Nurse-led Follow-up and Palliative Care of Esophageal Cancer Patients

Approximately 400,000 patients are annually diagnosed world-wide with esophageal cancer, which makes this malignancy the eight most common cancer (1). The incidence of esophageal cancer has risen remarkably over the past two decades in the Western world, because of a marked increase in the incidence of adenocarcinoma (2, 3). In the Netherlands, on average 1100 new patients are diagnosed annually with esophageal cancer. The prognosis of esophageal cancer is poor with a 5-year survival of 10-15% (4, 5). If a patient is able to undergo surgery and the tumor is considered resectable without evidence of distant metastases, a surgical resection is the primary treatment for esophageal cancer. Despite recent advances in the curative treatment of esophageal cancer (6), more than 50% of patients with esophageal cancer have an inoperable disease at presentation. For these patients, only palliative treatment is possible. The goal of such treatment is to relief dysphagia, the case of much distress to these patients. Self-expanding metal stents are commonly used for the palliation of esophageal obstruction because of inoperable cancer. One of the drawbacks of the presently used stents is the high percentage of recurrent dysphagia due to stent migration and tissue in-/overgrowth. New stent designs have been developed that should overcome this unwanted sequel of stent placement. In addition, to overcome the problem of stent migration, large diameter stents have been introduced. The extra pressure on the esophageal wall exerted by large diameter stents, however, may cause more complications. Stents are eff ective for the palliation of esophageal cancer, particularly if the tumor is located in the mid or distal esophagus. Strictures of the proximal esophagus are more diffi cult to palliate. The use of stents in the proximal esophagus is, in particular, hampered by the risk of complications, the risk of compression on the trachea or patients intolerance. Surgery for esophageal cancer is often accompanied by signifi cant morbidity and aff ects patients quality of life

Increased risks of third primary cancers of non-breast origin among women with bilateral breast cancer

Background: This study examined the risk of third cancer of non-breast origin (TNBC) among women with bilateral breast cancer (BBC; either synchronous or metachronous), focussing on the relation with breast cancer treatment.Methods:Risk was assessed, among 8752 Dutch women diagnosed with BBC between 1989 and 2008, using standardised incidence ratios (SIR) and Cox regression analyses to estimate the hazard ratio (HR) of TNBC for different treatment modalities.Results:Significant increased SIRs were observed for all TNBCs combined, haematological malignancies, stomach, colorectal, non-melanoma skin, lung, head and neck, endometrial, and ovarian cancer. A 10-fold increased risk was found for ovarian cancer among women younger than 50 years (SIR10.0, 95% confidence interval (CI)5.3-17.4). Radiotherapy was associated with increased risks of all TNBCs combined (HR1.3; 95%CI1.1-1.6, respectively). Endocrine therapy was associated with increased risks of all TNBCs combined (HR1.2; 95%CI1.0-1.5), haematological malignancies (HR2.0; 95%CI1.1-3.9), and head and neck cancer (HR3.3; 95%CI1.1-10.4). After chemotherapy decreased risks were found for all TNBCs combined (HR0.63; 95%CI0.5-0.87).Conclusion:Increased risk of TNBC could be influenced by genetic factors (ovarian cancer) or an effect of treatment (radiotherapy and endocrine therapy). More insight in the TNBC risk should further optimise and individualise treatment and surveillance protocols in (young) women with BBC

Nurse-Led Follow-Up at Home vs. Conventional Medical Outpatient Clinic Follow-Up in Patients With Incurable Upper Gastrointestinal Cancer: A Randomized Study

Context: Upper gastrointestinal cancer is associated with a poor prognosis. The multidimensional problems of incurable patients require close monitoring and frequent support, which cannot sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic. Objectives: To compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal, pancreatic, or hepatobiliary cancer. Methods: Patients were randomized to nurse-led follow-up at home or conventional medical follow-up in the outpatient clinic. Outcome parameters were quality of life (QoL), patient satisfaction, and health care consumption, measured by different questionnaires at one and a half and four months after randomization. As well, cost analyses were done for both follow-up strategies in the first four months. Results: In total, 138 patients were randomized, of which 66 (48%) were evaluable. At baseline, both groups were similar with respect to clinical and sociodemographic characteristics a

Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC-Netherlands Cancer Registry linked data with 20 years of follow-up

The survival of patients diagnosed with Hodgkin lymphoma (HL) has improved from 70% to 90% in clinical trials. However, population-based data has shown lower survival. I