Stratified breast cancer follow-up using a partially observable MDP

J.W.M. Otten, Annemieke Witteveen, Ingrid Vliegen, Sabine Siesling, Judith B. Timmer, Maarten J. IJzerman

    Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review

    3 Citations (Scopus)

    Abstract

    Frequency and duration of follow-up for patients with breast cancer is still under discussion. Current follow-up consists of annual mammography for the first five years after treatment and does not depend on the personal risk of developing a locoregional recurrence (LRR) or second primary tumor. Aim of this study is to gain insight in how to allocate resources for optimal and personal follow-up. We formulate a discrete-time Partially Observable Markov Decision Process (POMDP) with a finite horzion in which we aim to maximize the total expected number of quality-adjusted life years (QALYs). Transition probabilities were obtained from data from the Netherlands Cancer Registry (NCR). Twice a year the decision is made whether or not a mammography will be performed. Recurrent disease can be detected by both mammography or women themselves (self-detection). The optimal policies were determined for three risk categories based on differentiation of the primary tumor. Our results suggest a slightly more intensive follow-up for patients with a high risk and poorly differentiated tumor, and a less intensive schedule for the other risk groups.
    Original languageEnglish
    Title of host publicationMarkov decision processes in practice
    EditorsRichardus J. Boucherie, Nico van Dijk
    Place of PublicationCham
    PublisherSpringer
    Pages223-244
    Number of pages22
    ISBN (Print)978-3-319-47764-0
    DOIs
    Publication statusPublished - 1 Mar 2017

    Publication series

    NameInternational Series in Operations Research & Management Science
    PublisherSpringer International Publishing
    Volume248

    Keywords

    • EWI-27869, Partially observable markov decision process, Breast cancer, Optimal policies, IR-104507, Stratified follow-up

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