Publications by authors named "Mieke J Aarts"

39 Publications

ASO Visual Abstract: Non-small Cell Lung Cancer Patients with a High Predicted Risk of Irradical Resection-can Chemoradiotherapy Offer Similar Survival?

Ann Surg Oncol 2021 Nov 20. Epub 2021 Nov 20.

Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.

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http://dx.doi.org/10.1245/s10434-021-11061-3DOI Listing
November 2021

Trends and variations in the treatment of stage I-III small cell lung cancer from 2008 to 2019: A nationwide population-based study from the Netherlands.

Lung Cancer 2021 Oct 28;162:61-70. Epub 2021 Oct 28.

Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands.

Objectives: Recent treatment patterns for small cell lung cancer (SCLC) in the Netherlands were unknown. This nationwide population-based study describes trends and variations in the treatment of stage I-III SCLC in the Netherlands over the period 2008-2019.

Materials And Methods: Patients were selected from the population-based Netherlands Cancer Registry. Treatments were studied stratified for clinical stage. In stage II-III, factors associated with the use of concurrent (cCRT) versus sequential chemoradiation (sCRT) and accelerated versus conventionally fractionated radiotherapy in the context of cCRT were identified.

Results: In stage I (N = 535), 29% of the patients underwent surgery in 2008-2009 which increased to 44% in 2018-2019. Combined use of chemotherapy and radiotherapy decreased in stage I from 47% to 15%, remained constant (64%) in stage II (N = 472), and increased from 57% (2008) to 70% (2019) in stage III (N = 5,571). Use of cCRT versus sCRT in stage II-III increased over time (odds ratio (OR) : 0.53 (95%-confidence interval (95%CI): 0.41-0.69)) and was strongly associated with lower age, WHO performance status 0, and diagnosis in a hospital with in-house radiotherapy. Forty-six percent of patients with stage III received cCRT in 2019. Until 2012, concurrent radiotherapy was mainly conventionally fractionated, thereafter a hyperfractionated accelerated scheme was administered more frequently (57%). Accelerated radiotherapy was strongly associated with geographic region (OR: 4.13 (95%CI: 3.00-5.70)), WHO performance (OR: 0.50 (95%CI: 0.35-0.71)), and radiotherapy facilities treating ≥ 16 vs < 16 SCLC patients annually (OR: 3.01 (95%CI: 2.38-3.79)).

Conclusions: The use of surgery increased in stage I. In stages II and III, the use of cCRT versus sCRT increased over time, and since 2012 most radiotherapy in cCRT was accelerated. Treatment regimens and radiotherapy fractionation schemes varied between patient groups, regions and hospitals. Possible unwarranted treatment variation should be countered.
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http://dx.doi.org/10.1016/j.lungcan.2021.10.011DOI Listing
October 2021

Non-Small-Cell Lung Cancer Patients with a High Predicted Risk of Irradical Resection: Can Chemoradiotherapy Offer Similar Survival?

Ann Surg Oncol 2021 Oct 30. Epub 2021 Oct 30.

Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.

Purpose: Irradical resection of non-small-cell lung cancer (NSCLC) is a detrimental prognostic factor. Recently, Rasing et al. presented an internationally validated risk score for pre-treatment prediction of irradical resection. We hypothesized that chemoradiation therapy (CRT) could serve as an alternative approach in patients with a high risk score and compared overall survival (OS) outcomes between surgery and CRT.

Methods: Patients from a population-based cohort with stage IIB-III NSCLC between 2015 and 2018 in The Netherlands were selected. Patients with a 'Rasing score' > 4 who underwent surgery were matched with patients who underwent CRT using 1:1 nearest-neighbor propensity score matching. The primary endpoint of OS was compared using a Kaplan-Meier analysis.

Results: In total, 2582 CRT and 638 surgery patients were eligible. After matching, 523 well-balanced pairs remained. Median OS in the CRT group was 27.5 months, compared with 45.6 months in the surgery group (HR 1.44, 95% CI 1.23-1.70, p < 0.001). The 114 surgical patients who underwent an R1-2 resection (21.8%) had a worse median OS than the CRT group (20.2 versus 27.5 months, HR 0.77, 95% CI 0.61-0.99, p = 0.039).

Conclusion: In NSCLC patients at high predicted risk of irradical resection, CRT appears to yield inferior survival compared with surgery. Therefore, choosing CRT instead of surgery cannot solely be based on the Rasing score. Since patients receiving an R1-2 resection do have detrimental outcomes compared with primary CRT, the treatment decision should be based on additional information, such as imaging features, comorbidities, patient preference, and the surgeon's confidence in achieving an R0 resection.
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http://dx.doi.org/10.1245/s10434-021-10982-3DOI Listing
October 2021

Adjuvant Treatment Following Irradical Resection of Stage I-III Non-small Cell Lung Cancer: A Population-based Study.

Curr Probl Cancer 2021 Aug 14:100784. Epub 2021 Aug 14.

Department of Radiation Oncology, The Netherlands, University Medical Center Utrecht. Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address:

Irradical (R1-2) resection for non-small cell lung cancer (NSCLC) is associated with a dismal prognosis. Adjuvant treatment attempts to improve survival outcomes, but evidence on the optimal strategy is limited. The purpose of this study was to compare overall survival (OS) between different adjuvant treatment strategies in these patients. Out of 8,528 patients with newly diagnosed NSCLC from 2015-2018, those with an R1-2 resection were identified from the Netherlands Cancer Registry. First, OS was compared between adjuvant treatment groups 'no therapy', 'radiotherapy (RT) only', 'chemotherapy only', and 'chemo- and radiotherapy (CRT)' using multinomial propensity score-weighted Cox regression analysis. Second, three 1:1 propensity score-matched sets were created for chemotherapy vs no chemotherapy, RT only vs no therapy, and CRT vs chemotherapy only. Kaplan-Meier and Cox regression analyses for OS were performed in each set. With a median follow-up of 23 months, 427 patients were selected. In the weighted regression analysis, compared to no adjuvant therapy, chemotherapy and CRT were associated with improved OS (HR 0.41, 95%CI: 0.22-0.76; and HR 0.55, 95%CI: 0.37-0.81, respectively), whereas RT was not (HR 1.04, 95%CI: 0.73-1.50). In the matched sets, OS was improved after chemotherapy (+/- RT) compared to no chemotherapy (HR 0.47, 95%CI: 0.32-0.69). No OS difference was observed between matched groups of RT only vs no adjuvant therapy (HR 1.13, 95%CI: 0.74-1.72), nor for CRT vs chemotherapy only (HR 1.37, 95%CI: 0.70-2.71). Adjuvant chemotherapy, but not radiotherapy, improves survival after an R1-2 resection in stage I-III NSCLC.
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http://dx.doi.org/10.1016/j.currproblcancer.2021.100784DOI Listing
August 2021

Use of potentially inappropriate medication in older patients with lung cancer at the end of life.

J Geriatr Oncol 2021 Aug 5. Epub 2021 Aug 5.

Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), PO box 19079, Utrecht 3501 DB, the Netherlands; Netherlands Association for Palliative Care (PZNL), PO box 19079, Utrecht 3501 DB, the Netherlands.

Objectives: Medications at the end of life should be used for symptom control. Medications which potential adverse effects outweigh their expected benefits are called 'potentially inappropriate medications' (PIMs). PIMs are related with adverse drug events and reduced quality of life. In this study, we investigated to what extent PIMs are dispensed to older patients with lung cancer in the last month of life.

Methods: We selected patients with lung cancer, aged 65+, diagnosed between 2009 and 2014, and who died before April 1st 2015 from the population-based Netherlands Cancer Registry (NCR). The NCR is linked to the PHARMO Database Network, that includes medications dispensed by community pharmacies in the Netherlands. The eight PIM groups were based on the OncPal Deprescribing Guideline: aspirin, dyslipidaemia medications, antihypertensives, osteoporosis medications, peptic ulcer prophylaxis, oral hypoglycaemics, vitamins and minerals.

Results: Data of 7864 patients with lung cancer were analyzed. Median age was 74 year (IQR = 70-79) and 67% was male. 45% of all patients received at least one PIM in their last month of life. Taking into account all dispensed medications, patients receiving PIMs received more different medications compared to those receiving no PIMs, respectively 10 (SD = 5) vs. 3 (SD = 4) different medications (P < 0.001).

Conclusion: Almost half of the older patients with lung cancer in the Netherlands received PIMs in their last month of life. Since PIM use is associated with reduced quality of life, it is important that health care professionals continue to critically assess which medication can be discontinued at the end of life.
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http://dx.doi.org/10.1016/j.jgo.2021.07.009DOI Listing
August 2021

The psychosocial impact of living with mesothelioma: Experiences and needs of patients and their carers regarding supportive care.

Eur J Cancer Care (Engl) 2021 Nov 2;30(6):e13498. Epub 2021 Aug 2.

Department of Research & Development, Netherlands Comprehensive Cancer Organization (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands.

Objective: Mesothelioma is a rare cancer with a poor prognosis caused by exposure to asbestos. Psychosocial support and care for mesothelioma patients and their carers is limited and not tailored to their specific needs. The aim of this study was to explore patients' and carers' needs and experiences regarding psychosocial support and their coping mechanisms dealing with psychosocial problems.

Methods: A qualitative study was performed using semi-structured interviews with both mesothelioma patients and their carers. Participants were recruited through two specialised hospitals and two patient organisations. All interviews were transcribed verbatim and thematically analysed.

Results: Ten patients (70% male, mean age 67.7) and five carers (20% male, mean age 65) participated in the study. The main themes identified for patients were active coping, limited needs and limited knowledge and awareness about psychosocial support. The main themes for carers were passive coping and 'it's all about the patient'.

Conclusion: Mesothelioma patients do not seem to have high needs for psychosocial support, whereas carers do. However, knowledge about and awareness of psychosocial support is low among mesothelioma patients. The findings from this study should be used to adjust guidelines for psychosocial support in mesothelioma patients and their carers.
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http://dx.doi.org/10.1111/ecc.13498DOI Listing
November 2021

Trends and variations in treatment of stage I-III non-small cell lung cancer from 2008 to 2018: A nationwide population-based study from the Netherlands.

Lung Cancer 2021 05 20;155:103-113. Epub 2021 Mar 20.

Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands. Electronic address:

Introduction: This Dutch population-based study describes nationwide treatment patterns and its variations for stage I-III non-small cell lung cancer (NSCLC).

Materials And Methods: Patients diagnosed with clinical stage I-III NSCLC in the period 2008-2018 were selected from the Netherlands Cancer Registry. Treatment trends were studied over time and age groups. Use of radiotherapy versus surgery (stage I-II), and concurrent versus sequential chemoradiotherapy (stage III) were analyzed by logistic regression.

Results: In stage I, the rate of surgery decreased from 58 % (2008) to 40 % (2018) while radiotherapy use increased over time (from 31 % to 52 %), which mostly concerned stereotactic body radiotherapy (74 %). In stage II, 54 % of patients received surgery, and use of radiotherapy alone increased from 18 % to 25 %. The strongest factors favoring radiotherapy over surgery were WHO performance status (OR ≥ 2 vs 0: 23.39 (95% CI: 18.93-28.90)), increasing age (OR ≥ 80 vs <60 years: 14.52 (95% CI: 13.02-16.18)) and stage (OR stage II vs I: 0.61 (95% CI: 0.57-0.65)). In stage III, the combined use of chemotherapy and radiotherapy increased from 35 % (2008) to 39 % (2018). In all years, 23 % received concurrent chemoradiotherapy, 9 % sequential chemoradiotherapy, 23 % radiotherapy or chemotherapy alone, and 25 % best supportive care. The strongest factors favoring concurrent over sequential chemoradiotherapy were age (OR ≥ 80 vs <60 years: 0.14 (95% CI: 0.10-0.19)), WHO Performance status (OR ≥ 2 vs 0: 0.33 (95% CI: 0.24-0.47)) and region (OR east vs north: 0.39 (95% CI: 0.30-0.50)).

Conclusions: The use of radiotherapy became more prominent over time in stage I NSCLC. Combined use of chemotherapy and radiotherapy marginally increased in stage III: only one third of patients received chemoradiotherapy, mainly concurrently. Treatment variation seen between patient groups suggests tailored treatment decision, while variation between hospitals and regions indicate differences in clinical practice.
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http://dx.doi.org/10.1016/j.lungcan.2021.03.013DOI Listing
May 2021

Synchronous peritoneal metastases from lung cancer: incidence, associated factors, treatment and survival: a Dutch population-based study.

Clin Exp Metastasis 2021 06 18;38(3):295-303. Epub 2021 Mar 18.

Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.

Peritoneal metastases (PM) from lung cancer are rare and it is unknown how they affect the prognosis of patients with lung cancer. This population-based study aimed to assess the incidence, associated factors, treatment and prognosis of PM from lung cancer. Data from the Netherlands Cancer Registry were used. All patients diagnosed with lung cancer between 2008 and 2018 were included. Logistic regression analysis was performed to identify factors associated with the presence of PM. Cox regression analysis was performed to identify factors associated with the overall survival (OS) of patients with PM. Between 2008 and 2018, 129,651 patients were diagnosed with lung cancer, of whom 2533 (2.0%) patients were diagnosed with PM. The European Standardized Rate of PM increased significantly from 0.6 in 2008 to 1.4 in 2018 (p < 0.001). Age between 50 and 74 years, T3-4 tumour stage, N2-3 nodal stage, tumour morphology of a small cell lung cancer or adenocarcinoma, and the presence of systemic metastases were associated with the presence of PM. The median OS of patients with PM was 2.5 months. Older age, male sex, T3-4 tumour stage, N2-3 nodal stage, not receiving systemic treatment, and the presence of systemic metastases were associated with a worse OS. Synchronous PM were diagnosed in 2.0% of patients with lung cancer and resulted in a very poor survival.
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http://dx.doi.org/10.1007/s10585-021-10085-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8179897PMC
June 2021

Prophylactic cranial irradiation in patients with small cell lung cancer in The Netherlands: A population-based study.

Clin Transl Radiat Oncol 2021 Mar 12;27:157-163. Epub 2021 Feb 12.

Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.

Introduction: Controversy has arisen regarding the benefit of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC), particularly since the 2017 Takahashi trial publication that supports MRI surveillance in extensive-stage (ES-)SCLC. The primary aim of this study was to assess trends and determinants in PCI use over the years 2010-2018. A secondary aim was to determine contemporary practice considerations among radiation oncologists (ROs).

Methods: A nationwide population-based cohort study was conducted using the Netherlands Cancer Registry data on all newly diagnosed SCLC patients (2010-2018). The change in PCI frequency over the years and determinants for PCI were analyzed using logistic regression models. Second, an online survey was performed among Dutch lung cancer ROs in 2020.

Results: Among 10,264 eligible patients, 4,894 (47%) received PCI. Compared to 2010-2014, PCI use significantly decreased in 2017-2018 in ES-SCLC (OR 0.68, 95%CI 0.60-0.77) and LS-SCLC (OR 0.56, 95%CI 0.47-0.67). Incidence year, age, performance status, and thoracic radiotherapy were independent determinants for PCI. Among 41 survey participants, PCI was recommended always/sometimes/never by 22%/71%/7% in ES-SCLC and 54%/44%/2% in LS-SCLC. For ES-SCLC and LS-SCLC, 63% and 25% of ROs, respectively, confirmed influence of the Takahashi trial on PCI recommendations. Denial of such influence was associated with insufficient institutional MRI capacity.

Conclusions: A significant declining trend of PCI use in both ES-SCLC and LS-SCLC was observed in The Netherlands since 2017. The Takahashi trial seems an explanation for this trend even in LS-SCLC, with differential influence of the trial depending on institutional MRI capacity. An alarming increase in practice variation regarding PCI was found which stresses the importance of ongoing trials.
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http://dx.doi.org/10.1016/j.ctro.2021.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903055PMC
March 2021

Lung Cancer in the Netherlands.

J Thorac Oncol 2021 03;16(3):355-365

Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1016/j.jtho.2020.10.012DOI Listing
March 2021

Trends in mediastinal nodal staging and its impact on unforeseen N2 and survival in lung cancer.

Eur Respir J 2021 04 1;57(4). Epub 2021 Apr 1.

Dept of Surgery, Máxima MC, Veldhoven, The Netherlands

Introduction: Guidelines for invasive mediastinal nodal staging in resectable nonsmall cell lung cancer (NSCLC) have changed over the years. The aims of this study were to describe trends in invasive staging and unforeseen N2 (uN2) and to assess a potential effect on overall survival.

Methods: A nationwide Dutch cohort study included all clinical stage IA-IIIB NSCLC patients primarily treated by surgical resection between 2005 and 2017 (n=22 555). We assessed trends in invasive nodal staging (mediastinoscopy 2005-2017; endosonography 2011-2017), uN2 and overall survival and compared outcomes in the entire group and in clinical nodal stage (cN)1-3 patients with or without invasive staging.

Results: An overall increase in invasive nodal staging from 26% in 2005 to 40% in 2017 was found (p<0.01). Endosonography increased from 19% in 2011 to 32% in 2017 (p<0.01), while mediastinoscopy decreased from 24% in 2011 to 21% in 2017 (p=0.08). Despite these changes, uN2 was stable over the years at 8.7%. 5-year overall survival rate was 41% for pN1 compared to 37% in single node uN2 (p=0.18) and 26% with more than one node uN2 (p<0.01). 5-year overall survival rate of patients with cN1-3 with invasive staging was 44% 39% in patients without invasive staging (p=0.12).

Conclusion: A significant increase in invasive mediastinal nodal staging in patients with resectable NSCLC was found between 2011 and 2017 in the Netherlands. Increasing use of less invasive endosonography prior to (or as a substitute for) surgical staging did not lead to more cases of uN2. Performance of invasive staging indicated a possible overall survival benefit in patients with cN1-3 disease.
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http://dx.doi.org/10.1183/13993003.01549-2020DOI Listing
April 2021

Predicting Lung Cancer Survival Using Probabilistic Reclassification of TNM Editions With a Bayesian Network.

JCO Clin Cancer Inform 2020 05;4:436-443

Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.

Purpose: The TNM classification system is used for prognosis, treatment, and research. Regular updates potentially break backward compatibility. Reclassification is not always possible, is labor intensive, or requires additional data. We developed a Bayesian network (BN) for reclassifying the 5th, 6th, and 7th editions of the TNM and predicting survival for non-small-cell lung cancer (NSCLC) without training data with known classifications in multiple editions.

Methods: Data were obtained from the Netherlands Cancer Registry (n = 146,084). A BN was designed with nodes for TNM edition and survival, and a group of nodes was designed for all TNM editions, with a group for edition 7 only. Before learning conditional probabilities, priors for relations between the groups were manually specified after analysis of changes between editions. For performance evaluation only, part of the 7th edition test data were manually reclassified. Performance was evaluated using sensitivity, specificity, and accuracy. Two-year survival was evaluated with the receiver operating characteristic area under the curve (AUC), and model calibration was visualized.

Results: Manual reclassification of 7th to 6th edition stage group as ground truth for testing was impossible in 5.6% of the patients. Predicting 6th edition stage grouping using 7th edition data and vice versa resulted in average accuracies, sensitivities, and specificities between 0.85 and 0.99. The AUC for 2-year survival was 0.81.

Conclusion: We have successfully created a BN for reclassifying TNM stage grouping across TNM editions and predicting survival in NSCLC without knowing the true TNM classification in various editions in the training set. We suggest binary prediction of survival is less relevant than predicted probability and model calibration. For research, probabilities can be used for weighted reclassification.
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http://dx.doi.org/10.1200/CCI.19.00136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265790PMC
May 2020

Health-Related Quality of Life, Satisfaction with Care, and Cosmetic Results in Relation to Treatment among Patients with Keratinocyte Cancer in the Head and Neck Area: Results from the PROFILES Registry.

Dermatology 2020 21;236(2):133-142. Epub 2019 Aug 21.

Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.

Background: Little is known about the impact of keratinocyte cancer (KC) and its treatment on health-related quality of life (HRQoL).

Objectives: The objectives of the present study were (1) to evaluate HRQoL among patients with KC in a population-based setting and compare this with an age- end sex-matched normative population and (2) to compare HRQoL, satisfaction with care, and cosmetic results among patients who underwent conventional excision, Mohs' micrographic surgery, or radiotherapy.

Method: A random sample of 347 patients diagnosed with cutaneous basal cell or squamous cell carcinoma in the head and neck area between January 1, 2010, and December 31, 2014, were selected from the Netherlands Cancer Registry (NCR) and were invited to complete a questionnaire on HRQoL, satisfaction with care, and cosmetic results. Data were collected within Patient-Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship (PROFILES). Outcomes were compared to an age- and sex-matched normative population.

Results: Two hundred fifteen patients with KC returned a completed questionnaire (62% response). Patients with KC reported better global quality of life (79.6 vs. 73.3, p < 0.01) and less pain (p < 0.01) compared to the normative population. No statistically significant differences in HRQoL, satisfaction with care, and cosmetic results were found between patients with KC who underwent conventional excision, Mohs' micrographic surgery, or radiotherapy.

Conclusions: The impact of KC and its treatment seems relatively low and more positive than negative as patients reported better HRQoL compared to an age- and sex-matched normative population, probably due to adaptation. No statistically significant differences between treatment types were found concerning HRQoL, patient satisfaction, and cosmetic results. This information could be used by healthcare professionals involved in KC care to improve patients' knowledge about different aspects of the disease as patient's preference is an important factor for treatment choice.
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http://dx.doi.org/10.1159/000502033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212703PMC
February 2021

[Fight against cancer in the Netherlands: current state of affairs].

Ned Tijdschr Geneeskd 2019 06 17;163. Epub 2019 Jun 17.

Integraal Kankercentrum Nederland (IKNL), afd. Onderzoek, Utrecht.

Objective: To give insight into the fight against cancer in the Netherlands.

Design: Nationwide observational cohort study.

Method: Data from the Netherlands Cancer Registry on standardized incidence rates and relative survival were analysed. Mortality data was obtained from Statistics Netherlands.

Results: Between 1989 and 2017 the number of newly-diagnosed cancers doubled to 111,582. The standardized incidence (ESR) increased from 377 per 100,000 inhabitants in 1989 to 481 in 2011, and stabilized thereafter (459 in 2017). In 2018 the five most common types of cancer were skin cancer (excl. basal cell carcinoma, n = 21,000), breast cancer (n = 15,000), colorectal cancer (n = 14,000), lung cancer (n = 13,000) and prostate cancer (n = 13,000). The incidence of skin cancer rose the fastest (melanoma from 11 to 32 per 100,000; squamous cell carcinoma from 14 to 49 per 100,000). The largest shift to local disease (T1-T2 according to the TNM) was seen in breast cancer (from 50% to 75%). The 5-year survival improved from 50% in patients diagnosed with cancer in 1991-1996 to 65% in 2011-2016. Of the most common cancer types, survival of acute myeloid leukaemia increased the most (from 10% to 25%). The absolute number of deaths increased (from 35,000 in 1989 to 45,000 in 2017), but after standardization this decreased from 234 to 169.

Conclusion: The incidence of cancer in absolute numbers is still increasing due to the ageing population. However, taking population demographics into account, the standardized incidence has not increased since 2011. This is related to the decrease in smoking-related cancers, amongst other things. The increase in survival is related to early detection and improved treatment. The decrease in mortality is mainly related to the decrease in lung cancer mortality in men.
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June 2019

An actualised population-based study on the use of radiotherapy in breast cancer patients in the Netherlands.

Breast J 2019 09 4;25(5):942-947. Epub 2019 Jun 4.

Scientific Committee NABON Breast Cancer Audit (NBCA), The Netherlands.

The utilization rate of RT increased from 64.4% in 2011 to 70.3% in 2015. After BCS and mastectomy, 97.3% and 26.1% of the patients received RT, respectively. For patients undergoing BCS and mastectomy, lower age and ER + tumours were associated with higher RT utilisation rates. After mastectomy, also larger tumour sizes, lymph node involvement, grade-2 and 3 tumours and diagnosis in more recent years were associated with higher RT use.
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http://dx.doi.org/10.1111/tbj.13376DOI Listing
September 2019

Video-assisted thoracic lobectomy stereotactic body radiotherapy for stage I nonsmall cell lung cancer in elderly patients: a propensity matched comparative analysis.

Eur Respir J 2019 06 20;53(6). Epub 2019 Jun 20.

Dept of Surgery, Amphia Hospital, Breda, The Netherlands.

Comparative studies of the overall survival (OS) in elderly patients with nonsmall cell lung cancer (NSCLC) after surgery or stereotactic body radiotherapy (SBRT) have been limited by mixed extents of resection and different surgical approaches.792 patients aged ≥65 years with clinical stage I NSCLC underwent video-assisted thoracic surgery (VATS) lobectomy or SBRT between 2010 and 2015. The propensity score-matched primary analysis included data from the full cohort; the secondary analysis included data from a subgroup of patients with data on pulmonary function.Median OS for unmatched patients was 77 months for patients undergoing VATS lobectomy and 38 months for SBRT. The 1-, 3- and 5-year OS rates after VATS lobectomy were 92%, 76% and 65%, and after SBRT were 90%, 52% and 29% (p<0.001). Median OS for matched patients in the primary analysis was 77 months for patients undergoing VATS lobectomy and 33 months for SBRT. The 1-, 3- and 5-year OS rates after VATS lobectomy were 91%, 68% and 58%, and after SBRT were 87%, 46% and 29% (p<0.001). The survival advantage with VATS lobectomy persisted in the secondary analysis after adjusting for non-matched variables (p=0.034).We suggest that elderly patients with stage I NSCLC undergoing VATS lobectomy have a better rate of OS than patients undergoing SBRT, irrespective of matching. This could be clinically important in decision-making for elderly patients who can tolerate surgery.
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http://dx.doi.org/10.1183/13993003.01561-2018DOI Listing
June 2019

Changes in treatment patterns and survival in elderly patients with stage I non-small-cell lung cancer with the introduction of stereotactic body radiotherapy and video-assisted thoracic surgery.

Eur J Cancer 2018 09 14;101:30-37. Epub 2018 Jul 14.

Department of Surgery, Amphia Hospital, Breda, The Netherlands. Electronic address:

Background: The optimal treatment of elderly patients with early-stage non-small-cell lung cancer (NSCLC) remains elusive. Still, the introduction of video-assisted thoracic surgery (VATS) and stereotactic body radiotherapy (SBRT) may have led to more elderly receiving treatment and improved median overall survival (OS).

Materials And Methods: We analysed data from the Netherlands Cancer Registry of 2168 patients ≥65 years with clinical stage I NSCLC and distinguished two periods: 2004-2008 (A) and 2009-2013 (B). The analyses focussed on treatment patterns and median OS for patients receiving surgery, radiotherapy or neither surgery nor radiotherapy. Furthermore, we explored the influence of the application of VATS and SBRT.

Results: The resection rate did not differ between the periods A and B (51% versus 53%; p = 0.37), despite significantly more VATS procedures in the latter period (0% versus 32%; p < 0.001). Application of radiotherapy increased (26% versus 33%; p = 0.001), especially SBRT (3% versus 63%; p < 0.001). The proportion of patients receiving neither therapy decreased (23% versus 14%; p < 0.001). Median OS for all patients significantly improved (31 versus 42 months; p = 0.001), and also for those receiving radiotherapy (23 versus 33 months; p = 0.02), but not significantly for surgical patients (65 versus 74 months; p = 0.16). Still, in multivariable analysis, surgical patients had an increased risk of death in period A compared with period B (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.01-1.43); this was not the case for patients receiving radiotherapy (HR 1.19; 95% CI, 0.99-1.43). Five-year OS was 57% for surgical patients and 23% for those receiving radiotherapy.

Conclusion: In elderly patients with stage I NSCLC, the use of surgery remained constant, that of radiotherapy increased and fewer patients received neither treatment over the years. Median OS improved for all patients; surgery was associated with the highest long-term OS.
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http://dx.doi.org/10.1016/j.ejca.2018.06.016DOI Listing
September 2018

Patterns of treatment and survival among older patients with stage III non-small cell lung cancer.

Lung Cancer 2018 02 20;116:55-61. Epub 2017 Dec 20.

Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands. Electronic address:

Introduction: Patterns of treatment and survival are largely unknown for older patients with stage III non-small cell lung cancer (NSCLC) in daily clinical practice.

Methods: All patients ≥65 years with stage III NSCLC (2009-2013) were included from the population-based Netherlands Cancer Registry. Descriptive and multivariable treatment and survival analyses were stratified for patients aged 65-74 years and ≥75 years.

Results: Compared to older patients (n = 3163), those aged 65-74 years (n = 3876) underwent more often surgery (21% vs 12% for stage IIIA), chemoradiotherapy (47% vs 22% for both stage IIIA and IIIB), and chemotherapy (23% vs 12% for stage IIIB), and received less radiotherapy (8% vs 22% for both stage IIIA and IIIB). One-year survival was significantly higher among patients aged 65-74 compared to those aged ≥75 (61% vs 43%, for stage IIIA and 45% vs 30% for stage IIIB; P < .01). However, stratification of treatment showed similar survival rates between age groups. Among patients aged 65-74 years, the multivariably adjusted hazard ratio (HR) of death was twice as high for patients receiving radiotherapy (HR 1.9 (95%CI 1.6-2.2) for stage IIIA and HR 2.5 (95%CI 2.1-3.0) for stage IIIB) and chemotherapy (HR 2.2 (95%CI 1.9-2.5) and HR 2.2 (95%CI 1.8-2.7), respectively) compared to chemoradiotherapy, and were slightly lower for patients aged ≥75 years receiving radiotherapy (HR 1.6 (95%CI 1.4-1.9) and HR 1.8 (95%CI 1.5-2.1), respectively) and chemotherapy (HR 2.2 (95%CI 1.8-2.7) and HR 1.8 (95%CI 1.5-2.2), respectively). Comorbidity was not significantly associated with poorer survival (p = .07).

Conclusion: Chemoradiotherapy was more often applied among patients aged 65-74 years compared to those aged ≥75. While survival was worse for patients aged ≥75 years, differences between age groups largely disappeared after stratification for treatment. Future research should focus on predictive patient characteristics to distinguish patients within the heterogeneous older population who can benefit from curative-intent treatment.
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http://dx.doi.org/10.1016/j.lungcan.2017.12.013DOI Listing
February 2018

Association of socioeconomic status with outcomes in older adult community-dwelling patients after visiting the emergency department: a retrospective cohort study.

BMJ Open 2017 12 26;7(12):e019318. Epub 2017 Dec 26.

Department of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands.

Objectives: Older adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes.

Design: A retrospective study.

Participants: Older adults (≥65 years) visiting the ED, in the Netherlands. SES was stratified into tertiles based on average household income at zip code level: low (<€1800/month), intermediate (€1800-€2300/month) and high (>€2300/month).

Primary Outcomes: Hospitalisation, inhospital mortality and 30-day ED return visits. Effect of SES on outcomes for all groups were assessed by logistic regression and adjusted for confounders.

Results: In total, 4828 older adults visited the ED during the study period. Low SES was associated with a higher risk of hospitalisation among community-dwelling patients compared with high SES (adjusted OR 1.3, 95% CI 1.1 to 1.7). This association was not present for intermediate SES (adjusted OR 1.1, 95% CI 0.95 to 1.4). Inhospital mortality was comparable between the low and high SES group, even after adjustment for age, comorbidity and triage level (low OR 1.4, 95% CI 0.8 to 2.6, intermediate OR 1.3, 95% CI 0.8 to 2.2). Thirty-day ED revisits among community-dwelling patients were also equal between the SES groups (low: adjusted OR 1.0, 95% CI 0.7 to 1.4, and intermediate: adjusted OR 0.8, 95% CI 0.6 to 1.1).

Conclusion: In older adult ED patients, low SES was associated with a higher risk of hospitalisation than high SES. However, SES had no impact on inhospital mortality and 30-day ED revisits after adjustment for confounders.
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http://dx.doi.org/10.1136/bmjopen-2017-019318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770947PMC
December 2017

Immortal time bias in pharmacoepidemiological studies on cancer patient survival: empirical illustration for beta-blocker use in four cancers with different prognosis.

Eur J Epidemiol 2017 11 1;32(11):1019-1031. Epub 2017 Sep 1.

Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.

Immortal time bias (ITB) is still seen frequently in medical literature. However, not much is known about this bias in the field of cancer (pharmaco-)epidemiology. In context of a hypothetical beneficial beta-blocker use among cancer patients, we aimed to demonstrate the magnitude of ITB among 9876 prostate, colorectal, lung and pancreatic cancer patients diagnosed between 1998 and 2011, which were selected from a database linkage of the Netherlands Cancer Registry and the PHARMO Database Network. Hazard ratios (HR) and 95% confidence intervals from three ITB scenarios, defining exposure at a defined point after diagnosis (model 1), at any point after diagnosis (model 2) and as multiple exposures after diagnosis (model 3), were calculated to investigate the association between beta-blockers and cancer prognosis using Cox proportional hazards regression. Results were compared to unbiased estimates derived from the Mantel-Byar model. Ignoring ITB led to substantial smaller HRs for beta-blocker use proposing a significant protective association in all cancer types [e.g. HR 0.18 (0.07-0.43) for pancreatic cancer in model 1], whereas estimates derived from the Mantel-Byar model were mainly suggesting no association [e.g. HR 1.10 (0.84-1.44)]. The magnitude of bias was consistently larger among cancer types with worse prognosis [overall median HR differences between all scenarios in model 1 and Mantel-Byar model of 0.56 (prostate), 0.72 (colorectal), 0.77 (lung) and 0.85 (pancreas)]. In conclusion, ITB led to spurious beneficial associations of beta-blocker use among cancer patients. The magnitude of ITB depends on the duration of excluded immortal time and the prognosis of each cancer.
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http://dx.doi.org/10.1007/s10654-017-0304-5DOI Listing
November 2017

Trends in treatment and relative survival among Non-Small Cell Lung Cancer patients in the Netherlands (1990-2014): Disparities between younger and older patients.

Lung Cancer 2017 06 10;108:198-204. Epub 2017 Apr 10.

Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre, GROW School for Oncology and Developmental, Maastricht, the Netherlands.

Background: This study aimed to describe trends over time regarding disparities in treatment and relative survival (RS) between younger and older patients with non-small cell lung cancer (NSCLC).

Methods: All patients diagnosed with pathologically verified NSCLC in 1990-2014 were included from the Netherlands Cancer Registry (n=187,315). Treatment and RS (adjusted for sex, histology and treatment) were analyzed according to age group (<70 years versus ≥70 years), stage and five-year period of diagnosis.

Results: Between 1990 and 2014, five-year RS increased from 17 to 22% among younger patients and from 12 to 16% among elderly. The application of surgery increased over time for elderly with stage I NSCLC, decreased for elderly with stage II, and was stable but higher for younger patients. Disparities in RS between age groups with stage I became smaller since 2000-2004, but did not change over time for stage II. For stage III and IV, both age groups showed strong increases over time in chemoradiotherapy and chemotherapy from 2000 onwards, although considerably less among elderly. One-, three- and five-year RS increased more strongly over time for the younger group leading to larger disparities between age groups with stage III or IV NSCLC.

Conclusion: More curative-intent treatment and improved RS for NSCLC were seen over time, but were less profound among elderly. Disparities herein between age groups seemed to become smaller over time for stage I NSCLC, did not change for stage II, and were widening for stage III and IV at the expense of elderly. Future prospective studies should focus on optimizing treatment selection and outcomes for elderly.
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http://dx.doi.org/10.1016/j.lungcan.2017.04.005DOI Listing
June 2017

Timed Get Up and Go Test and Geriatric 8 Scores and the Association With (Chemo-)Radiation Therapy Noncompliance and Acute Toxicity in Elderly Cancer Patients.

Int J Radiat Oncol Biol Phys 2017 07 29;98(4):843-849. Epub 2017 Jan 29.

Department of Radiotherapy, Haaglanden Medical Center, The Hague, The Netherlands.

Purpose: To investigate whether the Geriatric 8 (G8) and the Timed Get Up and Go Test (TGUGT) and clinical and demographic patient characteristics were associated with acute toxicity of radiation therapy and noncompliance in elderly cancer patients being irradiated with curative intent.

Methods And Materials: Patients were eligible if aged ≥65 years and diagnosed with breast, non-small cell lung, prostate, head and neck, rectal, or esophageal cancer, and were referred for curative radiation therapy. We recorded acute toxicity and noncompliance and identified potential predictors, including the G8 and TGUGT.

Results: We investigated 402 patients with a median age of 72 years (range, 65-96 years). According to the G8, 44.4% of the patients were frail. Toxicity grade ≥3 was observed in 22% of patients who were frail according to the G8 and 9.1% of patients who were not frail. The difference was 13% (confidence interval 5.2%-20%; P=.0006). According to the TGUGT 18.8% of the patients were frail; 21% of the frail according to the TGUGT developed toxicity grade ≥3, compared with 13% who were not frail. The difference was 7.3% (confidence interval -2.7% to 17%; P=.11). Overall compliance was 95%. Toxicity was most strongly associated with type of primary tumor, chemotherapy, age, and World Health Organization performance status. Compliance was associated with type of primary tumor and age.

Conclusions: The usefulness of the TGUGT and G8 score in daily practice seems to be limited. Type of primary tumor, chemoradiotherapy, age, and World Health Organization performance status were more strongly associated with acute toxicity. Only chemoradiotherapy and age were associated with noncompliance. Overall the compliance was very high. To allow better-informed treatment decisions, a more accurate prediction of toxicity is desirable.
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http://dx.doi.org/10.1016/j.ijrobp.2017.01.211DOI Listing
July 2017

Cost-effectiveness of obinutuzumab for chronic lymphocytic leukaemia in The Netherlands.

Leuk Res 2016 11 3;50:37-45. Epub 2016 Sep 3.

Institute for Medical Technology Assessment, Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Netherlands Comprehensive Cancer Organisation, Netherlands Cancer Registry Utrecht, The Netherlands.

Background: Obinutuzumab combined with chlorambucil (GClb) has shown to be superior to rituximab combined with chlorambucil (RClb) and chlorambucil (Clb) in newly diagnosed patients with chronic lymphocytic leukaemia (CLL). This study evaluates the cost-effectiveness per life-year and quality-adjusted life-year (QALY) of GClb compared to RClb, Clb, and ofatumumab plus chlorambucil (OClb) in The Netherlands.

Methods: A Markov model was developed to assess the cost-effectiveness of GClb, RClb, Clb and other treatments in the United Kingdom. A country adaptation was made to estimate the cost-effectiveness of these therapies in The Netherlands using Dutch unit costs and Dutch data sources for background mortality and post-progression survival.

Results: An incremental gain of 1.06 and 0.64 QALYs was estimated for GClb compared to Clb and RClb respectively, at additional costs of €23,208 and €7254 per patient. Corresponding incremental cost-effectiveness ratios (ICERs) were €21,823 and €11,344 per QALY. Indirect treatment comparisons showed an incremental gain varying from 0.44 to 0.77 QALYs for GClb compared to OClb and additional costs varying from €7041 to €5028 per patient. The ICER varied from €6556 to €16,180 per QALY. Sensitivity analyses showed the robustness of the results.

Conclusion: GClb appeared to be a cost-effective treatment strategy compared to RClb, OClb and Clb.
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http://dx.doi.org/10.1016/j.leukres.2016.09.005DOI Listing
November 2016

Presence and Number of Positive Surgical Margins after Radical Prostatectomy for Prostate Cancer: Effect on Oncological Outcome in a Population-Based Cohort.

Urol Int 2015 3;95(4):472-7. Epub 2015 Nov 3.

Netherlands Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht, The Netherlands.

Introduction: Additional insight in the occurrence and number of positive surgical margins (PSM) and the potential consequences is needed, since earlier studies show divergent results. This study aims at investigating the effect of the presence and number of PSM on oncological outcomes.

Methods: Retrospective population-based cohort study including 648 consecutive prostate cancer patients who underwent RP in the Southern Netherlands in 2006-2008. The effect of PSM on risk of treatment failure, defined by either biochemical recurrence or necessity of any additional therapy (Cox regression), was evaluated.

Results: PSM were observed in 39%; 11% had multiple PSM. Treatment failure was observed in 26% of all patients. Multivariably, the presence (hazard ratio 2.5) and number of PSM (hazard ratios: single 2.3; multiple 3.1) were independently associated with higher treatment failure rates, unlike location of PSM.

Conclusions: Treatment failure rates are high among patients with PSM, especially in those with multiple PSM. This needs to be taken into account when decisions are made on the applicability of the adjuvant and salvage therapy.
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http://dx.doi.org/10.1159/000441012DOI Listing
September 2016

Comorbidity in Patients With Small-Cell Lung Cancer: Trends and Prognostic Impact.

Clin Lung Cancer 2015 Jul 11;16(4):282-91. Epub 2014 Dec 11.

Department of Pulmonary Diseases, TweeSteden Hospital and St. Elisabeth Hospital, Tilburg, The Netherlands.

Introduction: We evaluated the trends in the prevalence of comorbidity and its prognostic impact in a cohort of unselected patients with small-cell lung cancer (SCLC).

Patients And Methods: All patients (n = 4142) diagnosed with SCLC from 1995 to 2012 were identified from the population-based Netherlands Cancer Registry in the Eindhoven region.

Results: The prevalence of comorbidity increased from 55% in 1995 to 1998 to 76% in 2011 to 2012 and multimorbidity (ie, ≥ 2 concomitant diseases) from 23% to 51%. The prevalence of a comorbidity increased with age. Among the men, hypertension, cardiac disease, and diabetes, in particular, became more common (increased from 11% to 35%, from 19% to 36%, and from 7% to 18%, respectively). In the women, the rate of pulmonary disease, hypertension, and cardiac disease increased the most (increased from 18% to 30%, from 12% to 28%, and from 11% to 24%, respectively). Multimorbidity was associated with a slightly increased hazard of death, independent of treatment in those with limited-stage SCLC (hazard ratio [HR] for ≥ 2 comorbidities vs. no comorbidities, 1.2; 95% confidence interval [CI], 1.0-1.4). The prognostic effects of multimorbidity resulted from treatment in those with extensive-stage SCLC (HR for ≥ 2 comorbidities vs. no comorbidities, final model, 1.2; 95% CI, 1.0-1.2). The prognostic impact of the specific comorbidities varied, with digestive disease reducing the hazard and cardiac disease increasing the hazard in those with limited-stage SCLC (HR for digestive disease vs. no digestive disease, 0.7 [95% CI, 0.5-0.9], and HR for cardiac vs. no cardiac disease, 1.2 [95% CI, 1.0-1.3]). Also, cardiac and cerebrovascular disease increased the hazard in those with extensive-stage SCLC (HR 1.2 [95% CI, 1.0-1.3] and HR 1.3 [95% CI, 1.1-1.6], respectively).

Conclusion: Comorbidity among patients with SCLC is very common and has been increasing. Multimorbidity was associated with a slightly increased hazard of death in those with limited-stage SCLC, independent of treatment. However, the prognostic effects in those with advanced-stage SCLC resulted from treatment. Digestive disease favorably affected survival and cardiac disease negatively affected the prognosis for those with limited-stage SCLC, and cardiac and cerebrovascular diseases had a negative prognostic effect for those with extensive-stage SCLC. With the burden of comorbidities in patients with SCLC increasing, more attention to individualized treatment approaches is needed.
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http://dx.doi.org/10.1016/j.cllc.2014.12.003DOI Listing
July 2015

Effect of surgical margin status after radical prostatectomy on health-related quality of life and illness perception in patients with prostate cancer.

Urol Oncol 2015 Jan 14;33(1):16.e9-16.e15. Epub 2014 Nov 14.

Department of Research, Netherlands Cancer Registry/Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands. Electronic address:

Objective: The aim of the study was to evaluate the effect of positive surgical margins (PSM) on health-related quality of life and illness perception after radical prostatectomy in patients with prostate cancer.

Methods: Of all patients with prostate cancer diagnosed between 2006 and 2009 in 7 participating hospitals in the Eindhoven region of the Netherlands Cancer Registry, 197 patients who underwent radical prostatectomy were invited to fill in a questionnaire. Data from the Netherlands Cancer Registry were combined with questionnaire data (including European Organization for Research and Treatment of Cancer quality of life questionnaire-C30, quality of life questionnaire-Prostate Module 25, and the Brief Illness Perception Questionnaire). Mean scores per margin status group were compared in multivariate linear regression.

Results: Of the addressed patients, 166 (84%) responded to the questionnaire. At time of questioning, their surgery was 1.7 to 6.4 years ago. The prevalence of PSM was 34%. On most scales, patients with PSM reported more favorable scores than patients with negative surgical margins. However, differences were mostly trivial (<5 points on 100-point scales), or of small (5-10) to medium (10-20) clinical importance. Only differences on hormonal complaints and illness comprehensibility were statistically significant. Effect of PSM on scores did not vary between patients who were at different time points after surgery.

Conclusion: Although patients with PSM showed a trend toward more favorable scores, these differences were of little or no clinical importance. Additional research is needed to evaluate how patients value these differences with respect to oncological outcomes.
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http://dx.doi.org/10.1016/j.urolonc.2014.10.006DOI Listing
January 2015

Improvement in population-based survival of stage IV NSCLC due to increased use of chemotherapy.

Int J Cancer 2015 Mar 30;136(5):E387-95. Epub 2014 Sep 30.

Netherlands Cancer Registry, Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands.

This study aimed to investigate which factors were associated with the administration of chemotherapy for patients with stage IV non-small cell lung cancer (NSCLC), and their relation to survival at a population-based level. All patients with NSCLC stage IV from 2001 to 2012 were identified in the Netherlands Cancer Registry in the Eindhoven area (n = 5,428). Chemotherapy use and survival were evaluated by logistic and Cox regression analyses, respectively. The proportion of patients receiving chemotherapy increased from 30% in 2001 to 48% in 2012. Higher rates were found among younger patients [multivariable odds ratio (OR(≤ 64_vs._≥ 75_years)): 1.8 (95%CI 1.6-2.1)], high socioeconomic status [OR(high_vs._low): 1.8 (95%CI 1.6-2.2)], no comorbidity [OR0_vs._≥ 2 : 1.5 (95%CI 1.3-1.8)], diagnosed in recent years [OR(2010-2012_vs._2001-2003): 2.0 (95%CI 1.6-2.3)] and adenocarcinoma [ORsquamous_vs._adenocarcinoma : 0.8 (95%CI 0.6-0.9)]. Having liver metastasis was associated with reduced odds (OR(liver_ vs._brain): 0.8 (95%CI 0.7-1.0). The variation between hospitals was large, up to OR 2.0 (95%CI 1.5-2.6). Median survival increased from 18 weeks in 2001-2003 to 21 weeks in 2010-2012 (log-rank p = 0.007), and was 35 weeks in patients with and 10 weeks without chemotherapy. The multivariable hazard of death reduced significantly over time [HR(2001-2003_vs._2010-2012): 1.1 (95%CI 1.0-1.2), HR(2004-2005_vs._2010-2012): 1.2 (95%CI 1.1-1.3)] and only remained significant for 2004-2006 after additional adjustment for chemotherapy [final multivariable model, HR(2004-2006_vs._2010-2012): 1.1 (95%CI 1.0-1.2)]. Besides, prognostic factors were having chemotherapy [final multivariable model: HR 0.4 (95%CI 0.4-0.4)], female sex [HRmale_vs._female : 1.1 (95%CI 1.0-1.1)], socioeconomic status [HR(intermediate_and_high_vs._low) both 0.9 (95%CI 0.9-1.0)], comorbidity [HR(unknown_vs._≥ 2): 1.3 (95%CI 1.2-1.5)], histology [HRother_vs._adenocarcinoma : 1.1 (95%CI 1.1-1.2)], and location of metastasis [range: 1.2 (HR(lymph_nodes_vs._brain)) - 1.6 (HR(liver_vs._brain))]. In conclusion, population-based survival increased due to increasing administration rates of chemotherapy. The administration of chemotherapy was affected by hospital of diagnosis and both patient and tumour characteristics. Identifying patients who benefit from chemotherapy should become a key issue.
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http://dx.doi.org/10.1002/ijc.29216DOI Listing
March 2015

Burden of disease caused by keratinocyte cancer has increased in The Netherlands since 1989.

J Am Acad Dermatol 2014 Nov 1;71(5):896-903. Epub 2014 Sep 1.

Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Background: Keratinocyte cancer is the most common cancer among Caucasians.

Objective: We sought to study time trends of the burden of disease attributable to keratinocyte cancer in The Netherlands.

Methods: Data of all patients with newly diagnosed keratinocyte cancer (ie, squamous cell carcinoma and basal cell carcinoma) were obtained from the population-based Netherlands Cancer Registry and the Eindhoven Cancer Registry (1989-2008). Population structure, mortality data, and life expectancy data were extracted from Statistics Netherlands. The disability-adjusted life-years (DALY) was the sum of the years of life lived with disability and the years of life lost.

Results: The world standardized rate of keratinocyte cancer has doubled and was 103 and 94 per 100,000 person-years for males and females in 2004 to 2008, respectively. DALYs as a result of basal cell carcinoma increased by 124% and DALYs as a result of squamous cell carcinoma increased by 66% from 1989 to 1993. Keratinocyte cancer accounted for a total loss of 19,913 DALYs (15,369 years of life lived with disability and 4544 years of life lost) between 2004 and 2008.

Limitations: Only the first keratinocyte cancer was included in this study.

Conclusion: Keratinocyte cancer is a large burden to the Dutch society. Because incidence rates of keratinocyte cancer continue to increase, the management becomes even more challenging.
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http://dx.doi.org/10.1016/j.jaad.2014.07.003DOI Listing
November 2014

Does adjuvant chemoradiotherapy improve the prognosis of gastric cancer after an r1 resection? Results from a dutch cohort study.

Ann Surg Oncol 2015 Feb 28;22(2):581-8. Epub 2014 Aug 28.

Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Objective: The aim of this study was to investigate the impact of adjuvant chemoradiotherapy (CRT) on survival of non-metastatic gastric cancer patients who had undergone an R1 resection.

Methods: We compared the survival of patients after an R1 gastric cancer resection from the population-based Netherlands Cancer Registry who did not receive adjuvant CRT (no-CRT group) with the survival of resected patients who had been treated with adjuvant CRT (CRT group) at our institute. Patients who had a resection between 2002 and 2011 were included. CRT consisted of radiotherapy (45 Gy) combined with concurrent cisplatin- or 5-fluorouracil-based chemotherapy. The impact of CRT treatment on overall survival was assessed using multivariable Cox regression and stratified propensity score analysis.

Results: A series of 409 gastric cancer patients who had undergone an R1 resection were studied (no-CRT, N = 369; CRT, N = 40). In the no-CRT group, median age was higher (70 vs. 57 years; p < 0.001) and the percentage of patients with diffuse-type tumors was lower (43 vs. 80 %; p < 0.001). There were no significant differences in pathological T- and N-classification. There was a significant difference in median overall survival between the no-CRT and CRT group (13 vs. 24 months; p = 0.003). In a multivariable analysis, adjuvant CRT was an independent prognostic factor for improved overall survival (hazard ratio 0.54; 95 % confidence interval 0.35-0.84). This effect of CRT was further supported by propensity score analysis.

Conclusions: Adjuvant CRT was associated with an improved survival in patients who had undergone an R1 resection for gastric cancer.
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http://dx.doi.org/10.1245/s10434-014-4032-8DOI Listing
February 2015

The role of health literacy in perceived information provision and satisfaction among women with ovarian tumors: a study from the population-based PROFILES registry.

Patient Educ Couns 2014 Jun 20;95(3):421-8. Epub 2014 Mar 20.

CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands; Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven Cancer Registry, The Netherlands.

Objective: To assess the association of subjective health literacy (HL) and education with perceived information provision and satisfaction.

Methods: Women (N=548) diagnosed with an ovarian or borderline ovarian tumor between 2000 and 2010, registered in the Eindhoven Cancer Registry, received a questionnaire including subjective HL, educational level, perceived information provision, and satisfaction with the information received. Multiple linear and logistic regression analyses were performed, controlled for potential confounders.

Results: Fifty percent of the women responded (N=275). Thirteen percent had low and 41% had medium subjective HL. Women with low HL reported less perceived information provision about medical tests, and were less satisfied with the information received compared to women with high HL. Low educated women reported that they received more information about their disease compared to highly educated women.

Conclusion: Low subjective HL among women with ovarian tumors is associated with less perceived information provision about medical tests and lower information satisfaction, whereas low education is associated with more perceived information provision about the disease.

Practice Implications: HL should not be overlooked as a contributing factor to patients' perceived information provision and satisfaction. Health care providers may need training about recognizing low HL.
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http://dx.doi.org/10.1016/j.pec.2014.03.008DOI Listing
June 2014
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