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Eindhoven, Netherlands

Rosso S.,Center for Epidemiology and Prevention in Oncology in Piedmont | Gondos A.,German Cancer Research Center | Zanetti R.,Center for Epidemiology and Prevention in Oncology in Piedmont | Bray F.,Institute of Population based Cancer Research | And 8 more authors.
European Journal of Cancer | Year: 2010

Introduction: We investigated survival in breast cancer patients by age group, focussing on those covered by screening programmes, using data from 12 European population-based cancer registries participating in the European Network for Indicators on Cancer Survival Working Group. Methods: We calculated period estimates of 5-year relative survival for 2000-2004 and examined the change in survival estimates for four age groups between 1990-1994 and 2000-2004. Trends in age specific incidence, survival and mortality were additionally compared to those in the United States based on results from the Surveillance Epidemiology and End Results (SEER) programme. Results: Breast cancer survival uniformly increased particularly in areas with lower breast cancer survival for patients diagnosed in 1990-1994. With the exception of Geneva, Scotland and Estonia, the rise in survival was always larger among the younger age groups than in the 70+ age group and the age-gradient widened over time. The 5-year relative survival of patients aged 70 and above in the European registries was at least 7 percentage points lower than the 5-year relative survival of patients in the same age group in the US in 2000-2004. During the study period, incidence increased in all age groups and populations with a few exceptions, an observation paralleled by declining mortality. Conclusions: Results showed that some of the geographical differences in overall survival are even larger when considering age groups, in particular between Western and Eastern European countries. Furthermore, some of the differences in survival within the Northern and Western European areas could be due to variations in the implementation of screening programmes rather than economic inequalities. © 2010 Elsevier Ltd. All rights reserved. Source

Van De Water W.,Leiden University | Bastiaannet E.,Leiden University | Dekkers O.M.,Leiden University | De Craen A.J.M.,Leiden University | And 4 more authors.
British Journal of Surgery | Year: 2012

Background: Elderly patients with breast cancer are under-represented in clinical studies. It is not known whether treatment guidelines, based on clinical trials, can be extrapolated to this population. The aim of this study was to assess adherence to treatment guidelines by age at diagnosis, and to examine age-specific survival in relation to adherence to guidelines. Methods: Patients with early-stage breast cancer aged either less than 65 years, or 75 years or more, diagnosed between 2005 and 2008, were identified from the Netherlands Cancer Registry. Adherence to treatment guidelines for breast and axillary surgery, radiotherapy, chemotherapy and endocrine therapy was determined. Non-adherence to the guidelines was defined as overtreatment or undertreatment. The primary endpoint was overall survival, assessed by means of an instrumental variable, the comprehensive cancer centre region. Results: Some 24 959 patients younger than 65 years and 6561 patients aged 75 years or more were included in the analysis. Median follow-up was 2·8 years. Compared with patients younger than 65 years, those aged at least 75 years were less frequently treated in concordance with guidelines: 62·0 per cent (15 487 patients) versus 55·6 per cent (3647 patients) (P < 0·001). In both age groups, most patients received at least three of five treatment modalities in concordance with guidelines: 98·8 per cent (24 652 patients) and 93·8 per cent (6152 patients) respectively. Analysis of survival using the instrumental variable showed that adherence to guidelines was not associated with overall survival in patients younger than 65 years (P = 0·601) or those aged at least 75 years (P = 0·190). Conclusion: Adherence to treatment guidelines was affected by age at diagnosis. However, adherence to the guidelines was not associated with overall survival in either age group. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Source

Janssen-Heijnen M.L.G.,Eindhoven Cancer Registry | Janssen-Heijnen M.L.G.,Erasmus Medical Center | Extermann M.,University of South Florida | Boler I.E.,University of South Florida
Critical Reviews in Oncology/Hematology | Year: 2011

Elderly cancer patients with normal complete blood cell counts (CBCs) during the first course of (some types of) chemotherapy might be unlikely to experience grade 4 neutropenia during subsequent cycles. In this case, further weekly CBCs might be avoided.We used data of 223 cancer patients aged 70+ who were included in the CRASH (Chemotherapy Risk Assessment Score for High-age patients) trial between 2003 and 2007 in 7 cancer practices in the US. First cycle CBC values were compared to subsequent cycles. MAX2-score was used as a measure for toxicity of the chemotherapy regimen.Sixty-two patients (28%) experienced grade 4 neutropenia during subsequent cycles. Among patients who received chemotherapy with a MAX2-score lower than 0.20, only 4.6% of those without neutropenia during the first cycle experienced grade 4 neutropenia during subsequent cycles. Weekly CBC might be avoided in these patients receiving chemotherapy. Future prospective studies should confirm these results. © 2010 Elsevier Ireland Ltd. Source

Bastiaannet E.,Leiden University | Liefers G.J.,Leiden University | De Craen A.J.M.,Leiden University | Kuppen P.J.K.,Leiden University | And 7 more authors.
Breast Cancer Research and Treatment | Year: 2010

Breast cancer is the most common type of cancer in several parts of the world and the number of elderly patients is increasing. The aim of this study was to describe stage at diagnosis, treatment, and relative survival of elderly patients compared to younger patients in the Netherlands. Adult female patients with their first primary breast cancer diagnosed between 1995 and 2005 were selected. Stage, treatment, and relative survival were described for young and elderly (≥65 years) patients and within the cohort of elderly patients according to 5-year age groups. Overall, 127,805 patients were included. Elderly breast cancer patients were diagnosed with a higher stage of disease. Moreover, within the elderly differences in stage were observed. Elderly underwent less surgery (99.2-41.2%); elderly received hormonal treatment as monotherapy more frequently (0.8-47.3%); and less adjuvant systemic treatment (79-53%). Elderly breast cancer patients with breast cancer had a decreased relative survival. Although relative survival was lower in the elderly, the percentage of patients who die of their breast cancer less than 50% above age 75. In conclusion, the relative survival for the elderly is lower as compared to their younger counterparts while the percentage of deaths due to other causes increases with age. This could indicate that the patient selection is poor and fit patients could suffer from "under treatment". In the future, specific geriatric screening tools are necessary to identify fit elderly patients who could receive more "aggressive" treatment while best supportive care should be given to frail elderly patients. © 2010 Springer Science+Business Media, LLC. Source

Van Leersum N.J.,Leiden University | Janssen-Heijnen M.L.G.,Viecuri Medical Center | Wouters M.W.J.M.,Leiden University | Wouters M.W.J.M.,Netherlands Cancer Institute | And 5 more authors.
International Journal of Cancer | Year: 2013

Comorbidity has large impact on colorectal cancer (CRC) treatment and outcomes and may increase as the population ages. We aimed to evaluate the prevalence and time trends of comorbid diseases in patients with CRC from 1995 to 2010. The Eindhoven Cancer Registry registers comorbidity in all patients with primary CRC in the South of the Netherlands. We analyzed the prevalence of serious comorbid diseases in four time frames from 1995 to 2010. Thereby, we addressed its association with age, gender and socio-economic status (SES). The prevalence of comorbidity was registered in 27,339 patients with primary CRC. During the study period, the prevalence of comorbidity increased from 47% to 62%, multimorbidity increased from 20% to 37%. Hypertension and cardiovascular diseases were most prevalent and increased largely over time (respectively 16-29% and 12-24%). Pulmonary diseases increased in women, but remained stable in men. Average age at diagnosis increased from 68.3 to 69.5 years (p = 0.004). A low SES and male gender were associated with a higher risk of comorbidity (not changing over time). This study indicates that comorbidity among patients with CRC is common, especially in males and patients with a low SES. The prevalence of comorbidity increased from 1995 to 2010, in particular in presumably nutritional diseases. Ageing, increased life expectancy and life style changes may contribute to more comorbid diseases. Also, improved awareness among health care providers on the importance of comorbidity may have resulted in better registration. The increasing burden of comorbidity in patients with CRC emphasizes the need for more focus on individualized medicine. What's new Treating cancer in a patient who also has other diseases or conditions can be challenging, but is not unusual. In this study, the authors looked at comorbidity in patients with colorectal cancer over a period of 16 years, and found it increased over the time frame of the study, particularly hypertension and cardiovascular diseases. Patients with multiple conditions are less likely to respond well to treatment. These data underscore the importance of individualized treatment and awareness of other conditions that are increasingly present alongside the cancer. Copyright © 2012 UICC. Source

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