Background: Many cancer patients who have already survived some time want to know about their prognosis, given the pre-condition that they are still alive. We described and interpreted ...population-based conditional 5-year relative survival rates. Patients and methods: The long-standing Eindhoven Cancer Registry collects data on all patients diagnosed with cancer in the southern part of the Netherlands. Patients aged 25–74 years, diagnosed between 1960 and 2004, were included. Conditional 5-year relative survival was computed for every additional year survived (follow-up period 1980–2004). Results: For patients with colorectal cancer, cutaneous melanoma or stage I breast cancer, conditional 5-year relative survival was >95% after having survived 3–15 years. However, for stomach, lung, stage II or III breast, prostate cancer or Hodgkin lymphoma, conditional 5-year relative survival did not exceed 75–94%. Initial differences in survival at diagnosis between age, gender and stage groups largely disappeared after having survived for 5–10 years. Conclusion: Prognosis for patients with cancer generally improved with each year survived. Patients with colorectal cancer, cutaneous melanoma or stage I breast cancer hardly exhibit any excess mortality after 3–15 years, whereas for patients with other tumours survival remained poorer than for the general population. Insight into conditional survival is especially useful for (ex)patients, who may use this information to plan their remaining life.
Liver metastases present with distinct histopathological growth patterns (HGPs), including the desmoplastic, pushing and replacement HGPs and two rarer HGPs. The HGPs are defined owing to the ...distinct interface between the cancer cells and the adjacent normal liver parenchyma that is present in each pattern and can be scored from standard haematoxylin-and-eosin-stained (H&E) tissue sections. The current study provides consensus guidelines for scoring these HGPs.
Guidelines for defining the HGPs were established by a large international team. To assess the validity of these guidelines, 12 independent observers scored a set of 159 liver metastases and interobserver variability was measured. In an independent cohort of 374 patients with colorectal liver metastases (CRCLM), the impact of HGPs on overall survival after hepatectomy was determined.
Good-to-excellent correlations (intraclass correlation coefficient >0.5) with the gold standard were obtained for the assessment of the replacement HGP and desmoplastic HGP. Overall survival was significantly superior in the desmoplastic HGP subgroup compared with the replacement or pushing HGP subgroup (P=0.006).
The current guidelines allow for reproducible determination of liver metastasis HGPs. As HGPs impact overall survival after surgery for CRCLM, they may serve as a novel biomarker for individualised therapies.
Abstract We present trends in incidence, early treatment and survival of Chronic Lymphocytic Leukaemia (CLL) between 1989 and 2008, based on population-based data from the Netherlands Cancer ...Registry. Incidence rates were stable at 5.1 per 100,000 person-years for males, but increased from 2.3 to 2.5 for females, especially for females aged 50–64 years (from 3.6 to 4.3). Patients were less likely to receive chemotherapy within six months, i.e. from 29% to 24% among males and from 25% to 21% among females. Five-year relative survival increased from 61% in 1989–1993 to 70% 2004–2008 for males, and from 71% to 76% for females. The relative excess risk of dying decreased in time to 0.7 (males) and 0.9 (females) in 2004–2008, reference 1989–1993, and increased with age to 2.9 (males) and 1.8 (females) in patients aged 75–94 years, reference 30–64 years. The increasing incidence among females aged 50–64 coincided with the introduction of mass screening for breast cancer, which resulted in a large group of women under increased surveillance and possibly led to increased detection of CLL. The increase in survival might be underestimated due to possible decreased or delayed registration of indolent cases and the retroactive effect of the introduction of new therapies.
To compare overall survival between women with unilateral breast cancer (UBC) and contralateral breast cancer (CBC). Women with UBC (
N
= 182,562; 95 %) and CBC (
N
= 8,912; 5 %) recorded in the ...Netherlands Cancer Registry between 1989 and 2008 were included and followed until 2010. We incorporated CBC as a time-dependent covariate to compute the overall mortality rate ratio between women with CBC and UBC. Prognostic factors for overall death were examined according to age at first breast cancer. Women with CBC exhibited a 30 % increase in overall mortality (Hazard Ratio (HR), 95 % Confidence Interval: 1.3, 1.3–1.4) compared with UBC, decreasing with rising age at diagnosis of first breast cancer (<50 years: 2.3, 2.2–2.5 vs. ≥70 years: 1.1, 1.0–1.1). Women older than 50 years at CBC diagnosis and diagnosed 2–5 years after their first breast cancer exhibited a 20 % higher death risk (1.2, 1.0–1.3) compared to those diagnosed within the first 2 years. In women younger than 50 years, the HR was significantly lower if the CBC was diagnosed >5 years after the first breast cancer (0.7, 0.5–0.9). The prognosis for women with CBC significantly improved over time (2004–2008: 0.6, 0.5-0.7 vs. 1989–1993). Women with CBC had a lower survival compared to women with UBC, especially those younger than 50 years at first breast cancer diagnosis. A tailored follow-up strategy beyond current recommendations is needed for these patients who, because of their age and absence of known familial risk, are currently not invited for population-based screening.
The course of fatigue and quality of life in survivors of non-Hodgkin's lymphoma is unknown. The aims of this study were, therefore, to assess fatigue and quality of life in patients with ...non-Hodgkin's lymphoma following primary treatment, compare fatigue and quality of life in these patients with those of an age- and sex matched normative population to assess the severity of concerns and identify associations with fatigue of survivors who remained fatigued. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with non-Hodgkin's lymphoma from 1999-2009. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Fatigue Assessment Scale were completed once by 824 survivors of non-Hodgkin's lymphoma (80% response rate); 434 survivors completed these questionnaires again 1 year later. Survivors of non-Hodgkin's lymphoma reported more clinically relevant fatigue up till 10 years post-diagnosis compared to a normative population (P<0.001). Mean fatigue scores remained fairly stable over time (T1: x=28, SD=26; T2: x=30, SD=27, P=0.14): 22-28% of survivors reported deterioration, 19-23% reported improvement and 44-54% reported constant fatigue. Survivors who reported constant fatigue were more often diagnosed with stage IV disease and had more comorbid diseases. They were additionally more often female and divorced. Having comorbidities and being without a partner were also associated with constant fatigue in the normative population. In conclusion, six out of every ten responding non-Hodgkin's lymphoma survivors reported a high level of fatigue up till 10 years after diagnosis. Mean fatigue scores remained stable over time and survivors reporting constant fatigue more often had stage IV disease at diagnosis and comorbidities.
Abstract Background Time–space incidence maps of the Netherlands indicated differences in incidence of cutaneous melanoma (melanoma) over the country, which might be related to sociodemographic ...characteristics of living environment and socioeconomic status (SES) of the patients. The goal of this study was to refine the current approaches to prevention and early detection of melanoma by revealing relationships between sociodemographic factors and incidence of melanoma in the Netherlands. Methods Age-adjusted incidence rates were calculated from the Netherlands Cancer Registry. Data on sociodemographic factors were obtained from Statistics Netherlands. Logistic regression analysis was performed to investigate determinants of variation in incidence at the ecological level. At the individual level tumour characteristics were linked to SES based on postal code at the time of diagnosis. Results The lowest SES-group had a significantly lower incidence than the highest SES-group; 10.2 (95% confidence intervals (CI): 9.1–11.3) and 14.3 (95% CI: 12.9–15.8), respectively. Increased risk of melanoma was seen in municipalities with high population density, few people living on social security and many people with high income. Patients living in low SES neighbourhoods were diagnosed more often with higher stage disease (13% (95% CI: 12.3–13.8) diagnosed with pT4) than those living in high SES neighbourhoods (9% (95% CI: 8.5–9.8) diagnosed with pT4) ( p < 0.001) and with higher Breslow thickness ( p < 0.001). Conclusions Awareness of the risks of UV radiation (UVR) is important and in the higher SES-groups primary prevention should remain the focus. However, if the incidence rates for the higher SES-groups are illustrative for the lower SES-groups, then the focus should be on both primary and secondary prevention in the low SES-groups.
Purpose
The aim of this study was to assess the difference in explained variance of Health-Related Quality of Life (HRQoL) between comorbidity, sociodemographic characteristics and cancer ...characteristics. This association was assessed among thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma patients.
Methods
Data from three large population-based surveys on survivors of thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma were used. Cancer-specific HRQoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) of which physical function, emotional function, fatigue, and pain were included in the analyses. Comorbidity was assessed using the Self-reported Comorbidity Questionnaire. The association between comorbidity and HRQoL was assessed with multivariate linear regression models. Semi-partial
R
2
was reported to assess the amount of variance in HRQoL explained by comorbidity in comparison with sociodemographic and cancer characteristics.
Results
In total, 3,792 cancer survivors were included in this analysis. The variance in HRQoL subscales explained by comorbidity was higher compared with sociodemographic and cancer characteristics for physical function (11–17 vs. 2–4 and 1–2 %, respectively) and emotional function (7–17 vs. 1–3 and 1–3 %, respectively), regardless of cancer type. In addition, comorbidity explained 7–20 and 11–13 % of the variance in pain and fatigue, respectively, compared to 0–4 % for both sociodemographic and cancer characteristics. Osteoarthritis and back pain were strongly associated with physical function and pain, while depression was strongly associated with emotional function. Depression and back pain were strongly associated with fatigue.
Conclusions
This study showed that comorbidity explained more variance in physical and emotional function, pain, and fatigue in comparison with sociodemographic and cancer characteristics in cancer survivors, regardless of cancer type. Our findings emphasize the importance of adjusting for the presence of comorbid diseases when assessing HRQoL in cancer survivors.
Implication for cancer survivors
Cancer survivors suffering from comorbid diseases experience lower levels of health-related quality of life. Clinicians should become more aware of the impact of comorbidity on HRQoL and provide necessary psychological support to assist self-management of comorbid diseases.
We describe changes in prostate cancer incidence, survival and mortality and the resulting impact in additional diagnoses and avoided deaths in European areas and the United States.
Using data from ...12 European cancer registries and the Surveillance, Epidemiology and End Results program, we describe changes in prostate cancer epidemiology between the beginning of the PSA era (USA: 1985–1989, Europe: 1990-1994) and 2002–2006 among patients aged 40–64, 65–74, and 75+. Additionally, we examine changes in yearly numbers of diagnoses and deaths and variation in male life expectancy.
Incidence and survival, particularly among patients aged <75, increased dramatically, yet both remain (with few exceptions in incidence) lower in Europe than in the United States. Mortality reductions, ongoing since the mid/late 1990s, were more consistent in the United States, had a distressingly small absolute impact among patients aged 40–64 and the largest absolute impact among those aged 75+. Overall ratios of additional diagnoses/avoided deaths varied between 3.6 and 27.6, suggesting large differences in the actual impact of prostate cancer incidence and mortality changes. Ten years of remaining life expectancy was reached between 68 and 76 years.
Policies reflecting variation in population life expectancy, testing preferences, decision aids and guidelines for surveillance-based management are urgently needed.
The prevalence of coexistent diseases in addition to breast cancer becomes increasingly important in an ageing population. However, the clinical implications are unclear. The age-specific prevalence ...of serious comorbidity among all new breast cancer patients diagnosed from 1995 to 2001 (
n
=
8966) in the South of the Netherlands was analysed in relation to age, stage and treatment. Independent prognostic effects of age and comorbidity were evaluated (follow-up was continued until 1 January 2004). The prevalence of comorbidity increased from 9% for those aged <50 years to 56% for patients aged 80+ years. The most frequent conditions were cardiovascular disease (7%), diabetes mellitus (7%), and previous cancer (6%). In the presence of comorbidity, fewer patients received radiotherapy (51% vs. 66%,
P
<
0.0001) and fewer patients who underwent breast-conserving surgery also had axillary dissection (
P
<
0.0001). Relative 5-year survival rates for patients without comorbidity (87%) were significantly higher (
P
<
0.01) than those for patients with previous cancer (77%), diabetes mellitus (78%), and for patients with 2+ coexistent diseases (59%). Relative survival of patients without comorbidity increased with age to 93% for patients older than 70 years. Comorbidity negatively affected prognosis, independent of age, stage of disease, and treatment (Hazard Ratio (HR)
=
1.3,
P
=
0.0001 for one coexistent disease and HR
=
1.4,
P
=
0.0001 for 2+ coexistent diseases). The most important effects were found for previous cancer (HR
=
1.4,
P
=
0.003), cerebrovascular disease (HR
=
1.6,
P
<
0.004) or dementia (HR
=
2.3,
P
<
0.0001). Elderly breast cancer patients can be divided in those without other diseases, who have a relatively good prognosis, and those who have at least one other serious coexistent disease and significantly poorer prognosis.
Consensus molecular subtypes (CMSs) can guide precision treatment of colorectal cancer (CRC). We aim to identify methylation markers to distinguish between CMS2 and CMS3 in patients with CRC, for ...which an easy test is currently lacking. To this aim, fresh‐frozen tumor tissue of 239 patients with stage I‐III CRC was analyzed. Methylation profiles were obtained using the Infinium HumanMethylation450 BeadChip. We performed adaptive group‐regularized logistic ridge regression with post hoc group‐weighted elastic net marker selection to build prediction models for classification of CMS2 and CMS3. The Cancer Genome Atlas (TCGA) data were used for validation. Group regularization of the probes was done based on their location either relative to a CpG island or relative to a gene present in the CMS classifier, resulting in two different prediction models and subsequently different marker panels. For both panels, even when using only five markers, accuracies were > 90% in our cohort and in the TCGA validation set. Our methylation marker panel accurately distinguishes between CMS2 and CMS3. This enables development of a targeted assay to provide a robust and clinically relevant classification tool for CRC patients.
Consensus molecular subtypes (CMSs) can guide precision treatment of colorectal cancer (CRC). However, an easy test to distinguish between CMS2 and CMS3 in patients with colorectal cancer is currently lacking. We developed two methylation marker panels distinguishing between CMS2 and CMS3, both with accuracies > 90% in our cohort and in TCGA validation set. This enables development of a targeted assay to provide a robust and clinically relevant classification tool for CRC patients.
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