Stratified Breast Cancer Follow-Up Using a Partially Observable MDP
Stratified Breast Cancer Follow-Up Using a Partially Observable MDP
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DOI：
10.1007/978-3-319-47766-4_7
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发表时间：
2017-01-01
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影响因子：
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通讯作者：
IJzerman, M. J.
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文献类型：
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作者：
Otten, J. W. M.;Witteveen, A.;IJzerman, M. J.
乳腺癌患者的随访频率和持续时间仍在讨论中。目前的随访包括治疗后前五年的年度乳房X光检查，并且不依赖于发生局部复发（LRR）或第二原发肿瘤的个人风险。本研究的目的是深入了解如何分配资源的最佳和个人的后续行动。我们制定了一个离散时间部分可观测马尔可夫决策过程（POMDP）与有限的地平线，我们的目标是最大限度地提高预期的总数量的质量调整生命年（QELS）。转移概率来自荷兰癌症登记处（NCR）的数据。每年两次决定是否进行乳房X光检查。复发性疾病可以通过乳房X光检查或妇女自己（自我检测）来检测。根据原发肿瘤的分化程度，确定了三种风险类别的最佳策略。我们的研究结果表明，对高风险和低分化肿瘤患者的随访时间稍长，而对其他风险组的随访时间较短。
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 horizon 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.