Tailoring fellow-up in early-stage breastcancer

Hezewijk, M. van (2015)

Doctoral Thesis

In this thesis the feasibility of tailored follow-up for early-stage breast cancer patients is evaluated. In order to do so, we first determined the risk of locoregional recurrence (LRR) dependent on local treatment in a large cohort of low-risk breast cancer patients, treated with adequate modern systemic therapy. In the second part we evaluated both patients__ and professionals__ needs and preferences for breast cancer follow-up and we reviewed the literature on cost effectiveness of known follow-up schedules. Finally we prospectively examined whether the implementation of a tailored follow-up programme, based on a prognostic index for LRR, is feasible and acceptable to patients and professionals. The results show that in general, implementation of minimised tailored follow-up seems feasible, but professionals tend to more frequent follow-up. Patients accept less intensive follow-up schedules and follow-up by a nurse practitioner. Given the low risk of LRR, tailoring should not only be done based on this risk, but individually, based on the presence of treatment related side effects, either physical or psychosocial. If patients do not experience side effects, annual planned mammography and telephone contact coordinated by a single professional, preferably a specialised nurse, suffice in case of easily accessible information and on demand visits.

• Tailored care
• Costs
• Pati_nts
• Professionals
• Locoregional recurrence
• Follow-up
• Breast cancer

• All authors: Hezewijk, M. van
• Supervisor: Marijnen, C.A.M.; Velde, C.J.H. van de
• Co-supervisor: Scholten, A.N.
• Qualification: Doctor (dr.)
• Awarding Institution: Department Radiotherapy, Faculty of Medicine (LUMC), Leiden University
• Date: 2015-05-13
• ISBN (print): 9789462596139
• Sponsorship: The research in this thesis was financially supported the Dutch Cancer Society (project number UL 2008-4192) and Pfizer B.V. Financial support for the printing of this thesis was provided by the Bontius Stichting Doelfonds Klinische Oncologie, Pfizer B.V., Chipsoft B.V., Toshiba Medical Systems Nederland, and Elekta B.V.