title: Evaluation of nonlinear optimization for scheduling of follow-up cystoscopies to detect recurrent bladder cancer. The Bladder Cancer follow-up Group.
abstract: Standard recommendations for patients who have had superficial bladder cancer are inspection by cystoscopy quarterly for a year or two after tumor removal, then half-yearly and yearly. The authors assessed the potential for improvement in scheduling cystoscopies according to probabilistic optimization techniques. Eight hypothetical practices were created, based on retrospective analysis of 918 bladder-cancer-patient charts. Standard and alternative recommendations for the interval to next cystoscopy were compared. The alternatives were derived from patient-specific predictions of future tumor risks (based on the patient's prior recurrence rate and tumor stage and grade) and a nonlinear optimization approach to allocation of the same number of cystoscopies as were available for standard follow-up. The optimization proposed longer intervals between visits for low-risk patients and shorter intervals for high-risk patients. Overall, optimization reduced expected tumor detection delays by 30%, from 12.6 to 8.7 weeks. When optimization intervals were shorter than standard, cancer was found more often at subsequent cystoscopies (34% vs 27%, p less than 0.05), suggesting that the optimization was a better predictor of cancer recurrence. If reduction in tumor-detection delay is the goal of follow-up for recurrent cancers, then urologists can improve monitoring by using probabilistic optimization methods for scheduling cystoscopies. Further understanding of the accuracy of predictive models for bladder-cancer recurrence rates is desirable. Subsequently, the optimization method developed here may be tested prospectively.
authors.affiliation: VA Medical Center, Seattle, WA 98108.
authors.forename: D L
authors.initials: DL
authors.lastname: Kent
authors.forename: R A
authors.initials: RA
authors.lastname: Nease
authors.forename: H C
authors.initials: HC
authors.lastname: Sox
authors.forename: L D
authors.initials: LD
authors.lastname: Shortliffe
authors.forename: R
authors.initials: R
authors.lastname: Shachter
mesh_terms: D000359:Aftercare / Q000592:standards*; D000368:Aged; D001071:Appointments and Schedules; D003558:Cystoscopy / Q000592:standards*; D003661:Decision Support Techniques; D005069:Evaluation Studies as Topic; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control