This thesis assessed the quality of breast cancer care on different level by analyzing data from a tertiary cancer center and multiple nationwide databases.In order to do so, we first provided... Show moreThis thesis assessed the quality of breast cancer care on different level by analyzing data from a tertiary cancer center and multiple nationwide databases.In order to do so, we first provided insight into breast cancer patients changing hospital and the medical impact of a second opinion. The results demonstrated that a hospital transfer after diagnosis is a delaying factor for primary treatment, specifically for those who undergo surgery. Furthermore, we assessed in a reproducible manner that second opinions can have a significant impact on diagnostics and primary treatment strategies. In the second part, we assess the delaying impact of postmastectomy immediate breast reconstruction on the continuity of the adjuvant chemotherapy pathway. This part furthermore highlights the importance of timely initiation of adjuvant chemotherapy on survival in patients diagnosed with triple-negative breast cancer. Finally, we evaluate the use of breast‐contour preservation and safety of oncoplastic strategies on an (inter)national level. We demonstrate that a breast reconstruction using a direct‐to‐implant compared to a two‐stage technique is associated with a lower unplanned revision. Although the total breast‐contour preservation rate in the Netherlands is similar to Denmark, different strategies are used. Furthermore, oncoplastic techniques seem a safe option regarding re‐excision and conversion to mastectomy. Hereby, the findings in this thesis may contribute to different dimensions of the quality of breast cancer care. Show less
Background and purpose: During oncoplastic breast-conserving surgery (BCS), the surgical cavity is closed to reduce seroma formation. This makes the radiotherapy target definition using clips... Show moreBackground and purpose: During oncoplastic breast-conserving surgery (BCS), the surgical cavity is closed to reduce seroma formation. This makes the radiotherapy target definition using clips challenging, leading to poor inter-observer agreement and potentially geographical misses. We hypothesize that injecting a radiopaque hydrogel in the lumpectomy cavity before closure improves radiotherapy target definition and agreement between observers.Materials and methods: Women undergoing BCS in a single university hospital were prospectively accrued in the study. Three to 9 ml of iodined PolyEthylene Glycol (PEG) hydrogel and clips were inserted in the lumpectomy cavity. A CT-scan was performed at 4 to 6 weeks. CT images of BCS patients with standard clips only were used as control group, matched on age, specimen weight, and distance between clips. Six radiation oncologists delineated the tumor bed volumes and rated the cavity visualization scores (CVS). The primary endpoint was the agreement between observers measured using a Conformity Index (Cx).Results: Forty-two patients were included, 21 hydrogel procedures and 21 controls, resulting in 315 observer pairs. The feasibility of the intervention was 100%. The median Cx was higher in the intervention group (Cx = 0.70, IQR [0.54-0.79]) than in the control group (Cx = 0.54, IQR [0.42-0.66]), p < 0.00, as were the CVS (3.5 [2.5-4.5] versus 2.5 [2-3.5], p < 0.001). The rate of surgical site infections was similar to literature.Conclusions: The use of radiopaque PEG enables to identify the lumpectomy cavity, resulting in a high inter-observer agreement for radiotherapy target definition. This intervention is easy to perform and blend well into current practice. (C) 2018 Elsevier B.V. All rights reserved. Show less
