Objective: Unmet health care needs require additional care resources to achieve optimal patient well-being. In this nationwide study we examined associations between a number of risk factors and... Show moreObjective: Unmet health care needs require additional care resources to achieve optimal patient well-being. In this nationwide study we examined associations between a number of risk factors and unmet needs after treatment among women with breast cancer, while taking into account their health care practices. We expected that more care use would be associated with lower levels of unmet needs. Methods: A multicenter, prospective, observational design was employed. Women with primary breast cancer completed questionnaires 6 and 15 months post-diagnosis. Medical data were retrieved from medical records. Direct and indirect associations between sociodemographic and clinical risk factors, distress, care use, and unmet needs were investigated with structural equation modeling. Results: Seven hundred forty-six participants completed both questionnaires (response rate 73.7%). The care services received were not negatively associated with the reported levels of unmet needs after treatment. Comorbidity was associated with higher physical and daily living needs. Higher age was associated with higher health system-related and informational needs. Having had chemotherapy and a mastectomy were associated with higher sexuality needs and breast cancer-specific issues, respectively. A higher level of distress was associated with higher levels of unmet need in all domains. Conclusions: Clinicians may use these results to timely identify which women are at risk of developing specific unmet needs after treatment. Evidence-based, cost-effective (online) interventions that target distress, the most influential risk factor, should be further implemented and disseminated among patients and clinicians. Show less
In this thesis the feasibility of tailored follow-up for early-stage breast cancer patients is evaluated. In order to do so, we first determined the risk of locoregional recurrence (LRR) dependent... Show moreIn this thesis the feasibility of tailored follow-up for early-stage breast cancer patients is evaluated. In order to do so, we first determined the risk of locoregional recurrence (LRR) dependent on local treatment in a large cohort of low-risk breast cancer patients, treated with adequate modern systemic therapy. In the second part we evaluated both patients__ and professionals__ needs and preferences for breast cancer follow-up and we reviewed the literature on cost effectiveness of known follow-up schedules. Finally we prospectively examined whether the implementation of a tailored follow-up programme, based on a prognostic index for LRR, is feasible and acceptable to patients and professionals. The results show that in general, implementation of minimised tailored follow-up seems feasible, but professionals tend to more frequent follow-up. Patients accept less intensive follow-up schedules and follow-up by a nurse practitioner. Given the low risk of LRR, tailoring should not only be done based on this risk, but individually, based on the presence of treatment related side effects, either physical or psychosocial. If patients do not experience side effects, annual planned mammography and telephone contact coordinated by a single professional, preferably a specialised nurse, suffice in case of easily accessible information and on demand visits. Show less
Hezewijk, M. van; Smit, D.J.F.; Bastiaannet, E.; Scholten, A.N.; Ranke, G.M.C.; Kroep, J.R.; ... ; Velde, C.J.H. van de 2014
We reviewed the literature between January 1985 and June 2011 on the costs of different follow-up strategies for patients treated for early breast cancer. A total of 186 abstracts were retrieved of... Show moreWe reviewed the literature between January 1985 and June 2011 on the costs of different follow-up strategies for patients treated for early breast cancer. A total of 186 abstracts were retrieved of which eleven publications were considered relevant; 6 randomised clinical trials, 4 retrospective cohort studies and 1 'minisymposium'. The follow-up strategies, outcome measures and methods of analysis used in these studies vary widely, so no general conclusions can be drawn. However, from the results we infer that patient-led follow-up by a nurse practitioner, follow-up by a general practitioner, or telephone follow-up is feasible and cost-effective, without routine additional tests, except annual mammograms. In this era of increasing health care costs, cost-effectiveness, evaluated in a standardised way, should be taken into account in future clinical trials. Show less
Hezewijk, M. van; Hille, E.T.M.; Putter, H.; Rea, D.; Hasenburg, A.; Markopoulos, C.; ... ; Team Study Grp 2012
Background: In evaluating follow-up of early breast cancer, patients' views on care are important. The aim of this study was to evaluate the effect of the introduction of nurse practitioners (NPs)... Show moreBackground: In evaluating follow-up of early breast cancer, patients' views on care are important. The aim of this study was to evaluate the effect of the introduction of nurse practitioners (NPs) in a breast cancer unit on patients' informational needs, preferences and attitude towards follow-up. Patients and methods: A cross-sectional survey was performed among two groups in 2005. Group A (n = 89) consisted of patients operated before, and group B (n = 100) after the introduction of a breast cancer unit (respectively in 1998-1999 and 2001-2004). Results: Response was 72% in group A and 84% in group B. Median follow-up was 69 (54-86) and 33 (0-57) months, respectively. Aspects highly appreciated by patients in both groups were lifetime follow-up, information about prognosis, life style and additional investigations. Important discussion subjects were fatigue, pain, genetic factors, prevention and arm function/lymph-oedema. Less valued aspects were information about peers, conversations with psychologists or social workers, breast reconstruction, and acceptation by family members. The informational needs and preferences did not differ statistically significantly between both groups. In group B, communication with the caregiver was valued higher and more patients indicated that the caregiver took the time needed. More patients in group B indicated that follow-up could be performed by the NP. Duration of follow-up correlated with preferred frequency, not with informational needs in follow-up, only young age increased these needs. Conclusion: Despite the limitations of this retrospective study, we conclude that while expectations and informational needs did not change with the introduction of a NP to the standard care, patient satisfaction increased and communication and time taken were appreciated more. (C) 2011 Elsevier Ltd. All rights reserved. Show less
Hezewijk, M. van; Hille, E.T.M.; Scholten, A.N.; Marijnen, C.A.M.; Stiggelbout, A.M.; Velde, C.J.H. van de 2011
Aims: After treatment, early breast cancer patients undergo follow-up according to standard regimens. After the first year, the main goal is particularly to detect locoregional recurrences (LRR).... Show moreAims: After treatment, early breast cancer patients undergo follow-up according to standard regimens. After the first year, the main goal is particularly to detect locoregional recurrences (LRR). Our aim was to develop a simple prognostic index to predict LRR to tailor the follow-up programme. Methods: We used data from four large international clinical randomised trials and constructed the prognostic index using Cox proportional hazards regression. The bootstrap (a resampling method) was used for internal validation. Results: A total of 6516 patients treated according to current guidelines with complete covariable information were used for analysis. Covariables important for LRR in patients treated with breast conserving therapy were age, pathological tumour status, boost and surgical margins. The same variables were important for patients treated with a mastectomy, however, instead of the boost, the pathological nodal status was important. The index is composed to consist of three groups based on LRR risk after 10-years. Conclusions: We constructed a simple prognostic index that can be used to estimate risks of LRR in patients with early breast cancer. The prognostic index enables patients to be stratified into three subgroups with different outcomes with regard to LRR. (C) 2010 Elsevier Ltd. All rights reserved. Show less
AIMS After treatment, early breast cancer patients undergo follow-up according to standard regimens. After the first year, the main goal is particularly to detect locoregional recurrences (LRR).... Show moreAIMS After treatment, early breast cancer patients undergo follow-up according to standard regimens. After the first year, the main goal is particularly to detect locoregional recurrences (LRR). Our aim was to develop a simple prognostic index to predict LRR to tailor the follow-up programme. METHODS We used data from four large international clinical randomised trials and constructed the prognostic index using Cox proportional hazards regression. The bootstrap (a resampling method) was used for internal validation. RESULTS A total of 6516 patients treated according to current guidelines with complete covariable information were used for analysis. Covariables important for LRR in patients treated with breast conserving therapy were age, pathological tumour status, boost and surgical margins. The same variables were important for patients treated with a mastectomy, however, instead of the boost, the pathological nodal status was important. The index is composed to consist of three groups based on LRR risk after 10-years. CONCLUSIONS We constructed a simple prognostic index that can be used to estimate risks of LRR in patients with early breast cancer. The prognostic index enables patients to be stratified into three subgroups with different outcomes with regard to LRR. Show less
Hezewijk, M. van; Creutzberg, C.L.; Putter, H.; Chin, A.; Schneider, I.; Hoogeveen, M.; ... ; Marijnen, C.A.M. 2010
Background and purpose: Efficacy of radiotherapy for epithelial skin cancer was evaluated and treatment outcomes of two electron beam fractionation schedules were compared. Materials and methods:... Show moreBackground and purpose: Efficacy of radiotherapy for epithelial skin cancer was evaluated and treatment outcomes of two electron beam fractionation schedules were compared. Materials and methods: Outcome data of 434 epithelial skin cancers in 333 patients were analysed; 332 were basal cell carcinomas (BCCs) and 102 squamous cell carcinomas (SCCs). Patients were treated with electron beam, and received either 54 Gy in 18 fractions (n = 159) or 44 Gy in 10 fractions (n = 275). Local recurrence free (LRF) rates were analysed as well as metastases free rates, cancer specific survival (CSS) and cosmetic result. Results: Median follow-up was 42.8 months. For BCC, actuarial 3-year LRF rates were 97.6% for tumours treated with 54 Gy and 96.9% for 44 Gy. In SCC 3-year LRF rates were 97.0% for 54 Gy and 93.6% for 44 Gy (n.s.). T stage was found to be the only significant factor for recurrence (p = 0.036). Three-year CSS was 98% for SCC and 100% for BCC. Conclusions: Electron beam irradiation is a safe and effective treatment modality for epithelial skin cancer. In view of a similar efficacy and patient convenience of the hypofractionated schedule, 44 Gy in 10 fractions can be regarded the radiation schedule of choice. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 95 (2010) 245-249 Show less
