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Maastricht, Netherlands

Korfage I.J.,Rotterdam University | van Ballegooijen M.,Rotterdam University | Wauben B.,Comprehensive Cancer Center Limburg | Habbema J.D.F.,Rotterdam University | And 2 more authors.
Patient Education and Counseling | Year: 2011

Objective: Screening for cervical cancer may have favourable or unfavourable effects at the individual level. This study assesses whether invitees in the Netherlands made an informed choice about screen uptake. Methods: Attached to the invitation letter and the information leaflet, screen invitees were sent a questionnaire. An informed decision was defined as based on decision-relevant knowledge, while the woman's attitude was consistent with her actual screening behaviour. Results: Of all cervical screen participants, 60% (924/1551) responded to the questionnaire. Decision-relevant knowledge was sufficient in 595 women. Especially knowledge about false-positive and false-negative test results was limited. The attitude towards cervical screening was mainly positive (99%). Requirements for informed decision making were met in 571 (68%) women and in 91% when an alternative cut-off point of sufficient decision-relevant knowledge was applied. Most frequently reported main reasons to attend were early detection of abnormalities (67%) and reassurance in case of a normal smear (22%). Conclusion: Insufficient decision-relevant knowledge was the main cause of uninformed attendance. Practice implication: Adequate strategies to provide invitees with sufficient decision-relevant information are still needed, especially regarding false-positive and false-negative test results. © 2011 Elsevier Ireland Ltd. Source

Paap E.,Radboud University Nijmegen | Holland R.,Radboud University Nijmegen | Heeten G.J.D.,Radboud University Nijmegen | Van Schoor G.,Radboud University Nijmegen | And 3 more authors.
Cancer Causes and Control | Year: 2010

Objective: We designed a case-referent study to investigate the effect of mammographic screening at the individual level, looking at the association of breast cancer death with screening history. Methods: The study population included all women aged 50-75 in the province of Limburg, the Netherlands who had been invited to the screening program from 1989 to 2006. From this population, 118 cases originated who died of breast cancer in 2004 or 2005. The screening history of these cases was collected and compared with a sample of the invited population. The breast cancer death rate in the screened relative to the unscreened women was estimated as the odds ratio (OR). This OR was adjusted for self-selection bias, the difference in baseline risk for breast cancer death between screened and unscreened women. Results: Analysis of the data showed a breast cancer mortality reduction of 70% in the screened versus the unscreened women (OR = 0.30, 95% CI 0.14-0.63). The magnitude of self-selection was estimated specifically for Limburg. After correction for self-selection bias, the effect of screening increased to 76% (OR = 0.24, 95% CI 0.10-0.58). Conclusion: Screening resulted in a remarkable reduction in breast cancer mortality. Contrary to findings in other countries, adjustment for self-selection in Limburg had no influence on the impact of screening. Thanks to a well-organized centralized screening program, similar results are expected in other regions of the Netherlands. © 2010 Springer Science+Business Media B.V. Source

Verhoeven R.H.A.,Comprehensive Cancer Center South | Louwman M.W.J.,Comprehensive Cancer Center South | Buntinx F.,Maastricht University | Buntinx F.,Catholic University of Leuven | And 6 more authors.
European Journal of Cancer Prevention | Year: 2011

Exposure to cadmium has been established to be carcinogenic for humans by the International Agency for Research on Cancer, but this is mainly based on studies with occupational exposures. The substantial 100 year long emission of cadmium by three zinc smelters in the Kempen area across the Dutch-Belgian border might have affected the incidence of cancer in this region. Following a study of increased risks of lung cancer due to cadmium emission (hazard ratio was 4.2 for high vs. low cadmium exposure areas in that study), we used data from the three regional population-based cancer registries, covering an area with 2.9 million inhabitants. Analyses of observed incidence were carried out for all cancers and cancer of the lung, kidney, bladder, prostate, testis, and breast separately. At the municipality level standardized incidence ratios were calculated and smoothed using a Poisson-gamma or a conditional autoregressive model. To detect clusters and to calculate an observed/expected ratio (O/E ratio) for each cluster a spatial scan statistic was applied. Significantly increased cancer incidence rates were found at a multimunicipality level for female lung cancer (O/E ratio=1.2), male and female bladder cancer (O/E ratio male=1.8, O/E ratio female=1.7), and prostate cancer (O/E ratio=1.3), none of these clusters being located specifically around the area of the zinc smelters. Therefore, the long term emission of cadmium by the zinc smelters in the Kempen area did not seem to lead to an increase in the incidence of all cancers, and lung, kidney, bladder, prostate, testicular, or breast cancer. © 2011 Wolters Kluwer Health | Lippincott Williams &Wilkins. Source

Velthuis M.J.,Comprehensive Cancer Center Middle Netherlands | Velthuis M.J.,University Utrecht | May A.M.,University Utrecht | Koppejan-Rensenbrink R.A.G.,Comprehensive Cancer Center Middle Netherlands | And 9 more authors.
BMC Cancer | Year: 2010

Background: Fatigue is a major problem of cancer patients. Thirty percent of cancer survivors report serious fatigue three years after finishing treatment. There is evidence that physical exercise during cancer treatment reduces fatigue. This may also lead to an improvement of quality of life. Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave. However, no studies are known that investigated these hypotheses. Therefore, the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave.Methods/Design: The Physical Activity during Cancer Treatment study is a multicentre randomised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment. Participants will be randomised to an exercise or a control group. In addition to the usual care, the exercise group will participate in an 18-week supervised group exercise programme. The control group will be asked to maintain their habitual physical activity pattern. Study endpoints will be assessed after 18 weeks (short term) and after 9 months (long term). Validated questionnaires will be used. Primary outcome: fatigue (Multidimensional Fatigue Inventory and Fatigue Quality List) and cost-effectiveness, health service utilisation and sick leave. Secondary outcome: health related quality of life (European Organisation Research and Treatment of Cancer-Quality of Life questionnaire-C30, Short Form 36 healthy survey), impact on functioning and autonomy (Impact on functioning and autonomy questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), physical fitness (aerobic peak capacity, muscle strength), body composition and cognitive-behavioural aspects. To register health service utilisation and sick leave, participants will keep diaries including the EuroQuol-5D. Physical activity level will be measured using the Short Questionnaire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer.Discussion: This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer. If early physical exercise proves to be (cost) effective, establishing standardised physical exercise programmes during cancer treatment will be planned.Trial registration: Current Controlled trials ISRCTN43801571, Dutch Trial Register NTR2138. © 2010 Velthuis et al; licensee BioMed Central Ltd. Source

Kimman M.L.,Maastricht University | Dirksen C.D.,Maastricht University | Voogd A.C.,Maastricht University | Falger P.,Maastricht University | And 14 more authors.
European Journal of Cancer | Year: 2011

Objective: To investigate whether frequent hospital follow-up in the first year after breast cancer treatment might partly be replaced by nurse-led telephone follow-up without deteriorating health-related quality of life (HRQoL), and whether a short educational group programme (EGP) would enhance HRQoL. Patients and methods: A multicentre pragmatic randomised controlled trial (RCT) with a 2 x 2 factorial design was performed among 320 breast cancer patients who were treated with curative intent. Participants were randomised to follow-up care as usual (3-monthly outpatient clinic visits), nurse-led telephone follow-up, or the former strategies combined with an educational group programme. The primary outcome for both interventions was HRQoL, measured by EORTC QLQ-C30. Secondary outcomes were role and emotional functioning and feelings of control and anxiety. Results: Data of 299 patients were available for evaluation. There was no significant difference in HRQoL between nurse-led telephone and hospital follow-up at 12 months after treatment (p = 0.42; 95% confidence interval (CI) for difference: -1.93-4.64) and neither between follow-up with or without EGP (p = 0.86; 95% CI for difference: -3.59-3.00). Furthermore, no differences between the intervention groups and their corresponding control groups were found in role and emotional functioning, and feelings of control and anxiety (all p-values >0.05). Conclusion: Replacement of most hospital follow-up visits in the first year after breast cancer treatment by nurse-led telephone follow-up does not impede patient outcomes. Hence, nurse-led telephone follow-up seems an appropriate way to reduce clinic visits and represents an accepted alternative strategy. An EGP does not unequivocally affect positive HRQoL outcomes. © 2010 Elsevier Ltd. All rights reserved. Source

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