Expertisecentrum Nederlands

Abstract Background: In early-stage breast cancer, surgical de-escalation from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB) did not compromise oncologic safety. This has led to the realization that SLNB predominantly provides prognostic information and may itself not influence recurrence or survival. The BOOG 2013-08 trial was therefore designed to evaluate whether omission of SLNB in clinically T1-2N0 patients treated with breast-conserving surgery and whole-breast irradiation (summarized together as BCT) is safe with respect to regional recurrence rates (RR) and distant disease-free survival (DDFS). Methods: The BOOG 2013-08 (NCT02271828) is a multicenter, non-inferiority, randomized phase-3 trial including women with unilateral cT1-2N0 breast cancer treated with BCT. Clinically node-negative was based on negative findings on physical examination and preoperative axillary ultrasound (including negative cyto- or histopathology in case of a suspicious findings). The trial was conducted in the Netherlands between 2015 and 2022 across 25 centers. Patients were randomized (1:1) to SLNB or omission of SLNB. Randomization was stratified by clinical tumor size (<3 cm vs ≥3 cm), histological grade (grade I-II vs III), hormone receptor status (HR), HER2 status, age (≤50, 50 ≤ 75, >75 years), primary systemic therapy (PST) and participating center. The primary endpoint was 5-year RR; secondary endpoints as presented here were 3-year RR and DDFS. Cumulative probabilities of RR and DDFS were estimated using the Kaplan-Meier method. Non-inferiority was defined as an absolute difference in RR ≤5% in favor of the control group at 5 years. Analyses were performed per-protocol. Results: A total of 1,733 patients were enrolled across 25 centers. After excluding 159 patients (n=106 due to radiation therapy protocol violations), 1574 patients were included (SLNB: n=749; no-SLNB: n=825). At the time of analysis, 100% of patients had reached 3 years and 73% 5-year follow-up. Median follow-up was 5.0 years (range 0.78-6.86, IQR 1.94). Mean age was 61.5 years, 83% had cT1 tumors and 17% cT2 tumors. Tumor grade was I in 28.7%, II in 54.1% and III in 17.2%. Breast cancer subtype was HR+HER2- in 86.8%, triple negative in 5.8% and HER2+ in 7.4% of patients. In the SLNB arm, micro- and macrometastatic disease was detected in 6.0% and 7.7%, respectively. Preliminary data at a median 5-year follow-up showed that the estimated probability of RR was 0.5% in the SLNB arm (95% CI 0.0-1.1) and 1.2% in the no-SLNB arm (95% CI 0.4-2.0), corresponding to an absolute difference of 0.7% (95% CI -0.3 to 1.7). The confidence interval ranges from -0.3 to 0.7, indicating that the 5% non-inferiority margin is not exceeded. Five-year DDFS was 98.3% (95% CI 97.3-99.3) in the SLNB arm versus 96.1% (95% CI 94.5-97.7) in the no-SLNB arm (log-rank p=0.071).Chemo- or endocrine therapy was administered in 11.3% of patients as PST (12.3% SLNB arm vs. 10.3 no-SLNB arm, p=0.214). In total, 50.0% of patients received systemic therapy (51.2% SLNB vs. 49.0% no-SLNB, p 0.202). Of these 50.0%, 39.4% received chemotherapy with or without targeted therapy. Among ER-positive patients, adjuvant endocrine therapy was administered in 48.6% (SLNB) and 46.6% (no-SLNB), p=0.732, while chemotherapy was given in 9.8% and 8.2%, respectively (p=0.532). Conclusions: In cT1-2N0 breast cancer patients treated with BCT, omission of SLNB resulted in a non-inferior median 5-year RR and DDFS compared with SLNB. These premature findings support the omission of SLNB, at least in case of cT1N0, ER+, grade 1-2 breast cancer. This study further demonstrates that adjuvant hormonal therapy should not be a prerequisite for omission of the SLNB. Citation Format: R. J. Schipper, L. M. van Roozendaal, V. M. Wintraecken, J. M. Simons, M. Moossdorff, E. J. T. Luiten, F. van Duijnhoven, L. de Munck, L. F. C. Dols, R. Koelemij, R. van Eekeren, A. B. Francken, T. van Dalen, K. Keymeulen, J. Volders, J. A. van der Hage, H. Torrenga, P. A. Neijenhuis, P. Nijhuis, D. van Uden, E. Heuts, M. A. Bessems, C. D. Dirksen, M. H. Martens, M. F. Bouwmeester, K. Schenk, A. V. R. J. Bell, S. Maaskant-Braat, L. J. A. Strobbe, S. C. Linn, P. M. P. Poortmans, M. L. G. Vane, V. C. G. Tjan-Heijnen, K. K. B. T. van der Vijver, M. B. I. Lobbes, J. de Vries, L. Emelianova-Hiddink, J. Kandt, L. J. Boersma, J. H. W. de Wilt, S. M. J. van Kuijk, M. L. Smidt, BOOG 2013-08 Study Group. Omission of sentinel lymph node biopsy in clinically T1-2 node-negative breast cancer patients treated with breast-conserving therapy: results of the Dutch BOOG 2013-08 randomized controlled trial after a median follow-up of 5 years [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr GS2-11.

BackgroundChronic musculoskeletal pain (CMP) impacts around 20% of people globally, resulting in patients living with pain, fatigue, restricted social and employment capacity, and reduced quality of life. Interdisciplinary multimodal pain treatment (IMPT) programs have been shown to provide positive and sustained outcomes where all other interventions have failed. IMPT programs combined with multidimensional machine learning predictive patient profiles aim to improve clinical decision support and personalized patient assessments, potentially leading to better treatment outcomes.ObjectiveWe aimed to investigate integrating machine learning with IMPT programs and its potential contribution to clinical decision support and treatment outcomes for patients with CMP.MethodsThis prospective pilot study used a machine learning prognostic patient profile of 7 outcome measures across 4 clinically relevant domains, including activity or disability, pain, fatigue, and quality of life. Prognostic profiles were created for new IMPT patients in the Netherlands in November 2023 (N=17). New summary indicators were developed, including defined categories for positive, negative, and mixed prognostic profiles; an accuracy indicator with high, medium, and low levels based on weighted true- or false-positive values; and an indicator for consistently positive or negative outcomes. The consolidated reporting guidelines checklist for prognostic machine learning modeling studies was completed to provide transparency of data quality, model development methodology, and validation.ResultsThe machine learning IMPT prognostic patient profiles demonstrated high accuracy and consistency in predicting patient outcomes. The profile, combined with extended new prognostic summary indicators, provided improved identification of patients with predicted positive, negative, and mixed outcomes, supporting more comprehensive assessment. Overall, 82.4% (14/17) of prognostic patient profiles were consistent with clinician assessments. Notably, clinician case notes indicated the stratified prognostic profiles were directly discussed with around half (8/17, 47.1%) of patients. Clinicians found the prognostic patient profiles helpful in 88.2% (15/17) of initial IMPT assessments to support shared clinician and patient decision-making and discussion of individualized treatment planning.ConclusionsMachine learning prognostic patient profiles showed promising contributions for IMPT clinical decision support and improving treatment outcomes for patients with CMP. Further research is needed to validate these findings in larger, more diverse populations.

This chapter aims to provide teachers with a brief overview of the current research on what digital reading entails, the differences between print-based reading and on-screen reading, and what skills are required for digital reading. This chapter will serve as a frame of reference for the rest of the book. Reading comprehension is, in essence, the same when reading digitally or on paper. However, digital texts have a number of characteristics that require a different approach or additional skills when reading. In addition, when searching the internet for information for school assignments, students have to search for and read multiple digital texts. Multiple document reading entails navigating and searching for information, reading texts and evaluating them on their relevance and reliability, and integrating information from a variety of different texts. Finally, we describe the four dimensions of digital inclusion and their importance in schools for preparing students for digital society.

Tics can have a serious impact on the quality of life of children and their families. Behavioural therapy is an evidence-based first line treatment for tic disorders. This randomised controlled trial studied the efficacy of a brief, condensed group-based programme for children with tics (Dutch Trial Registry NL8052, 27 September 2019). Tackle your Tics is a four-day group treatment, including exposure and response prevention and supporting components, delivered by therapists and ‘experts by experience’. We collected outcome measures at baseline (T1), directly post-treatment (T2), and at three- and 6-months follow-up (T3, T4) including tic severity (primary outcome measure), tic-related impairment, quality of life, tic-related cognitions, emotional/behavioural functioning, family functioning, treatment satisfaction and adherence. Outcomes directly post-treatment improved in both the treatment group (n = 52) and waiting list (n = 54), but showed no statistically significant differences between the conditions (differential change over time T1-T2) on tic severity (Yale Global Tic Severity Scale), quality of life (Gilles de la Tourette Syndrome Quality of Life Scale), tic-related cognitions and family functioning. At longer term (T3), again no between-group difference was found on tic severity, but tic-related impairment, quality of life and emotional/behavioural functioning significantly improved in the treatment group compared to the waiting list. Mean treatment satisfaction scores were favourable for both children and parents. Directly posttreatment, Tackle your Tics showed no superior effect compared to waiting list. However, on longer term this brief four-day group treatment was effective in improving tic-related impairment, quality of life and emotional/behavioural functioning.

ObjectiveIntegrating patient’s and physician’s goals, especially in elderly patients with multimorbidity, might ultimately improve care. Efforts to develop such care innovations in patients with rheumatoid arthritis (RA) are lacking. The objective of our study was to develop and to pilot test a clinic for elderly patients with RA and multimorbidity.MethodsFirst, a referral strategy for and the content of an Elderly Multimorbidity Clinic (EMC) was developed. Next, the EMC was implemented, and it primarily focused on the personal goals of patients and medication review. The EMC was evaluated in a quantitative–qualitative approach.ResultsReferral considered useful by the rheumatologist was chosen as the referral criterion. A rheumatologist and internist–geriatrician provided care to referred patients (≥ 55 years) at the EMC during three visits over 1 year. Twenty patients with RA participated in the pilot study (mean age 76.8±7.7 years; 30% male). Only 12 (60%) patients attended the first follow‐up consultation, and three (15%) attended the second follow‐up consultation. During any follow‐up visit, 9/12 (75%) patients achieved one or more goals. Examples of accomplished goals were reduction of medication and improvement of mobility. In 19/20 (95%) patients, medication was remediated (stop medication for 13 patients; start medication for five patients) during the first visit. After 1 year, medication was changed back in 10 patients. Rheumatologists revealed uncertainty about meaningful referral, and patients and rheumatologists mentioned high (caregiver) burden because of extra visits as reasons for not attending follow‐up. Patients were satisfied with the care provided.ConclusionThis goal‐directed EMC led to the accomplishment of at least one goal in 75% of patients. Sustained benefits could not be demonstrated because of low follow‐up.

In de dialectische gedragstherapie (DGT) wordt het probleemgedrag bij de antisociale persoonlijkheidsstoornis (ASPS) gezien als een manier waarop de client emoties reguleert. Probleemgedrag is effectief gedrag op de korte termijn, maar veroorzaakt grote problemen op de lange termijn. In DGT laat de behandelaar de client vanaf de start van het contact ervaren dat hij de keuze heeft tussen doorgaan met problematisch gedrag of ermee stoppen, ook binnen een gedwongen kader. De therapeutische relatie vormt daarbij het houvast voor de client in het proces van veranderen van gedrag. Tegelijkertijd staat de behandelaar voor de taak haar eigen grenzen te bewaken. Hier beschrijven we de behandeling van ASPS met DGT bij een 32-jarige man. We bespreken de theoretische basis van het DGT-behandelprogramma en de voor DGT specifieke strategieen en interventies. Dan volgen de aanpassingen voor ASPS. Verbatim verslagen, aangevuld met reflecties, laten het beloop van de behandeling zien, waarna een conclusie en enkele aanbevelingen volgen.

In dit artikel krijgt de gz-psycholoog een overzicht aangeboden van de psychodiagnostiek van autismespectrumstoornissen (ASS) bij normaal intelligente volwassenen. Onderdelen als ontwikkelingsdiagnostiek, persoonlijkheidsonderzoek en onderzoek naar de cognitieve stijl worden beschreven waarbij de in de praktijk meest gebruikte testen en vragenlijsten worden besproken, met daarbij de belangrijkste bevindingen uit wetenschappelijk onderzoek. De onderdelen van psychodiagnostisch onderzoek naar ASS zijn overzichtelijk geschaard onder de overkoepelende benaming van descriptieve en structurele psychodiagnostiek. ASS-diagnostiek stelt de hulpverlener in staat zowel een ASS-diagnose te stellen als inzicht te krijgen in persoonlijkheid(spathologie) en sterke en zwakke (neuro-)cognitieve kanten van de onderzochte.