Voelkel
- Tumor Center Regensburg/University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Kay Schreuder
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Jeroen Veltman
- Department of Radiology, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Anneriet Dassen
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Luc Strobbe
- Department of Surgery, Canisius Hospital, Nijmegen, The Netherlands
| | - Harald J Heijmans
- Department of Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Ron Koelemij
- Department of Surgery, Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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7
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Ankersmid JW, Drossaert CHC, Strobbe LJA, Battjes MS, Uden‐Kraan CF, Siesling S, Riet YEA, Bode‐Meulepas JM, Strobbe LJA, Dassen AE, Olieman AFT, Witjes HHG, Doeksen A, Contant CME. Health care professionals' perspectives on shared decision making supported by personalised‐risk‐for‐recurrences‐calculations regarding surveillance after breast cancer. Eur J Cancer Care (Engl) 2022. [PMCID: PMC9539946 DOI: 10.1111/ecc.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective Breast cancer patients for whom less intensive surveillance is sufficient can be identified based on the risk for locoregional recurrences (LRRs). This study explores health care professionals' (HCPs) perspectives on less intensive surveillance, preferences for shared decision‐making (SDM) about surveillance and perspectives on the use of patients' estimated personal risk for LRRs in decision‐making about surveillance. Methods We conducted semi‐structured interviews with 21 HCPs providing follow‐up care for breast cancer patients in seven Dutch teaching hospitals (Santeon hospitals). Results HCPs were predominantly positive about less intensive surveillance for women with a low risk for recurrences. They mentioned important prerequisites such as clearly defined surveillance schedules based on risk categories, information provision and communication support for patients and HCPs. Most HCPs supported SDM about surveillance and were positive about using patients' estimated personal risk for LRRs. HCPs specified prerequisites such as clear visualisation and explanation of risk information, attention for fear of cancer recurrence (FCR) and defined surveillance schedules for specific risk groups. Conclusion Mentioned prerequisites for less intensive surveillance need to be accounted for. Information needs and existing misconceptions need to be addressed. Outcome information regarding risks for LRRs and FCR can enrich the SDM process about surveillance.
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Affiliation(s)
- Jet W. Ankersmid
- Department of Health Technology and Services Research, Technical Medical Center University of Twente Enschede
- Santeon Hospital Group Utrecht
| | | | - Luc J. A. Strobbe
- Department of Surgery Canisius Wilhelmina Hospital Nijmegen The Netherlands
| | - Melissa S. Battjes
- Department of Health Technology and Services Research, Technical Medical Center University of Twente Enschede
| | | | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Center University of Twente Enschede
- Department of Research and Development Netherlands Comprehensive Cancer Organisation Utrecht The Netherlands
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Brain D, Jadambaa A. Economic Evaluation of Long-Term Survivorship Care for Cancer Patients in OECD Countries: A Systematic Review for Decision-Makers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111558. [PMID: 34770070 PMCID: PMC8582644 DOI: 10.3390/ijerph182111558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 01/23/2023]
Abstract
Long-term cancer survivorship care is a crucial component of an efficient healthcare system. For numerous reasons, there has been an increase in the number of cancer survivors; therefore, healthcare decision-makers are tasked with balancing a finite budget with a strong demand for services. Decision-makers require clear and pragmatic interpretation of results to inform resource allocation decisions. For these reasons, the impact and importance of economic evidence are increasing. The aim of the current study was to conduct a systematic review of economic evaluations of long-term cancer survivorship care in Organization for Economic Co-operation and Development (OECD) member countries and to assess the usefulness of economic evidence for decision-makers. A systematic review of electronic databases, including MEDLINE, PubMed, PsycINFO and others, was conducted. The reporting quality of the included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Each included study’s usefulness for decision-makers was assessed using an adapted version of a previously published approach. Overall, 3597 studies were screened, and of the 235 studies assessed for eligibility, 34 satisfied the pre-determined inclusion criteria. We found that the majority of the included studies had limited value for informing healthcare decision-making and conclude that this represents an ongoing issue in the field. We recommend that authors explicitly include a policy statement as part of their presentation of results.
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Wischnewsky M, Schwentner L, Diessner J, de Gregorio A, Joukhadar R, Davut D, Salmen J, Bekes I, Kiesel M, Müller-Reiter M, Blettner M, Wolters R, Janni W, Kreienberg R, Wöckel A, Ebner F. BRENDA-Score, a Highly Significant, Internally and Externally Validated Prognostic Marker for Metastatic Recurrence: Analysis of 10,449 Primary Breast Cancer Patients. Cancers (Basel) 2021; 13:cancers13133121. [PMID: 34206581 PMCID: PMC8268855 DOI: 10.3390/cancers13133121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The BRENDA-Score provides an easy to use tool for clinicians to estimate the risk of recurrence in primary breast cancer. The algorithm has been validated via a second independent database and provides five recurrence risk groups. This grouping helps clinicians to encourage high risk patients to undergo the recommended treatment. Abstract Background Current research in breast cancer focuses on individualization of local and systemic therapies with adequate escalation or de-escalation strategies. As a result, about two-thirds of breast cancer patients can be cured, but up to one-third eventually develop metastatic disease, which is considered incurable with currently available treatment options. This underscores the importance to develop a metastatic recurrence score to escalate or de-escalate treatment strategies. Patients and methods Data from 10,499 patients were available from 17 clinical cancer registries (BRENDA-project. In total, 8566 were used to develop the BRENDA-Index. This index was calculated from the regression coefficients of a Cox regression model for metastasis-free survival (MFS). Based on this index, patients were categorized into very high, high, intermediate, low, and very low risk groups forming the BRENDA-Score. Bootstrapping was used for internal validation and an independent dataset of 1883 patients for external validation. The predictive accuracy was checked by Harrell’s c-index. In addition, the BRENDA-Score was analyzed as a marker for overall survival (OS) and compared to the Nottingham prognostic score (NPS). Results: Intrinsic subtypes, tumour size, grading, and nodal status were identified as statistically significant prognostic factors in the multivariate analysis. The five prognostic groups of the BRENDA-Score showed highly significant (p < 0.001) differences regarding MFS:low risk: hazard ratio (HR) = 2.4, 95%CI (1.7–3.3); intermediate risk: HR = 5.0, 95%CI.(3.6–6.9); high risk: HR = 10.3, 95%CI (7.4–14.3) and very high risk: HR = 18.1, 95%CI (13.2–24.9). The external validation showed congruent results. A multivariate Cox regression model for OS with BRENDA-Score and NPS as covariates showed that of these two scores only the BRENDA-Score is significant (BRENDA-Score p < 0.001; NPS p = 0.447). Therefore, the BRENDA-Score is also a good prognostic marker for OS. Conclusion: The BRENDA-Score is an internally and externally validated robust predictive tool for metastatic recurrence in breast cancer patients. It is based on routine parameters easily accessible in daily clinical care. In addition, the BRENDA-Score is a good prognostic marker for overall survival. Highlights: The BRENDA-Score is a highly significant predictive tool for metastatic recurrence of breast cancer patients. The BRENDA-Score is stable for at least the first five years after primary diagnosis, i.e., the sensitivities and specificities of this predicting system is rather similar to the NPI with AUCs between 0.76 and 0.81 the BRENDA-Score is a good prognostic marker for overall survival.
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Affiliation(s)
- Manfred Wischnewsky
- FB Mathematik u. Informatik, Universität Bremen, Bibliothekar. 1, 28359 Bremen, Germany; (M.W.); (R.W.)
| | - Lukas Schwentner
- Frauenklinik Universität Ulm, Prittwitzstr. 43, 89081 Ulm, Germany; (L.S.); (A.d.G.); (D.D.); (I.B.); (W.J.); (R.K.)
| | - Joachim Diessner
- Universitätsfrauenklinik Würzburg, Josef-Schneider-Str. 4, 97080 Würzburg, Germany; (J.D.); (R.J.); (J.S.); (M.K.); (M.M.-R.); (A.W.)
| | - Amelie de Gregorio
- Frauenklinik Universität Ulm, Prittwitzstr. 43, 89081 Ulm, Germany; (L.S.); (A.d.G.); (D.D.); (I.B.); (W.J.); (R.K.)
| | - Ralf Joukhadar
- Universitätsfrauenklinik Würzburg, Josef-Schneider-Str. 4, 97080 Würzburg, Germany; (J.D.); (R.J.); (J.S.); (M.K.); (M.M.-R.); (A.W.)
| | - Dayan Davut
- Frauenklinik Universität Ulm, Prittwitzstr. 43, 89081 Ulm, Germany; (L.S.); (A.d.G.); (D.D.); (I.B.); (W.J.); (R.K.)
| | - Jessica Salmen
- Universitätsfrauenklinik Würzburg, Josef-Schneider-Str. 4, 97080 Würzburg, Germany; (J.D.); (R.J.); (J.S.); (M.K.); (M.M.-R.); (A.W.)
| | - Inga Bekes
- Frauenklinik Universität Ulm, Prittwitzstr. 43, 89081 Ulm, Germany; (L.S.); (A.d.G.); (D.D.); (I.B.); (W.J.); (R.K.)
| | - Matthias Kiesel
- Universitätsfrauenklinik Würzburg, Josef-Schneider-Str. 4, 97080 Würzburg, Germany; (J.D.); (R.J.); (J.S.); (M.K.); (M.M.-R.); (A.W.)
| | - Max Müller-Reiter
- Universitätsfrauenklinik Würzburg, Josef-Schneider-Str. 4, 97080 Würzburg, Germany; (J.D.); (R.J.); (J.S.); (M.K.); (M.M.-R.); (A.W.)
| | - Maria Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin Mainz, 55131 Mainz, Germany;
| | - Regine Wolters
- FB Mathematik u. Informatik, Universität Bremen, Bibliothekar. 1, 28359 Bremen, Germany; (M.W.); (R.W.)
| | - Wolfgang Janni
- Frauenklinik Universität Ulm, Prittwitzstr. 43, 89081 Ulm, Germany; (L.S.); (A.d.G.); (D.D.); (I.B.); (W.J.); (R.K.)
| | - Rolf Kreienberg
- Frauenklinik Universität Ulm, Prittwitzstr. 43, 89081 Ulm, Germany; (L.S.); (A.d.G.); (D.D.); (I.B.); (W.J.); (R.K.)
| | - Achim Wöckel
- Universitätsfrauenklinik Würzburg, Josef-Schneider-Str. 4, 97080 Würzburg, Germany; (J.D.); (R.J.); (J.S.); (M.K.); (M.M.-R.); (A.W.)
| | - Florian Ebner
- Frauenklinik Universität Ulm, Prittwitzstr. 43, 89081 Ulm, Germany; (L.S.); (A.d.G.); (D.D.); (I.B.); (W.J.); (R.K.)
- Helios Amper Klinikum Dachau, Krankenhausstr. 15, 85221 Dachau, Germany
- Correspondence:
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