Oesophageal and Gastric Cancer: optimising care and outcomes in changing clinical practice

Improving quality of care for patients with oesophageal and gastric cancer is a major challenge as the incidence is relatively low and most patients have an advanced disease at time of diagnosis. The studies presented in this thesis aimed to give more insight in the provided care and outcomes for patients with oesophageal and gastric cancer in daily clinical practice. It was shown that the hospital of diagnosis influences the probability to receive curative treatment for oesophageal and gastric cancer. Moreover, its impact on survival indicates that treatment decision-making may be improved for patients with these malignancies. It was also shown that survival improved for patients with oesophageal cancer the last 26 years, probably due to the introduction of neoadjuvant chemoradiotherapy and centralisation of surgery. Survival of patients with gastric cancer improved as well in the period after centralisation of surgery. Nevertheless, many gastric cancer patients that are eligible for perioperative treatment do not receive the adjuvant component of perioperative treatment or they do not receive chemotherapy at all in addition to surgery. Furthermore, survival remained stable for patients with metastatic gastric cancer, despite an increase in the use of palliative chemotherapy. To conclude, the studies in this thesis addressed several important challenges in diagnosis and treatment of oesophageal and gastric cancer

Proximal Esophageal Cancer

Proximal esophageal cancer (PEC) is a highly mortal cancer with a five-year survival rate of 30%. Because second primary tumors could decrease survival in PEC patients, this research is aiming at finding out about tumors associated with PEC and their infuence on survival. With the use of a database with PEC patients, diagnosed between 1989 and 2014, it was found that head and neck cancers (H&N) are the most prevalent previous tumor in PEC patients. Previous tumors have a negative effect on surivval. Prospective studies are needed to investigate on the effectiveness of prevention and surveillance methods for H&N patients

Correlates of physical activity among colorectal cancer survivors:Results from the longitudinal population-based profiles registry

Contains fulltext : 172219.pdf (Publisher’s version ) (Open Access)PURPOSE: Physical activity can improve health of cancer survivors. To increase physical activity levels among colorectal cancer (CRC) survivors, we need to understand which factors affect physical activity. Therefore, this study examined the longitudinal relationship between symptom-related, functioning-related, and psychological barriers and socio-demographic and clinical factors with physical activity among CRC survivors. METHODS: CRC survivors identified from the population-based Eindhoven Cancer Registry (ECR) diagnosed between 2000 and 2009 were included. Survivors completed validated questionnaires measuring moderate-to-vigorous physical activity (MVPA) and barriers in 2010(T1), 2011(T2), and 2012(T3). Linear-mixed models and linear regression techniques were used. RESULTS: Response rates were 74 % (N = 2451, T1); 47 % (N = 1547, T2); and 41 % (N = 1375, T3). Several factors were negatively associated with MVPA: symptom-related barriers (e.g., fatigue, dyspnea, chemotherapy side effects, pain, appetite loss, and weight loss); psychological barriers (i.e., depressive symptoms and anxiety); functioning-related barriers (e.g., low physical or role functioning, unfavorable future perspective); socio-demographic (i.e., older age, female, no partner); and clinical factors (i.e., obesity). However, no within-subject effects were significantly associated with MVPA. Groups of functioning-related barriers, socio-demographic factors, symptom-related barriers, psychological barriers, and clinical factors explained 11, 3.9, 3.8, 2.4, and 2.2 % of the variance in MVPA at T1, respectively. CONCLUSIONS: Several functioning-related and symptom-related barriers and few socio-demographic factors were associated with physical activity among CRC survivors. Future interventions to promote physical activity among CRC survivors could benefit by taking into account functioning aspects and symptoms of cancer and its treatment, and assess the causal direction of these associations

Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

Purpose. This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery. Methods. In this population-based study, all patients with potentially curable EC (cT1N?/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan–Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS). Results. A total of 702 patients was included. Age C 75 years and multiple comorbidities were associated with a higher