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Papers by Marjan van Hezewijk

The Breast, 2014

As the number of breast cancer survivors increases, this study prospectively examined whether tai... more As the number of breast cancer survivors increases, this study prospectively examined whether tailored follow-up with differentiated number of visits per risk group, based on a prognostic index for local recurrence, is feasible and acceptable for patients and professionals. Between March 2007 and March 2010, 180 breast cancer patients (pT1-2N0-2cM0) were included. Primary endpoint was feasibility of tailored follow-up, based on the number of follow-up visits, patient satisfaction, anxiety and attitude towards follow-up. Secondary endpoints were reasons for visits, incidence, time to detection of local recurrences and the use of alternative care. In the second and third year of follow-up, the results show a 22% reduction in visits per patient in the low-risk group compared to the intermediate-risk group; 2.8 versus 3.6 visits. The majority of interval visits in both groups was initiated by the professional. No significant differences were found in attitude towards follow-up, patient satisfaction, anxiety and depression, alternative health care use or local recurrences between the risk groups. In conclusion, implementation of a tailored follow-up programme with decreased number of visits for low-risk patients is feasible and acceptable to patients. Appointing one coordinating professional, possibly a nurse practitioner, could further reduce the number of follow-up visits.

Radiotherapy and Oncology, 2013

The TEAM trial investigated the efficacy and safety of adjuvant endocrine therapy consisting of e... more The TEAM trial investigated the efficacy and safety of adjuvant endocrine therapy consisting of either exemestane or the sequence of tamoxifen followed by exemestane in postmenopausal hormone-sensitive breast cancer. The present analyses explored the association between locoregional therapy and recurrence (LRR) in this population. Between 2001 and 2006, 9779 patients were randomized. Local treatment was breast conserving surgery plus radiotherapy (BCS+RT), mastectomy without radiotherapy (MST-only), or mastectomy plus radiotherapy (MST+RT). Patients with unknown data on surgery, radiotherapy, tumor or nodal stage (n=199), and patients treated by lumpectomy without radiotherapy (n=349) were excluded. After a median follow-up of 5.2 years, 270 LRRs occurred (2.9%) among 9231 patients. The 5-years actuarial incidence of LRR was 4.2% (95% CI 3.3-4.9%) for MST-only, 3.4% (95% CI 2.4-4.2%) for MST+RT and 1.9% (95% CI 1.5-2.3%) for BCS+RT. After adjustment for prognostic factors, the hazard ratio (HR, reference BCS+RT) for LRR remained significantly higher for MST-only (HR 1.53; 95% CI 1.10-2.11), not for MST+RT (HR 0.78; 95% CI 0.50-1.22). This explorative analysis showed a higher LRR risk after MST-only than after BCS+RT, even after adjustment for prognostic factors. As this effect was not seen for MST+RT versus BCS+RT, it might be explained by the beneficial effects of radiation treatment.

The Breast, 2012

We reviewed the literature between January 1985 and June 2011 on the costs of different follow-up... more We reviewed the literature between January 1985 and June 2011 on the costs of different follow-up strategies for patients treated for early breast cancer. A total of 186 abstracts were retrieved of which eleven publications were considered relevant; 6 randomised clinical trials, 4 retrospective cohort studies and 1 'minisymposium'. The follow-up strategies, outcome measures and methods of analysis used in these studies vary widely, so no general conclusions can be drawn. However, from the results we infer that patient-led follow-up by a nurse practitioner, follow-up by a general practitioner, or telephone follow-up is feasible and cost-effective, without routine additional tests, except annual mammograms. In this era of increasing health care costs, cost-effectiveness, evaluated in a standardised way, should be taken into account in future clinical trials.

Journal of Pediatric Gastroenterology and Nutrition, 2000

Body composition evaluation by bioelectrical impedance analysis in children makes use of differen... more Body composition evaluation by bioelectrical impedance analysis in children makes use of different group-specific population-derived equations. The present study was conducted to attempt to validate the use of population-independent physical model-derived equations in children. The validity of bioelectrical impedance analysis for the measurement of total body water in children was evaluated by comparing results of two physical model-derived and two population-derived equations with those of deuterium dilution as reference method in a group of 38 heterogeneous children. Means +/- standard deviation (in liters) for total body water measured with deuterium dilution and the physical model 1-derived equation were 18.4 +/- 4.7 L and 18.1 +/- 4.4 L, respectively. This difference is not significant, whereas significant differences were found for all other tested equations. Significant smaller absolute differences between the model 1 equation and deuterium reference results were found when compared with the results of the other three tested equations. When compared with results of the reference deuterium method the physical model 1-derived equation was the only one that provided reliable total body water results by bioelectrical impedance analysis in children.

European Journal of Surgical Oncology (EJSO), 2013

European Journal of Surgical Oncology (EJSO), 2010

European Journal of Surgical Oncology (EJSO), 2011

Background: In evaluating follow-up of early breast cancer, patients' views on care are important... more Background: In evaluating follow-up of early breast cancer, patients' views on care are important. The aim of this study was to evaluate the effect of the introduction of nurse practitioners (NPs) in a breast cancer unit on patients' informational needs, preferences and attitude towards follow-up. Patients and methods: A cross-sectional survey was performed among two groups in 2005. Group A (n ¼ 89) consisted of patients operated before, and group B (n ¼ 100) after the introduction of a breast cancer unit (respectively in 1998e1999 and 2001e2004). Results: Response was 72% in group A and 84% in group B. Median follow-up was 69 (54e86) and 33 (0e57) months, respectively. Aspects highly appreciated by patients in both groups were lifetime follow-up, information about prognosis, life style and additional investigations. Important discussion subjects were fatigue, pain, genetic factors, prevention and arm function/lymph-oedema. Less valued aspects were information about peers, conversations with psychologists or social workers, breast reconstruction, and acceptation by family members. The informational needs and preferences did not differ statistically significantly between both groups. In group B, communication with the caregiver was valued higher and more patients indicated that the caregiver took the time needed. More patients in group B indicated that follow-up could be performed by the NP. Duration of follow-up correlated with preferred frequency, not with informational needs in follow-up, only young age increased these needs. Conclusion: Despite the limitations of this retrospective study, we conclude that while expectations and informational needs did not change with the introduction of a NP to the standard care, patient satisfaction increased and communication and time taken were appreciated more.

European Journal of Surgical Oncology (EJSO), 2011

To provide insight into professionals&amp... more To provide insight into professionals' opinions on breast cancer follow-up to facilitate implementation of new follow-up strategies. The study focuses on current practice, purpose and perceived effects, and preferred frequency and duration of follow-up. A 29-item questionnaire on professionals' demographics, current practice, opinion on the current guideline, preferences in frequency and duration of tailored follow-up, and the purpose and perceived effects of follow-up was sent to 633 Dutch professionals. The current national guideline is followed by 81% of respondents. All different specialists are involved in follow-up. Sixty-nine percent of respondents' report nurse practitioners to be involved in follow-up. When asked for tailored follow-up, professionals indicate more factors for increased follow-up (age<40 years, pT3-4 tumour, pN2-3, treatment related morbidity, and psychosocial support), than for reduced schedules (age >70 years and DCIS histology). Alternative forms of follow-up are not endorsed by >90% of respondents. Detection of a new primary tumour of the breast is considered the most important purpose of follow-up (98%), 57% still indicates detecting metastases as a goal. Professionals tend towards longer and more intensive follow-up than the current guideline for a large group of patients. Limitations and developments in follow-up need to be considered to facilitate alternative follow-up strategies.

Ejc Suppl, 2009

Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4... more Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4 and Cdk4/Cdk6, have been selected for further analysis to evaluate these cyclin dependent kinases as novel therapeutic targets for the treatment of metastatic melanoma. Table1: Effective Cdk inhibitors in two melanoma cell lines Inhibitor Sk-Mel-28% Inhibition (± std dev) Sk-Mel-2% Inhibition (± std dev) Alsterpaullone, 2-Cyanoethyl (Cdk1/5; GSK-3b) 65.6± 13.0 64.5± 4.1 Cdk1/2 Inhibitor III 99.9± 0.0 98.0± 1.0 Cdk4 Inhibitor III (Cdk2/4) 72.6± 22.8 53.9± 8.5 Cdk/Crk Inhibitor 99.8± 0.0 99.6± 0.2 Fascaplysin (Cdk4/6) 99.2± 0.6 98.0± 1.0

The Breast, 2014

As the number of breast cancer survivors increases, this study prospectively examined whether tai... more As the number of breast cancer survivors increases, this study prospectively examined whether tailored follow-up with differentiated number of visits per risk group, based on a prognostic index for local recurrence, is feasible and acceptable for patients and professionals. Between March 2007 and March 2010, 180 breast cancer patients (pT1-2N0-2cM0) were included. Primary endpoint was feasibility of tailored follow-up, based on the number of follow-up visits, patient satisfaction, anxiety and attitude towards follow-up. Secondary endpoints were reasons for visits, incidence, time to detection of local recurrences and the use of alternative care. In the second and third year of follow-up, the results show a 22% reduction in visits per patient in the low-risk group compared to the intermediate-risk group; 2.8 versus 3.6 visits. The majority of interval visits in both groups was initiated by the professional. No significant differences were found in attitude towards follow-up, patient satisfaction, anxiety and depression, alternative health care use or local recurrences between the risk groups. In conclusion, implementation of a tailored follow-up programme with decreased number of visits for low-risk patients is feasible and acceptable to patients. Appointing one coordinating professional, possibly a nurse practitioner, could further reduce the number of follow-up visits.

Radiotherapy and Oncology, 2013

The TEAM trial investigated the efficacy and safety of adjuvant endocrine therapy consisting of e... more The TEAM trial investigated the efficacy and safety of adjuvant endocrine therapy consisting of either exemestane or the sequence of tamoxifen followed by exemestane in postmenopausal hormone-sensitive breast cancer. The present analyses explored the association between locoregional therapy and recurrence (LRR) in this population. Between 2001 and 2006, 9779 patients were randomized. Local treatment was breast conserving surgery plus radiotherapy (BCS+RT), mastectomy without radiotherapy (MST-only), or mastectomy plus radiotherapy (MST+RT). Patients with unknown data on surgery, radiotherapy, tumor or nodal stage (n=199), and patients treated by lumpectomy without radiotherapy (n=349) were excluded. After a median follow-up of 5.2 years, 270 LRRs occurred (2.9%) among 9231 patients. The 5-years actuarial incidence of LRR was 4.2% (95% CI 3.3-4.9%) for MST-only, 3.4% (95% CI 2.4-4.2%) for MST+RT and 1.9% (95% CI 1.5-2.3%) for BCS+RT. After adjustment for prognostic factors, the hazard ratio (HR, reference BCS+RT) for LRR remained significantly higher for MST-only (HR 1.53; 95% CI 1.10-2.11), not for MST+RT (HR 0.78; 95% CI 0.50-1.22). This explorative analysis showed a higher LRR risk after MST-only than after BCS+RT, even after adjustment for prognostic factors. As this effect was not seen for MST+RT versus BCS+RT, it might be explained by the beneficial effects of radiation treatment.

The Breast, 2012

We reviewed the literature between January 1985 and June 2011 on the costs of different follow-up... more We reviewed the literature between January 1985 and June 2011 on the costs of different follow-up strategies for patients treated for early breast cancer. A total of 186 abstracts were retrieved of which eleven publications were considered relevant; 6 randomised clinical trials, 4 retrospective cohort studies and 1 'minisymposium'. The follow-up strategies, outcome measures and methods of analysis used in these studies vary widely, so no general conclusions can be drawn. However, from the results we infer that patient-led follow-up by a nurse practitioner, follow-up by a general practitioner, or telephone follow-up is feasible and cost-effective, without routine additional tests, except annual mammograms. In this era of increasing health care costs, cost-effectiveness, evaluated in a standardised way, should be taken into account in future clinical trials.

Journal of Pediatric Gastroenterology and Nutrition, 2000

Body composition evaluation by bioelectrical impedance analysis in children makes use of differen... more Body composition evaluation by bioelectrical impedance analysis in children makes use of different group-specific population-derived equations. The present study was conducted to attempt to validate the use of population-independent physical model-derived equations in children. The validity of bioelectrical impedance analysis for the measurement of total body water in children was evaluated by comparing results of two physical model-derived and two population-derived equations with those of deuterium dilution as reference method in a group of 38 heterogeneous children. Means +/- standard deviation (in liters) for total body water measured with deuterium dilution and the physical model 1-derived equation were 18.4 +/- 4.7 L and 18.1 +/- 4.4 L, respectively. This difference is not significant, whereas significant differences were found for all other tested equations. Significant smaller absolute differences between the model 1 equation and deuterium reference results were found when compared with the results of the other three tested equations. When compared with results of the reference deuterium method the physical model 1-derived equation was the only one that provided reliable total body water results by bioelectrical impedance analysis in children.

European Journal of Surgical Oncology (EJSO), 2013

European Journal of Surgical Oncology (EJSO), 2010

European Journal of Surgical Oncology (EJSO), 2011

Background: In evaluating follow-up of early breast cancer, patients' views on care are important... more Background: In evaluating follow-up of early breast cancer, patients' views on care are important. The aim of this study was to evaluate the effect of the introduction of nurse practitioners (NPs) in a breast cancer unit on patients' informational needs, preferences and attitude towards follow-up. Patients and methods: A cross-sectional survey was performed among two groups in 2005. Group A (n ¼ 89) consisted of patients operated before, and group B (n ¼ 100) after the introduction of a breast cancer unit (respectively in 1998e1999 and 2001e2004). Results: Response was 72% in group A and 84% in group B. Median follow-up was 69 (54e86) and 33 (0e57) months, respectively. Aspects highly appreciated by patients in both groups were lifetime follow-up, information about prognosis, life style and additional investigations. Important discussion subjects were fatigue, pain, genetic factors, prevention and arm function/lymph-oedema. Less valued aspects were information about peers, conversations with psychologists or social workers, breast reconstruction, and acceptation by family members. The informational needs and preferences did not differ statistically significantly between both groups. In group B, communication with the caregiver was valued higher and more patients indicated that the caregiver took the time needed. More patients in group B indicated that follow-up could be performed by the NP. Duration of follow-up correlated with preferred frequency, not with informational needs in follow-up, only young age increased these needs. Conclusion: Despite the limitations of this retrospective study, we conclude that while expectations and informational needs did not change with the introduction of a NP to the standard care, patient satisfaction increased and communication and time taken were appreciated more.

European Journal of Surgical Oncology (EJSO), 2011

To provide insight into professionals&amp... more To provide insight into professionals' opinions on breast cancer follow-up to facilitate implementation of new follow-up strategies. The study focuses on current practice, purpose and perceived effects, and preferred frequency and duration of follow-up. A 29-item questionnaire on professionals' demographics, current practice, opinion on the current guideline, preferences in frequency and duration of tailored follow-up, and the purpose and perceived effects of follow-up was sent to 633 Dutch professionals. The current national guideline is followed by 81% of respondents. All different specialists are involved in follow-up. Sixty-nine percent of respondents' report nurse practitioners to be involved in follow-up. When asked for tailored follow-up, professionals indicate more factors for increased follow-up (age<40 years, pT3-4 tumour, pN2-3, treatment related morbidity, and psychosocial support), than for reduced schedules (age >70 years and DCIS histology). Alternative forms of follow-up are not endorsed by >90% of respondents. Detection of a new primary tumour of the breast is considered the most important purpose of follow-up (98%), 57% still indicates detecting metastases as a goal. Professionals tend towards longer and more intensive follow-up than the current guideline for a large group of patients. Limitations and developments in follow-up need to be considered to facilitate alternative follow-up strategies.

Ejc Suppl, 2009

Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4... more Proffered Papers and NRAS mutated metastatic melanoma. Two Cdk inhibitors, which target Cdk2/Cdk4 and Cdk4/Cdk6, have been selected for further analysis to evaluate these cyclin dependent kinases as novel therapeutic targets for the treatment of metastatic melanoma. Table1: Effective Cdk inhibitors in two melanoma cell lines Inhibitor Sk-Mel-28% Inhibition (± std dev) Sk-Mel-2% Inhibition (± std dev) Alsterpaullone, 2-Cyanoethyl (Cdk1/5; GSK-3b) 65.6± 13.0 64.5± 4.1 Cdk1/2 Inhibitor III 99.9± 0.0 98.0± 1.0 Cdk4 Inhibitor III (Cdk2/4) 72.6± 22.8 53.9± 8.5 Cdk/Crk Inhibitor 99.8± 0.0 99.6± 0.2 Fascaplysin (Cdk4/6) 99.2± 0.6 98.0± 1.0