The decision to treat elderly patients with cancer aged 70 years or older with chemotherapy is generally based on clinical judgment of the clinician, in combination with the evidence obtained from... Show moreThe decision to treat elderly patients with cancer aged 70 years or older with chemotherapy is generally based on clinical judgment of the clinician, in combination with the evidence obtained from clinical studies performed in younger age groups. The instrument GA might be helpful to detect hidden shortcomings and may aid clinical decision making with regard to the feasibility of treatment with chemotherapy and prediction of survival in the elderly patients with cancer. The following questionnaires and tests were considered appropriate to obtain a practical GA: MNA, GFI, IQCODE, MMSE, and laboratory values of albumin, creatinine, lactate dehydrogenase and hemoglobin. The main questions we tried to answer were firstly to assess the predictive value prior to the start of chemotherapy of the chosen GA with respect to the probability to complete the planned chemotherapy and overall survival and secondly to analyze and determine which elements of the chosen GA were independently predictive to complete chemotherapy and which elements predicted early mortality.This thesis is the result of clinical research on certain elements of GA that might be useful for routine daily oncology practice, in order to select the proper patients and improve the outcome of treatment with chemotherapy. Show less
Kroep, J.R.; Werkhoven, E. van; Polee, M.; Groeningen, C.J. van; Beeker, A.; Erdkamp, F.; ... ; Gelderblom, H. 2015
Colorectal cancer is one of the most common cancers worldwide. Although there have been several improvements in screening, staging, and treatment in the past decades, survival differences remain.... Show moreColorectal cancer is one of the most common cancers worldwide. Although there have been several improvements in screening, staging, and treatment in the past decades, survival differences remain. For example among certain subgroups of patients, such as elderly patients and patients with comorbidities. Besides, inequalities in the quality of care between European countries remain. Quality control on surgery, radiotherapy, and pathology have been introduced in trials, followed by incorporation in the general care. Another option to incorporate improved quality of care is via an audit structure in which hospitals and clinicians can improve their results by learning from their own outcome statistics and those from colleagues treating a similar patient group. Although all these audit structures have achieved excellent results within countries, differences in outcome between European countries remain. A next step will b e to combine these national audits. The combined audit structure will provide a network in which __best practices__ can be compared and identified, including for certain subgroups, which has been initiated as European Registration of Cancer Care (EURECCA). To achieve optimal care for all patients, multidisciplinary care is the only way. By comparing multidisciplinary audit structures across countries, optimal treatment strategies within subgroups can be identified Show less
Aaldriks, A.A.; Giltay, E.J.; Cessie, S. le; Geest, L.G.M. van der; Portielje, J.E.A.; Tanis, B.C.; ... ; Maartense, E. 2013
