Routine follow-up examinations in breast cancer patients have minimal impact on life expectancy: A simulation study

Background: Little is known about the effects of routine follow-up examinat ions on life expectancy in cancer patients. Lately, the benefits of follow- up examinations have been debated, which has given rise to less extensive, though still frequent, follow-up strategies. In this study, a simulation mo del was applied to evaluate the impact of different follow-up strategies on life expectancy in breast cancer patients. Materials and methods: A five-state Markov chain model was developed, with which various follow-up strategies with regard to frequency and elaboratene ss were simulated. Calculations were based on a hypothetical population of breast cancer patients treated with curative intent. Medical aspects were s tudied, such as life expectancy and the proportion of patients who died fro m breast cancer. Social and psychological aspects and quality of life were not taken into account. Data from the literature were used to estimate the parameters needed for the model. Results: The gain in life expectancy with standard follow-up compared to no follow-up examination, was about 2 months in breast cancer patients aged 5 0 years treated with curative intent. The percentage of patients who died f rom breast cancer was 45.4% with standard follow-up, versus 45.8% without f ollow-up. In older women, the gain was even less. Sensitivity analyses show ed that the effects on life expectancy were robust. Conclusions: Our model showed that standard follow-up had minimal impact on the prognosis of breast cancer patients. It may be unnecessary to continue standard follow-up by medical specialists after the end of the surveillanc e period of the primary therapy, provided that the patients continue to hav e easy access to health care facilities in the case of symptoms or concern. However, future research is needed to study quality of life aspects of fol low-up.