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Thielen N.,VU University Amsterdam | Visser O.,Netherlands Comprehensive Cancer Organisation IKNL | Ossenkoppele G.,VU University Amsterdam | Janssen J.,VU University Amsterdam
European Journal of Haematology | Year: 2016

Objective: To assess the impact and results of treatment of CML in the general population, we conducted a population-based, nationwide study on 3585 CML patients diagnosed between 1989 and 2012 in the Netherlands. Methods: Patient demographics were obtained from the Netherlands Cancer Registry. Information on age, gender, year of diagnosis, first treatment, and date of death were recorded. Overall survival (OS) was adjusted for death rates in the normal population. Results: Incidence in males decreased slightly from 1.2 per 100.000 person years (PY) in 1989–2000 to 0.9 in 2001–2012. For females, incidence remained stable with 0.7 per 100.000 PY in both periods. Incidence was age dependent and highest in males in the last decades of life. Treatment before 2000 mainly consisted of chemotherapy, while after 2007 TKI use was 88%. Five-year relative survival was only 36% before the introduction of TKIs but significantly increased to 79% after the introduction of TKI. Conclusions: This study gives insight into CML incidence, treatment, and survival in routine care in the Netherlands. Although OS improved since the introduction of TKIs, there is still room for further improvement. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Vugts G.,Catharina Hospital | Maaskant-Braat A.J.G.,Maxima Medical Center | de Roos W.K.,Gelderse Vallei Hospital | Voogd A.C.,Netherlands Comprehensive Cancer Organisation IKNL | And 2 more authors.
European Journal of Surgical Oncology | Year: 2016

Background Axillary pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is achieved in a substantial part of clinically node positive breast cancer patients. Treatment of the axilla after NAC varies widely, and new techniques to spare patients from an axillary lymph node dissection (ALND) are being introduced. Methods This Dutch nationwide survey regarding treatment of the initially clinically node positive axilla in patients receiving NAC was conducted amongst 148 surgical oncologists during November 2014–June 2015, to survey the diagnostic work-up, axillary mapping and willingness to omit ALND. Results Axillary ultrasound was considered a standard procedure in the diagnostic work-up by 99% of participants. The majority of 70% of participants stated that ALND could possibly be omitted in node positive patients with a favourable response to NAC. A positive correlation was observed between the total amount of patients treated, versus patients receiving NAC (P < 0.01). A total of 93 respondents performed axillary response evaluation after NAC, using imaging (72%), excision of localized lymph nodes (56%) or sentinel node biopsy (SNB; 45%). Decision-making in omitting ALND was influenced by the presence of N2–3 disease, patient age and type of breast surgery. Multivariable analysis showed that clinicians who administered NAC more often, were more likely to omit ALND (P < 0.01). Discussion The majority of surgeons are inclined to omit ALND in case of an axillary pCR. A large variety of techniques is being used to identify a pCR. The lack of consensus on this topic indicates the need for guidelines based on the best available evidence. © 2016 Elsevier Ltd

Paalman C.H.,Netherlands Cancer Institute | Van Leeuwen F.E.,Netherlands Cancer Institute | Aaronson N.K.,Netherlands Cancer Institute | De Boer A.G.E.M.,Coronel Institute of Occupational Health | And 4 more authors.
British Journal of Cancer | Year: 2016

Background:Little is known about employment outcomes after breast cancer (BC) beyond the first years after treatment.Methods:Employment outcomes were compared with a general population comparison group (N=91 593) up to 10 years after BC for 26 120 patients, diagnosed before age 55 between 2000-2005, with income and social benefits data from Statistics Netherlands. Treatment effects were studied in 14 916 patients, with information on BC recurrences and new cancer events.Results:BC survivors experienced higher risk of losing paid employment (Hazard Ratio (HR): 1.6, 95% Confidence Interval (95% CI) 1.4-1.8) or any work-related event up to 5-7 years (HR 1.5, 95% CI 1.3-1.6) and of receiving disability benefits up to 10 years after diagnosis (HR 2.0, 95% CI 1.6-2.5), with higher risks for younger patients. Axillary lymph node dissection increased risk of disability benefits (HR 1.5, 95% CI 1.4-1.7) or losing paid employment (HR 1.3, 95% CI 1.2-1.5) during the first 5 years of follow-up. Risk of disability benefits was increased among patients receiving mastectomy and radiotherapy (HR 1.2; 95% CI 1.1-1.3) and after chemotherapy (HR 1.7; 95% CI 1.5-1.9) during the first 5 years after diagnosis.Conclusions:BC treatment at least partly explains the increased risk of adverse employment outcomes up to 10 years after BC. © 2016 Cancer Research UK.

Bruins H.M.,Radboud University Nijmegen | Aben K.K.H.,Netherlands Comprehensive Cancer Organisation IKNL | Aben K.K.H.,Radboud University Nijmegen | Arends T.J.,Radboud University Nijmegen | And 2 more authors.
Urologic Oncology: Seminars and Original Investigations | Year: 2016

Introduction: Data from single-center series suggest that a delay in time to radical cystectomy (RC) more than 3 months after diagnosis of muscle-invasive bladder cancer (MIBC) is associated with pathological upstaging and decreased survival. However, limited data is available from population-based studies. In this study, the effect of delayed RC was assessed in a nationwide cohort. Materials and methods: Patients who underwent RC between 2006 and 2010 with primary clinical T2-T4N0M0 urothelial bladder cancer were selected using the Netherlands Cancer Registry database. Data from the Netherlands Cancer Registry was supplemented with data from the Nationwide Network and Registry of Histo- and Cytopathology database in case of incomplete information. The cohort was divided in patients who underwent RC ≤3 months (group I) vs. patients who underwent RC >3 months (group II). Median time from MIBC diagnosis to RC, variables associated with delayed RC >3 and the effect of delayed RC on staging and overall survival (OS) were evaluated in patients who underwent neoadjuvant therapy and patients who did not. Results: A total of 1,782 patients were included. Median follow-up time was 5.1 years for living patients and 1.3 years for deceased patients. Median time from MIBC diagnosis to RC was 50 days (interquartile range: 27 days) and 93% of patients underwent RC≤3 months. Patients older than 75 years (odds ratio [OR] = 0.50; 95% CI: 0.32-0.77), referred for RC (OR = 0.41; 95% CI: 0.26-0.69), and treated in a university hospital (OR = 0.34; 95% CI: 0.21-0.56) were less likely to undergo RC≤3 months. Pathologic upstaging rate (43.9% vs. 42.1%) and node-positive disease rate (20.2% vs. 21.7%) did not differ for group I and II. Delayed RC>3 months was not associated with decreased OS adjusting for confounding variables (hazard ratio = 1.16; 95% CI: 0.91-1.48; P = 0.25). Median time from MIBC diagnosis to RC in patients that received neoadjuvant therapy (n = 105) was 133 days (interquartile range: 62 days). Adjusting for confounding variables, delayed RC>3 months was not associated with OS (hazard ratio = 0.90; 95% CI: 0.45-1.82). Conclusions: The vast majority of patient underwent RC within 3 months after diagnosis of MIBC, as recommended in the European Association of Urology MIBC guideline. Delayed RC for more than 3 months had no adverse effect on staging and survival. © 2016 Elsevier Inc.

Vlenterie M.,Radboud University Nijmegen | Ho V.K.Y.,Netherlands Comprehensive Cancer Organisation IKNL | Kaal S.E.J.,Radboud University Nijmegen | Vlenterie R.,Health Evidence | And 3 more authors.
British Journal of Cancer | Year: 2015

Background:We performed a retrospective nationwide study to explore age as a prognostic factor in synovial sarcoma patients.Methods:Data on 613 synovial sarcoma patients were obtained from the Netherlands Cancer Registry. The prognostic relevance of age groups (children, adolescent and young adults (AYAs), adults, and elderly) was estimated by Kaplan-Meier survival curves and multivariable Cox-proportional hazards modelling.Results:A total of 461 patients had localised disease at diagnosis. The 5-year overall survival (OS) was 89.3±4.6%, 73.0±3.8%, 54.7±3.6%, and 43.0±7.0% in children (n=54), AYAs (n=148), adults (n=204), and elderly (n=55), respectively. Treatment modalities had no significant effect on survival in the univariable analysis. Multivariable analysis identified age at diagnosis, tumour localisation, and tumour size as significant factors affecting OS. Both tumour localisation and size were equally distributed over the age groups.Conclusions:We show that outcome of synovial sarcoma patients significantly decreases with age regardless of primary tumour site, size, and treatment. © 2015 Cancer Research UK.

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