Netherlands Comprehensive Cancer Organisation

Abstract Objective Population-based information regarding adherence to first-line chemotherapy in epithelial ovarian cancer is scarce. This study aimed to evaluate chemotherapy adherence, reasons for chemotherapy modifications, and associations with overall survival. Methods Advanced-stage epithelial ovarian cancer patients diagnosed between January 2015 and December 2021 were identified from the Netherlands Cancer Registry. Patients who underwent cytoreductive surgery combined with platinum- and taxane-based chemotherapy were included. Patients were categorized into two groups: adherent (patients without modifications) and non-adherent (patients with modifications: dose reduction, chemotherapy interruption, and/or reduction in chemotherapy cycles). Reasons for modifications were assessed. Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze overall survival. Results Among the cohort (N = 3,687), 54% of patients underwent chemotherapy modifications. Dose reduction (38%) was the most common, followed by interruption (24%) and reduction in chemotherapy cycles (9%). Non-adherence was associated with poorer performance scores, higher comorbidity indices, and undergoing primary cytoreductive surgery. Neurotoxicity and hematologic toxicity were the primary reasons for modifications in platinum (33% and 37%) and taxane (47% and 35%) agents. No association with survival was found for dose reduction and interruption. However, reduction in chemotherapy cycles was associated with lower 5-year overall survival (32% (95% CI 26%-38%) vs. 36% (95% CI 34%-38%)), remaining significant after multivariable adjustment (hazard ratio 1.36; 95% CI 1.17-1.59). Conclusion A significant proportion of Dutch advanced-stage epithelial ovarian cancer patients undergo chemotherapy modifications. No impact on overall survival was found for dose reduction or chemotherapy interruption, warranting prospective studies. Reduction in chemotherapy cycles was negatively associated with overall survival, possibly reflecting underlying treatment ineffectiveness. Key messages What is already known on this topic Guideline-recommended chemotherapy for advanced epithelial ovarian cancer is often difficult to deliver in routine practice, and real-world data on adherence and its impact on survival are limited. What this study adds In this nationwide retrospective cohort, over half of patients experienced chemotherapy modifications; dose reductions and interruptions were not associated with poorer overall survival, whereas a reduction in the number of cycles showed an association with worse outcomes, although this may partly reflect underlying disease severity or treatment response. How this study might affect research, practice or policy Our findings suggest that standard dosing and treatment duration of six cycles may not always be necessary, emphasizing the need to tailor treatment plans to optimize both efficacy and tolerability in advanced-stage epithelial ovarian cancer patients

People facing incurable cancer need appropriate informal psychosocial care. This study examines the experiences and needs of visitors of IPSO centers (psychosocial supporting centers for life with and after cancer) for people facing incurable cancer in order to optimize the services provided by IPSO centers for this group. Semi-structured interviews were conducted with visitors of IPSO centers, both patients and relatives facing incurable cancer. The interviews were analyzed thematically. Eight themes and two sub themes were identified. In total, 18 patients and 13 relatives and bereaved relatives were interviewed. Participants expressed a strong need for understanding, exchanging information and finding ways to fill their days. They appreciated IPSO's non-obligatory approach and highlight the value of sharing stories with others. Many participants experienced mixed peer groups including both people facing curable and incurable cancer, as uncomfortable. They emphasized the benefit of having separate peer groups for those facing incurable cancer, including able to talk openly about end of life and a deeper sense of understanding and connection. A few participants found these groups inaccessible due to a specific setup. Visitors also experience unpredictability and uncertainty from their illness, making planning difficult, which also affect their IPSO visit. IPSO centers play a crucial role in supporting people facing incurable cancer. To best meet their needs, it is essential to facilitate peer contact by organizing special peer groups or by introducing those facing incurable cancer to each other in another way. It is important to take into account accessibility. Further research should focus on individuals who need IPSO's informal care but are not able to benefit from it due to their burden of disease.

The FAST-Forward trial demonstrated that 26Gy in 5 fractions for whole breast irradiation (WBI) has similar outcomes as 40Gy in 15 fractions. Since radiation treatment plans in the Netherlands in general deliver higher target doses, we aimed to compare acute toxicity and quality of life of the adjuvant 26Gy and the 40Gy schedules in a real-world setting, including after oncoplastic surgery. Eligible were women ≥50years with breast cancer receiving WBI or partial breast irradiation (PBI) between 2018 and 2023 in two Dutch centres, with either 26Gy/5 fractions in 1week or 40Gy/15 fractions in 3weeks. Acute toxicity was assessed using CTCAE v5.0 during and≤4 weeks following radiotherapy. Patient-reported outcomes were evaluated using EORTC-QLQ-C30/BR23 prior to radiotherapy, at 3months and 1year post-radiotherapy. In total, 832 patients received 26Gy/5 fractions (70.2% WBI, 12.9% oncoplastic surgery) and 845 patients 40Gy/15 fractions (81.9% WBI, 14.2% oncoplastic surgery). For WBI and PBI, grade≥1 dermatitis and fatigue were less common after 26Gy than 40Gy: 61-67 % versus 86-91% and 42-43% versus 56% respectively (p<0.001-0.005). After oncoplastic surgery, 26Gy patients less often experienced grade≥1 dermatitis than 40Gy patients (77% vs 94%, p<0.001). At 3months and 1-year post-radiotherapy, 26Gy and 40Gy patients reported comparable patient-reported outcomes. We confirmed the safety of the 26Gy/5 fractions schedule in terms of acute toxicity and quality of life compared to the 40Gy/15 fractions schedule, also when treated with higher target coverage and following oncoplastic breast-conserving surgery.

Studies on patient-reported outcomes (PROs) among cancer survivors are increasing but are most often limited to PRO and clinical data. To better understand the underlying biological mechanisms that mediate a decline in health after cancer, several PROFILES-registry studies were enriched with biological data. This paper summarizes lessons learned from collecting blood samples to obtain biomarker data among survivors and controls in large-scale ambulatory cohort studies. These lessons address financial challenges, ethical issues, insurance, legal matters, standardization of assessment, recruitment, communication with participants, lab facilities and protocols, transportation, the need for a biobank, and the value of a normative population. We also describe our experiences with collecting remote blood samples in these studies among cancer patient populations and a study in our normative population to illustrate these issues further.

BackgroundPREDICT Breast is a clinical decision-support tool estimating prognosis and the absolute benefit of adjuvant systemic therapies in early breast cancer. PREDICT v2.2 is recommended in Dutch guidelines. Both v2.2 and the recently updated v3.1 have not been validated in the Dutch population. This study compares the predictive performance of PREDICT v3.1 and v2.2 for 10-year OS in Dutch breast cancer patients.MethodsWomen diagnosed between 2005 and 2013 with primary invasive breast cancer were selected from the Netherlands Cancer Registry. Ten-year OS predictions from v2.2 and v3.1 were compared with observed OS for the overall cohort and 36 subgroups defined by oestrogen receptor (ER) status, HER2-status, age, and tumour stage. Discrimination (ability to distinguish patients with different outcomes) and calibration (agreement between predicted and observed outcomes) of both models were assessed.ResultsAmong 101,282 patients, both versions showed moderate discrimination (AUC v2.2 = 0.768; v3.1 = 0.775) and calibration (v2.2 intercept: 0.07; slope: 1.09; v3.1 intercept: 0.12, slope: 1.00). V3.1 slightly overestimated (1.9%), whereas v2.2 slightly underestimated (1.6%) 10-year OS. Across subgroups, v3.1 generally outperformed v2.2 except in patients aged >75 years, where v2.2 provided more accurate estimates. In ER-/HER- patients aged 50–75 years, v3.1 overestimated (1.5–2.8%) and v2.2 underestimated (2.8–5.3%) 10-year OS.ConclusionBoth PREDICT v2.2 and v3.1 accurately predict 10-year OS in Dutch breast cancer patients, with small differences between versions that vary by subgroup. No single model is optimal for all patients highlighting the need for subgroup-specific recalibration and careful interpretation when applying PREDICT.

Overall survival (OS) of patients with stage IV large cell neuroendocrine carcinoma (LCNEC) is poor and optimal systemic treatment is unknown. Here, we describe clinical outcomes per treatment strategy of patients with stage IV LCNEC, including stratification by immunohistochemical (IHC) protein RB1 (pRb) status. Clinical data were obtained from all patients with LCNEC (2019-2022) in the Netherlands Cancer Registry (NCR). Central pathology review and IHC pRb staining were performed when tumor material was available. OS was calculated from time of diagnosis of stage IV until death, last OS update was April 2024. In total 269/530 patients (51 %) received systemic treatment, and 132 samples were eligible for pathology review. In 88/132 (67 %) the diagnosis LCNEC was confirmed (other diagnoses: SCLC (34 %), NSCLC NOS (34 %)). The median OS of all panel-reviewed LCNEC patients was 7.4 months. Patients treated with chemo-immunotherapy had a numerically, but not statistically significant different survival compared to chemotherapy (median OS 9.6 months versus OS of 6.5 months; HR 0.71, 95 % CI 0.42-1.2). This was different from the real-world LCNEC patients, where a benefit of immunotherapy was observed (median OS 10.7 months versus OS of 6.7 months; HR 0.53, 95 % CI 0.4-0.72). In real-world half of patients with stage IV LCNEC do not receive systemic treatment. Accurate diagnosing LCNEC is challenging and therefore introduces bias (i.e. other diagnoses as SCLC instead of LCNEC) in real-world cohorts, which in turn has impact on analysis of treatment outcomes. Patients with panel-reviewed LCNEC have a poor prognosis and no statistically significant improvement was observed with chemo-immunotherapy.

BackgroundAdopting and maintaining favorable lifestyle changes can be challenging for postmenopausal breast cancer (PMBC) survivors. Understanding their experiences and needs can help tailor lifestyle support throughout their care journey.PurposeThis qualitative study explored 1) perceived determinants relevant for favorable lifestyle change among PMBC survivors, 2) the needs and preferences of PMBC survivors regarding lifestyle support, and 3) perceived determinants relevant for preferred timing of lifestyle support among PMBC survivors.MethodsA total of 42 in-depth longitudinal interviews were conducted at one year (n = 24) and 1.5 years (n = 21) following a breast cancer diagnosis. Data were analyzed using thematic analysis.ResultsOur analysis revealed 12 main themes: 1) 3 themes describe determinants that may affect the process of favorable lifestyle change (type of lifestyle behavior, previous attempts to change lifestyle, comorbidities), 2) 3 themes express PMBC survivors’ needs for lifestyle support from health care professionals (HCPs) (need for information, need for activation by lifestyle support, need for effective communication by HCPs), 3) 6 themes describe determinants influencing PMBC survivors’ preferred timing of addressing these needs (type of treatment, coping style, previous experience with cancer, personality, motivation for lifestyle change, social support).ConclusionsLifestyle support should consider psychological and physical effects of breast cancer diagnosis and treatment, which may hinder some PMBC survivors’ ability to make favorable lifestyle choices. Our results suggest that HCPs should offer ongoing individualized lifestyle support throughout the care continuum to meet the varied needs of PMBC survivors.

This study investigated the association between income, tumor stage, and treatment in non-small cell lung cancer (NSCLC) patients, stratified by Eastern Cooperative Oncology Group performance status (ECOG-PS). Patients diagnosed with NSCLC between 2017 and 2022 were selected from the Netherlands Cancer Registry (N = 71,025). Median household income at postal code level served as a proxy for income. Logistic regression was used to investigate the association between income, tumor stage at diagnoses and treatment. All analyses were stratified by ECOG-PS (PS0-1 vs. PS2+). Patients with an intermediate or higher income were more likely to be diagnosed with a stage IV tumor compared with those with a lower income. This was seen in patients with PS0-1 (odds ratio [OR]intermediate_vs_lower: 1.13 [95% confidence interval [95% CI]: 1.08-1.18], ORhigher_vs_lower: 1.23 [1.18-1.29]) and PS2+ (ORintermediate_vs_lower: 1.19 [1.11-1.27], ORhigher_vs_lower: 1.30 [1.19-1.41]). In patients with PS0-1 and a stage II or III tumor, those with an intermediate or higher income more often received a cancer treatment (stage II ORintermediate_vs_lower: 1.47 [1.09-1.99], ORhigher_vs_lower: 1.54 [1.13-2.11], stage III ORintermediate_vs_lower: 1.20 [1.03-1.40], ORhigher_vs_lower: 1.30 [1.09-1.55]). In patients with PS0-1 and a stage IV tumor, those with an intermediate or higher income more often received immunotherapy (ORintermediate_vs_lower: 1.10 [1.02-1.19], ORintermediate_vs_lower: 1.30 [1.20-1.41]) and systemic treatment (ORintermediate_vs_lower: 1.29 [1.20-1.39], ORhigher_vs_lower: 1.50 [1.37-1.63]). The latter was also found in patients with PS2+ (ORintermediate_vs_lower: 1.22 [1.08-1.38], ORhigher_vs_lower: 1.42 [1.23-1.64]). We thereby showed that even in a country with a universal healthcare system, large differences can be seen in the treatments of NSCLC patients according to income.