Abstract Objective This study aims to describe trends and variation in treatment and survival of cervical cancer in two regions in The Netherlands and to relate this to adherence to the treatment ...recommendations. Study design Patient characteristics, tumour characteristics, treatment and follow-up data were collected for 1954 cervical cancer cases diagnosed in the period 1989–2004. Results In FIGO stages IB-IIA 93% of patients were treated according to the recommendations of The Netherlands Working Group Gynaecologic Oncology. Older patients received radiotherapy more often than younger patients: 48% (95%CI 40–57) of patients older than 70 compared to 15% (95%CI 10–20) of patients aged 50–69 and 5% (95%CI 3–7) of patients aged 50 or younger ( p < 0.05). In FIGO stages IIB-IVA 76% of patients were treated according to the recommendations of the Working Group. Chemoradiation was given to older patients less often than to younger patients: 2% (95%CI 0.5–5) versus 23% (95%CI 16–29). A decreased risk of death was found for patients receiving chemoradiation (RER 0.6, 95%CI 0.3–0.9) compared to those receiving “radiotherapy only”. Conclusion Far from being always followed, the treatment recommendations were better implemented for treatment of patients with FIGO IB-IIA. Elderly patients received different treatment compared to younger patients in this study and showed an independent increased risk of death in the lower stages, which confirms that the need becomes stronger for paying attention to treatment of elderly patients.
An objective assessment of the clinical findings in patients with Huntington's disease (HD) is necessary for an evaluation of the longitudinal progression of the disease features. The Unified ...Huntington's Disease Rating Scale (UHDRS) is a scale to assess clinical performance and functional capacity. The authors examined the 1‐year change in UHDRS scores in 78 patients with HD examined either in Leiden, the Netherlands (24 men, 25 women), or in Rochester, New York, United States (12 men, 17 women). A significant decline was seen in motor function, measured with the total motor scale. The total dystonia score increased significantly; the total chorea score did not. The frequency of behavioral disorders tended to increase. The scores on independence scale, functional assessment, total functional capacity, and symbol digit decreased significantly. No relation was observed between the UHDRS items and the age at onset or duration of illness. Thirteen patients with 2‐year follow up showed a clear increase in score on the total motor scale and a decline on the independence scale and in total functional capacity. The UHDRS may also be used as a tool for determining therapeutic intervention. Annual evaluation of the total motor scale in every patient gives a clear description of the motor progression of the disease. The authors suggest performing a total UHDRS evaluation every second year for every HD patient as part of the routine longitudinal evaluation.
Juvenile Huntington disease (JHD) patients are distinguished from adult patients by an age at onset of less than 20 years. Investigating patients in our own database, we examined the proposition ...derived from studies in world literature that JHD should not be viewed as a separate clinical entity but rather as a manifestation of the rigid variant of the disease. Of 53 patients with JHD recorded in the Leiden Roster for Huntington Disease, relationships between sex, age at onset, duration of illness, maternal or paternal inheritance, motor symptom, first clinical features, and characteristics during the disease course, were obtained from the patients' files, and investigated. Although chorea is present in JHD, patients more often developed rigidity. Paternal inheritance, early dementia, epilepsy/myoclonus, and tremor during the disease course are confined for the most part to the rigid cases. A shorter duration of illness was evident in male patients with rigid JHD who inherited the disease from their father and developed their first disease feature at a younger age. The recognition of JHD as a distinct clinical entity does not appear to be warranted. Therefore, we propose, in accordance with other investigators, that rigid JHD be considered a clinical variant with special features.
Liver metastases have the poorest prognosis of all types of breast cancer metastases, with a 5-year survival rate of 0 to 12%. In comparison, the 5-year overall survival rate of patients with ...colorectal liver metastases undergoing curative liver resection is approximately 30 to 40% and even 50% in selected patients. Partial liver resection in combination with systemic treatment for patients with hepatogenic metastases from breast cancer may lead to improved survival rates for selected patients.
To estimate the impact of the Huntington gene on mortality, we studied ten families with Huntington disease, whose records started before 1800. We investigated mortality from 1800 to 1997 in 257 ...carriers of the Huntington gene and 474 potential carriers. Follow-up extended from age 20 years to the date of death or end-of-study date. The observed deaths were compared with those expected on the basis of the general population, adjusted for sex, age, and calendar time. To study the influence of the family and parental transmission, we calculated hazard ratios adjusted for sex, probability of carrying the gene, and year of birth. In 25,013 person-years, 420 deaths occurred, whereas 278 deaths were expected standardized mortality ratio = 1.5; 95% confidence interval (CI) = 1.4-1.7. Excess mortality was confined to ages 40-70 years (standardized mortality ratio = 2.2; 95% CI = 1.9-2.4). To study the evolution of mortality over time in this age group, we calculated absolute mortality rates per calendar period. From 1800 onward, mortality rates in the general population continuously declined, but among the families with Huntington disease this decline was absent. There were only small differences in risk between families, and the relative risk for paternal over maternal transmission was 1.2 (95% CI = 0.9-1.5). Our main finding is that persons who carry the Huntington gene and reach middle age have not benefited from advances in medical care and overall increase in life expectancy.
To gain insight into the survival of cancer patients in order to evaluate any improvement in cancer care.
A retrospective population-based cohort study.
Data from the Netherlands Cancer Registry were ...used for this study. For all patients diagnosed with cancer in the Netherlands between 1989 and 2008, information on vital status was obtained from hospitals, municipalities and the Municipal Personal Records Database. Age-standardised, relative survival rates per cancer type were calculated.
The 5-year relative survival for all types of cancer combined increased from 47% in 1989-1993 to 59% in 2004-2008. This increase was greater in males than in females (from 40% to 55% and from 55% to 62%, respectively). The most striking improvements in survival were observed in breast, prostate and colorectal cancers, probably for reasons differing for each cancer type. Patients with chronic myeloid leukaemia showed the greatest gain in survival (43%). Survival rates in older patients were generally worse in comparison to those in younger patients, especially in case of head and neck cancer, ovarian cancer and haematological malignancies. The survival gap between older and younger patients has increased over the last 20 years. The 10-year survival rate for most cancer types was not much lower than the 5-year rate, except in chronic and indolent haematological malignancies and cancers that may reoccur after a long time, such as breast and prostate cancer.
The increase in survival rates of cancer patients in the Netherlands, attributed to early detection and improved treatment, could represent either an increase in the number of patients cured or to cancer patients living longer lives. A potential area for further improvement is especially notable in the elderly. This is even more important given the ageing population.
To describe the percentage of local recurrences within 5 years after surgery for breast cancer as a performance indicator for Dutch hospitals.
Descriptive, cohort study.
All women diagnosed with a ...primary invasive breast cancer in 2003 for which they underwent curatively intended surgical treatment (with or without radiotherapy), were selected from the Netherlands Cancer Registry (NCR). NCR registration clerks collected additional information on recurrences within 5 years after initial diagnosis following standardized protocol. Percentages of local recurrences per hospital were estimated using Kaplan Meier analysis and were presented in forest plots and funnel plots.
In 2003, 9898 women diagnosed with primary breast cancer were curatively treated in one of the 99 Dutch hospitals. 266 patients experienced local recurrences within 5 years. The 5-year percentage of local recurrences was 3.03% (95% CI: 2.69-3.41). Following breast conserving surgery the 5-year percentage of local recurrence was 2.63% (95% CI: 2.21-3.12), and following mastectomy 3.50% (95% CI: 2.97-4.13). Stratification by hospital shows large variation in recurrence rates (0-17%). However, the number of patients treated in most hospitals is too small to provide reliable estimates.
The percentage of local recurrences following surgical treatment for breast cancer in the Netherlands was lower than the accepted standard of 5% within 5 years. Statements on differences in quality of care between hospitals cannot be made on the basis of these data, on account of the low average recurrence rate and the small number of cases per hospital.
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