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R A Damhuis

Publications and source records attributed to R A Damhuis.

At least 19 recordsLinked to original sources
PubMed2001

[Screening for lung cancer in the Netherlands: the role of spiral CT scan].

The very poor prognosis of lung cancer has barely changed in the last two decades despite all efforts. However, prognosis is better when the disease is detected earlier, so that curative surgery or radiotherapy can be applied. Lung cancer screening in the past by chest X-ray did not lead to a decrease in lung cancer mortality, because the chest X-ray has low sensitivity for early invasive stages. With the advent of the low-dose spiral CT scan it has become feasible to detect early invasive stage I lung cancer in 80-90%. Modern screening for lung cancer by spiral CT scan could possibly decrease lung cancer mortality. Despite the first favourable results of screening the question remains whether lung cancer screening will be cost-effective. These questions can only be resolved in a randomised controlled trial with lung cancer mortality as unbiased end-point. Such a study should be initiated in the Netherlands, a country with large experience in screening trials and a good health care system. Only after lung cancer screening has proven to be cost-effective can appropriate implementation be recommended to prevent uncontrolled and opportunistic diffusion of this new screening technique into clinical practice in the near future.

Clinical Trials as Topic↗
PubMed2001

[Lung cancer in the Netherlands in the period 1989-1997: the epidemic is not over yet].

OBJECTIVE: To describe and interpret changes in incidence, mortality and survival of lung cancer in the Netherlands in the period 1989-1997. DESIGN: Secondary data analysis. METHODS: Data on the incidence of lung cancer were collected from the Dutch Cancer Registration (1989-1997), on mortality from Statistics Netherlands (CBS; 1989-1994), on the incidence of lung cancer in other European countries from EUROCIM (1990-1994), on survival of Dutch lung cancer patients from the Comprehensive Cancer Centre Amsterdam (1988-1997) and the Comprehensive Cancer Centre South (1988-1992) and on survival of other European lung cancer patients from EUROCARE (1985-1989). Incidence rates were calculated per 100,000 person years and standardized by age according to the European population structure. Survival was calculated as the ratio of observed survival among the lung cancer patients and the expected survival of the general population. RESULTS: The incidence of lung cancer among men decreased from 109 to 93, whereas that among women increased from 18 to 23. The incidence of lung cancer among Dutch men was high in comparison to other European countries, whereas that among women was average. The trends in lung cancer incidence were probably related to the trends in past smoking behaviour. Mortality decreased among men from 106 to 91 and increased among women from 15 to 20. Survival was better for younger patients, a localised tumour, and better for squamous cell carcinoma or adenocarcinoma than for large-cell undifferentiated or small-cell carcinoma. The relative 5-year survival was 12%, the relative 1-year survival 39%; these were good in comparison with other European countries. CONCLUSION: The incidence and mortality of lung cancer among Dutch men decreased, but still in 1997 almost 20 men in the Netherlands died each day of lung cancer. Among women the end of the increase is not in sight and in 1997 over 5 women died each day of lung cancer.

Adult↗
PubMed2000

Trends in the curative treatment of localized prostate cancer after the introduction of prostate-specific antigen: data from the Rotterdam Cancer Registry.

OBJECTIVE: To investigate changes in the incidence and treatment of prostate cancer over the period in which new diagnostic tools were introduced and the attitude towards treatment was changing. PATIENTS AND METHODS: Information on the extent of disease and treatment of patients diagnosed with prostate cancer within the Rotterdam region was retrieved from the Rotterdam Cancer Registry. RESULTS: In the period 1989-95, 4344 patients were diagnosed with prostate cancer and the age-standardized incidence increased from 62 to 125 per 100 000 men. This increase mainly comprised tumours localized to the prostate, while the incidence of advanced cancers remained stable. The proportion of poorly differentiated tumours decreased from 33% in 1989 to 24% in 1995. In the same period the number of patients receiving radiotherapy increased from 80 to 258, while the annual number of radical prostatectomies rose from 17 to 159. Radiotherapy was the preferred type of treatment in patients over 70 years of age, whereas radical prostatectomy was used more frequently in younger patients with localized tumours. CONCLUSION: While the value of screening for prostate cancer remains in debate, incidence and treatment patterns are changing rapidly. Information on patterns of care is needed to interpret future mortality data and to plan resources for adequate health care.

Age Distribution↗
PubMed2000

Understanding variations in survival for colorectal cancer in Europe: a EUROCARE high resolution study.

BACKGROUND: Marked differences in population based survival across Europe were found for colorectal cancers diagnosed in 1985-1989. AIMS: To understand the reasons for these differences in survival in a new analysis of colorectal cancers diagnosed between 1988 and 1991. SUBJECTS: A total of 2720 patients with adenocarcinoma of the large bowel from 11 European cancer registries (CRs). METHODS: We obtained information on stage at diagnosis, diagnostic determinants, and surgical treatment (not routinely collected by CRs) and analysed the data in relation to three year observed survival, calculating relative risks (RRs) of death and adjusting for age, sex, site, stage, and determinants of stage. RESULTS: Three year observed survival rates ranged from 25% (Cracow) to 59% (Modena), and were low in the Thames area (UK) (38%). Survival rates between registries for "resected" patients varied less than those for all patients. When age, sex, and site were considered, RRs ranged from 0.7 (95% confidence intervals (CI) 0.6-0.9) (Modena) to 2.3 (95% CI 1.9-2.9) (Cracow). After further adjustment by stage, between registry RR variation was between 0.8 (95% CI 0.6-0.9) and 1.8 (95% CI 1.5-2.2). Inter-registry RR differences were slightly reduced when the determinants of stage (number of nodes examined and liver imaging) were included in the model. The reduction was marked for the UK registries. CONCLUSIONS: The wide differences across Europe in colorectal cancer survival depend to a large extent on differences in stage at diagnosis. There are wide variations in diagnostic and surgical practices. There was a twofold range in the risk of death from colorectal cancer even after adjustment for surgery and disease stage.

Adenocarcinoma↗
PubMed1999

Increased but low incidence and poor survival of malignant mesothelioma in the southeastern part of The Netherlands since 1970: a population-based study.

Changes in the incidence and survival rates for malignant mesothelioma in the southeastern part of The Netherlands since 1970 were investigated, using data from the Eindhoven Cancer Registry (ECR). The exposure to asbestos in this area is presumed to be limited. Most of the mesotheliomas occurred in the pleura, where there were 119 (88%) against 15 (11%) in the peritoneum and two in the tunica vaginalis testis. Compared to other European countries, the incidence rate for the southeastern part of The Netherlands was fairly low in the second half of the 1980s. Between 1975 and 1994 the age-adjusted incidence rates (ESR) for pleural mesothelioma increased twofold (from 10 to 19 per one million person-years among men and from 2.4 to 3.8 among women). The rate for peritoneal mesothelioma remained constant. The overall relative 0.5-, 1-, and 3-year survival rates remained 68, 42, and 8%, respectively. The fourfold higher incidence rate for men compared with women reflects the fact that mesothelioma is mainly an occupational disease. In view of presumed limited exposure to asbestos and small geographical variation, the incidence of mesothelioma in the southeastern part of The Netherlands will probably remain low, despite an increase in the past decades.

Adult↗
PubMed1998

Variation in survival of patients with prostate cancer in Europe since 1978. EUROCARE Working Group.

Since the incidence of prostate cancer has increased considerably over the past two decades in most European countries, knowledge of the variation in survival is pertinent. The collaboration across Europe in the EUROCARE study has now been extended to 45 registries in 17 countries. We report on variation in relative survival according to age of 65,728 patients diagnosed with prostate cancer between 1985 and 1989 and also explore time trends since 1978 for most countries. Considerable variation in survival was found within and between countries, with the highest survival in Switzerland (5-year relative survival 72%), followed by Germany (67%) and the Nordic countries (except Denmark). The lowest survival was found in Estonia (39%), preceded by Slovenia (40%), Denmark (41%) and England (45%). Between 1978 and 1986, relative survival barely changed over time, but it improved from 55% (95% confidence interval [CI] 53-57) during 1984-1986 to 59% (CI 56-61) during 1987-1989. A small but unexpected deterioration of survival for patients aged between 45 and 54 years from 61% to 56% was observed in the early 1980s. It is likely that variation in both detection methods and treatment plays a role in the observed variation in survival, but more information is needed to assess each contribution.

Adolescent↗
PubMed1998

Improvement in survival of patients with cancer of the kidney in Europe. EUROCARE Working Group.

Survival of adult patients with cancer of the kidney, renal pelvis, ureter and urethra (ICD-9 189) was analysed using data from the EUROCARE II study, a collaborative project of 45 population-based cancer registries in 17 European countries. For the period 1985-1989, more than 24000 patients were included and 5-year relative survival was 48%. Large variations were observed between countries with 5-year relative survival ranging from 57% in France, 53% in Italy and 51% in Spain to 35% in Denmark, 33% in Poland and 30% in Estonia. A number of registries also provided information on previous years and survival was seen to improve with time from 44% in 1978-1980 to 50% in 1987-1989. Age was an important determinant of survival with 5 year survival rates decreasing from 63% in patients aged 15-44 years to 36% in patients aged 75 years and older. Variation in survival rates by country or time is probably related to differences in the distribution of tumour stage at diagnosis. Evidence to confirm this theory is, however, lacking.

Adolescent↗
PubMed1997

The effects of alcohol and smoking upon the age, anatomic sites and stage in the development of cancer of the oral cavity and oropharynx in females in the south west Netherlands.

A retrospective review of 303 women, aged 40 or over, with squamous cell carcinomas of the oral cavity or oropharynx was conducted in the south-west Netherlands to study the effects of smoking and alcohol upon the age of onset, site and stage of disease. It was noted that patients presenting with oropharyngeal cancers were younger and had a higher incidence of smoking and history of heavy drinking. Age at presentation was also affected by the amount of alcohol and tobacco consumed with non-users presenting with tumors approximately 15 years later. A specific finding was that heavy drinkers and smokers tended to present with late-stage-disease.

Adult↗
PubMed1997

Association between age and local recurrence of rectal cancer: results from a retrospective study of 902 patients.

Due to the ageing of the general population, there has been a relative increase of elderly patients with rectal cancer. The relation between age and the risk of local recurrence after apparently curative surgery for cancer of rectum and rectosigmoid was studied in a retrospective study of 902 patients, diagnosed from 1984 through 1991 in the southwestern part of the Netherlands. Three age-groups were defined: 15-64 (n = 328), 65-74 (n = 327) and 75 and over (n = 247). After exclusion of postoperative deaths and controlling for unrelated causes of death, 5-year survival rates were similar in the three age-groups (70%, 71% and 75%, respectively). Local recurrence rates, however, decreased with age from 23% to 18% and 14%, respectively. In multivariate analysis, the hazard ratios were 1, 0.84 and 0.66, respectively. These results suggest that local recurrence occurs less frequently in the elderly, which needs confirmation from prospective studies and warrants consideration in decisions about the use of adjuvant treatment.

Adolescent↗
PubMed1997

Local recurrence and survival in patients with rectal cancer, diagnosed 1981-86: a community hospital-based study in the south-east Netherlands.

We carried out a population-based audit of local recurrence rates in curatively resected patients with rectal cancer, diagnosed between 1981 and 1986. The study comprises 372 patients treated for rectal cancer in five community hospitals in the south-east of the Netherlands. The follow-up period was 7-12 years. We studied the medical records of these patients in the Eindhoven Cancer Registry, and by checking the endoscopical, surgical and pathological reports, we traced the following events: local recurrence, distant metastasis and (cause of) death. Curative resection was carried out in 232 of the 372 cases (62%); post-operative radiotherapy was administered to 27% of stage B2 and 50% of stage C (Astler-Coller) patients. Crude and net 5-year survival rates were 45% and 58%, respectively. Local recurrence rates were 18%, without much variation per hospital. After adjustment for age, gender, tumour site and type of surgery, local recurrence was primarily determined by tumour penetration of the muscularis propria and lymph node infiltration, the relative risks being 2.5 and 3.1, respectively (90% confidence intervals: 1.1-5.9 and 1.5-6.4). Although patients with cancer of the distal segment (0-6 cm) had shorter survival times than with proximal tumours, tumour site only weakly influenced local recurrence rates. These results confirm that the risk of recurrence for stage B2 and C patients can be reduced by more extensive surgical procedures. This study has contributed to the growing awareness of improved surgical treatment in rectal cancer.

Adult↗
PubMed1997

The influence of alcohol and smoking on the incidence of oral and oropharyngeal cancer in women.

A retrospective case reference study examining the use of alcohol and tobacco in 303 women aged 40 or over suffering from oral or oropharyngeal cancer was conducted in the south-west Netherlands. Both alcohol and tobacco consumption are important in the development of oral and oropharyngeal cancer with increased consumption of both markedly increasing the risks of cancer, but alcohol having the greater effect.

Adult↗
PubMed1996

European randomized study of screening for prostate cancer--the Rotterdam pilot studies.

Five randomized pilot studies of screening for prostate cancer (PC) have been conducted in the area of Rotterdam from 1991 to 1994. The purpose of these studies was to establish the feasibility of a randomized screening protocol with PC mortality as the major end point in The Netherlands and at a European level. All procedures related to recruitment of participants, to application of the screening tests and to data collection were evaluated. Men (7,200) aged 55-74 years were invited through the Rotterdam Population Registry. The recruitment rate over the 5 pilot studies averaged 38.2% (2,747 men). Recruitment procedures proved to be relevant for establishing higher participation rates (invitation and consent by mail). The screening tests were well accepted and tolerated. The general population-based character of the sample was confirmed by studying symptoms of prostatic disease in participants and in men who refused participation. Data based on one PSA serum determination, rectal examination and transrectal ultrasonography are presented; 204/1,403 men (14.5%) had a positive screening result by either test combination and underwent biopsy. Forty-nine cancers were found in 1,403 men (3.5%); 65% of prostate cancers (17/26) identified in men who eventually underwent radical prostatectomy proved to be locally confined. From the pilot studies, we conclude that a large contribution to a European Randomized Study of Screening for Prostate Cancer (ERSPC) can be made by recruiting about 40,000 men in the area of Rotterdam. The preliminary data suggest that after confirmation of the present data during the first years in the European study, DRE and TRUS can be withheld depending on the PSA result in a large proportion of the screening population.

Age Factors↗
PubMed1996

The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer.

Due to the ageing of the general population, the proportion of elderly patients with colorectal cancer has increased. In a registry-based study, we evaluated the influence of age and other variables on resection rates and operative risk. Resection rates and postoperative mortality rates (30-day) were analysed in 6457 patients with colorectal cancer, diagnosed from 1985 through 1992 in hospitals connected to the Rotterdam Cancer Registry. Overall, 87% of the patients underwent resection but resection rates were lower for patients older than 89 years (67%) and for patients with rectal cancer (83%). The postoperative mortality rate was 1% for patients younger than 60 years and steadily increased with age. For patients 80 years and older the operative risk was 10%. According to multivariate analysis gender, age, subsite and stage were defined as independent prognostic factors. In view of the lack of alternatives, elderly patients with colorectal cancer should not be denied surgery on account of chronological age alone. Even in patients over 90 years of age resections can be performed with acceptable risk.

Adult↗
PubMed1996

Resection rates and postoperative mortality in 7,899 patients with lung cancer.

Postoperative death used to be an important complication of resections for lung cancer, especially in elderly patients. To support decision making in a general situation, contemporary results and prognostic factors were evaluated. The computer records of 7899 lung cancer patients, diagnosed from 1984 until 1992 in hospitals connected to the Rotterdam Cancer Registry, were analysed to evaluate resection rates and 30 day postoperative mortality. Resections were carried out in 20% of all patients. In patients 70 yrs of age and older, the resection rate was 14%, and in younger patients 26%. The postoperative mortality was 3.1%; 3.6% for males and 0.4% for females. According to multivariate analysis, age and extent of surgery were the major determinants of operative risk. For patients aged 0-59, 60-69 and > or = 70, postoperative mortality rates were 1.4, 3.5 and 4.0%, respectively. The operative risk was 5.7% after pneumonectomy, 4.4% after bilobectomy, and 1.4% after lesser resections. Pneumonectomies were performed less often in elderly patients: 27% of operations in patients > or = 70 yrs versus 37% of operations in younger patients. Age appears to be related to treatment choice and postoperative mortality in patients with lung cancer. However, even in patients over 70 yrs of age, resections can be performed at acceptable risk, implying that chronological age should not automatically determine treatment decisions.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1995

[Good surgery results in older patients with stage 1 lung carcinoma].

OBJECTIVE: To determine the influence of age on survival of patients undergoing resection for lung cancer. DESIGN: Retrospective. SETTING: South-western part of the Netherlands. METHODS: Follow-up information was gathered on patients who had undergone resection for stage I non-small cell lung cancer from 1984 through 1990 and had been registered by the Rotterdam Cancer Registry. Operative mortality, 2-year and 5-year survival in the age groups 20-59, 60-69 and 70 years and older were compared. RESULTS: Of the 630 patients (median age of 66 years) one-third was 70 years or older. Operative mortality was mainly determined by the type of operation: 6% after pneumonectomy versus 1% after lesser resections. Five-year survival declined with age from 65% to 48% and 43% (p < 0.01). After adjustment for non-related causes of death this difference decreased: 68%, 55%, 61% (p = 0.15). The main prognostic factor was tumour size. CONCLUSION: Chronological age has a limited influence on the survival of patients with lung cancer and does not preclude surgical treatment.

Adult↗
PubMed1995

Mesothelioma.

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Asbestos↗
PubMed1995

The influence of age on resection rates and postoperative mortality in 2773 patients with gastric cancer.

Resection rates and postoperative mortality rates were studied in patients with gastric cancer, diagnosed from 1982 until 1992 in the southwestern area of the Netherlands. Overall, 51% of the patients underwent resection. For patients aged 0-59, 60-69, 70-79 and 80 years and over, resection rates were 64, 55, 54 and 35%, respectively. Tumours located in the cardia were less often resected than tumours of the antrum, 39 versus 71%. The postoperative mortality after resectional operations was 8.3%; 9.2% for men and 6.7% for women. The operative risk increased markedly after the age of 70 years; for patients under 70 years of age, the rate was 3.4% compared with 12.4% for those aged 70 years and older. These results indicate that elderly patients can be operated on at an acceptable risk, and that palliative resections may be considered, especially in patients younger than 70 years.

Adolescent↗