Zinnige Zorg room for improvement report - Appropriate post-treatment surveillance of women treated for breast cancer

Within the framework of the Zinnige Zorg Programme, the National Health Care Institute systematically assesses the Dutch minimal and mandatory package of health care that all Dutch health care insurers must. There are four phases to this systematic assessment: screening, in-depth assessment, implementation and monitoring. In 2015 we published a screening report: Systematic analysis of neoplasms. One of the topics mentioned in response to this screening and which is eligible for in-depth study is Appropriate post-treatment surveillance of women treated for breast cancer. The aim of the in-depth phase is to map the potential for improving after-care (the period following primary treatment). We engaged external parties to carry out research into possibilities for designing post-treatment surveillance, which is part of after-care. We describe current care practice based on eight elements of good and appropriate care. Where lacunas exist, there is room for improvement.

Room for Improvement Report

We conclude that room exists for improving post-treatment surveillance for women treated for curable forms of breast cancer. A more appropriate design of post-treatment surveillance is necessary for a more appropriate interpretation of after-care in a broader sense. It is important that post-treatment surveillance is in line with the actual individual risk of a locoregional recurrence. This creates room for other topics such as coping with the consequences patients can expect after treatment has ended and they return to their everyday lives. Research shows that designing after-care more appropriately is possible by supplying individualised post-treatment surveillance based on:

  1. risk stratification and
  2. providing good information and shared decision-making

Zinnige Zorg (Appropriate Care)

The motto of the National Health Care Institute is "Taking care of good health care: no more and no less than necessary". Every citizen must be able to count on receiving good health care. No more and no less than is necessary, while also avoiding unnecessary costs.
As a public organisation, the National Health Care Institute assesses health care systematically. We assess whether diagnostics and (therapeutic) interventions are being deployed in a patient-oriented, effective and cost-effective manner. We do these analysis within the framework of the 'Zinnige Zorg' (Appropriate Care) programme of the National Health Care Institute.

This report is a summary of recommendations by the National Health Care Institute. The original text is in Dutch.