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
Jacobs, A.; Liem, R.S.L.; Janssen, I.M.C.; Tollenaar, R.A.E.M.; Monpellier, V.M.; NOK Res Grp 2021
Background: In the Netherlands, patients only qualify for bariatric surgery when they have followed a 6-month mandatory weight loss program (MWP), also called the "last resort" criterion. One of... Show moreBackground: In the Netherlands, patients only qualify for bariatric surgery when they have followed a 6-month mandatory weight loss program (MWP), also called the "last resort" criterion. One of the rationales for this is that MWPs result in greater weight loss.Objectives: To determine weight loss during MWPs and the effect of delayed versus immediate qualification on weight loss 3 years after bariatric surgery.Setting: Outpatient clinic.Methods: This is a nationwide, retrospective study with prospectively collected data. All patients who underwent a primary bariatric procedure in 2016 were included. We compared weight loss between patients who did not qualify according to the last resort criterion at screening (delayed group) with patients that qualified (immediate group).Results: In total 2628 patients were included. Mean age was 44.4 years, 81.3% were female, and baseline BMI was 42.3 kg/m(2). Roux-en-Y gastric bypass (RYGB) was the most frequently performed surgery (77.0%), followed by sleeve gastrectomy (15.8%) and banded RYGB (7.3%). The delayed group (n = 831; 32%) compared with immediate group (n = 1797; 68%), showed less percentage of total weight loss (%TWL) during the MWP (1.7% versus 3.9%, P < .001) and time between screening and surgery was longer (42.3 versus 17.5 wk, P < .001). Linear mixed model analysis showed no significant difference in %TWL at 18- (P = .291, n = 2077), 24- (P = .580, n = 1993) and 36-month (P = .325, n = 1743) follow-up.Conclusion: This study shows that delayed qualification for bariatric surgery compared with immediate qualification does not have a clinically relevant impact on postoperative weight loss 3 years after bariatric surgery. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved. Show less
Purpose: Patients may transfer of hospital for clinical reasons but this may delay time to treatment. The purpose of this study is to provide insight in the extent of hospital transfer in breast... Show morePurpose: Patients may transfer of hospital for clinical reasons but this may delay time to treatment. The purpose of this study is to provide insight in the extent of hospital transfer in breast cancer care; which type of patients transfer and what is the impact on time to treatment.Methods: We included 41,413 breast cancer patients registered in the Netherlands Cancer Registry between 2014 and 2016. We investigated transfer of hospital between diagnosis and first treatment being surgery or neoadjuvant chemotherapy (NAC). Co-variate adjusted characteristics predictive for hospital transfer were determined. To adjust for possible treatment by indication bias we used propensity score matching (PSM). Time to treatment in patients with and without hospital transfer was compared.Results: Among 41,413 patients, 8.5% of all patients transferred to another hospital between diagnosis and first treatment; 4.9% before primary surgery and 24.8% before NAC. Especially young (aged <40 years) patients and those who underwent a mastectomy with immediate breast reconstruction (IBR) were more likely to transfer. The association of mastectomy with IBR with hospital transfer remained when using PSM. Hospital transfer after diagnosis significantly prolonged time to treatment; breast conserving surgery by 5 days, mastectomy by 7 days, mastectomy with IBR by 9 days and NAC by 1 day.Conclusions: While almost 5% of Dutch patients treated with primary surgery transfer hospital after diagnosis and up to 25% for patients treated with NAC, our findings suggest that especially those treated with primary surgery are at risk for additional treatment delay by hospital transfer. (C) 2018 Published by Elsevier Ltd. Show less
