Sunday , November 29 2020

Breast cancer monitoring can be much less and more customized



& # 39; More Customized & # 39;

The compensation may be offered more tailored to the risk of a recurrence of the disease, so that low-risk women may need to go to the hospital on a chest regularly (mammography). The accompanying instructions prevent unnecessary burden on both the patient, the care provider and the health care budget. For example, high-risk patients can gain more control if necessary. Patients with lower risk, after proper consultation between a doctor and a patient, require less visits.

Treatments are getting better

In the Netherlands, almost 50 women say they have breast cancer and this number is increasing. By contrast, the number of women dying from breast cancer is decreasing. This is because the treatment improves and because it has been detected earlier. After treatment for breast cancer, women risk getting the disease back. This is called repetition. Within ten years after treatment, about 4% of women will experience recurrence in the same breast, and about 5% will develop a new tumor in the second breast. The purpose of monitoring is to find recurrence as soon as possible, because the outcomes for the patient are better.

Difference at risk of return

Although more and more personalization (by order) takes place in the treatment of breast cancer, this is not the case with continuation: it continues to be based on consensus and is not adapted to the real risk the patient has. Vitteveen: "At this point, a subsequent review of breast cancer is the same for all in the first five years, an annual mammogram and a physical examination .After five years, monitoring according to the current guidelines depends on the age of the patient, but there is a difference in the risk of breast cancer returns per patient It would be more logical for low-risk women to check less frequently, and high-risk women can be checked for more than five years.

Tension and uncertainty

The study showed that women with higher risk were subjected to even less monitoring than women with lower risk. At present, about half of the repetition is found by women, and not during monitoring. Although it can be subsequently verified, passing the mammogram is unpleasant, and subsequent checks also provide tension and uncertainty. So, when women have very little risk, they are actually unnecessarily burdened. In addition, service providers are also charged and there are costs related to monitoring, also for the patient. Mirjam Velting, program manager at the Breast Cancer Association in the Netherlands: "Observation visits are not always necessary from the medical point of view, it almost never talks to the patient, and that is the moment of choosing between the patient and the patient."

Manage subsequent checks

It is therefore important to optimize monitoring based on a personal risk of re-emergence. In order to determine the risk of re-behavior, the Dutch Carcinoma Carcinoma Register (NKR) was used. Almost all new cancer cases have been registered since 1989 in the NKR. The database used for the study was made up of almost 50,000 women. Together with the Dutch Comprehensive Cancer Center (IKNL) and health care providers, Vitteveen has developed an INOGLUENCE nomogram to identify the risk of recurrence.

Profile of risk

In his research, Vitteveen also shows that breast cancer monitoring can be optimized based on the risk of recurrence for any possible risk profile, taking into account the benefits of early detection and tracking deficiencies, such as discomfort and tension. With this model, doctors can make informed decisions together with the patient. For example, high-risk women can gain more control if needed, and lower-risk patients will be spared unnecessary ex-post visits.

Model

Prof. dr. Siesling, one of the promoters of Vitteveen: Together with care providers, associating with the National Breast Cancer Consulting in the Netherlands (NABON), nurses, GPs and the Breast Cancer Association, we are considering how this model can best be developed and applied in everyday practice. Both of the calculations, risk presentation in an understandable way, as well as the organization, at what time and with whom do you talk about risk. In addition, monitoring is just one component of post-care, which also includes psychosocial complaints, for example. "


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