Biomedical subjects

Renée Otter

Publications and source records attributed to Renée Otter.

7 recordsLinked to original sources

PubMed2007

Ten-year survival and risk of relapse for testicular cancer: a EUROCARE high resolution study.

Effective treatments for testicular cancer have been available since the 1970s, yet EUROCARE uncovered marked inter-country survival differences for this disease. To investigate these differences, we reviewed clinical records of 1350 testicular cancer cases diagnosed during 1987-1992 from 13 population-based cancer registries in nine European countries. Patients were followed up for life status and relapse. Ten-year observed survival was estimated by the Kaplan-Meier method. Cox multivariable analyses were performed separately for seminomas and non-seminomas. Overall, 66% of seminomas and 36% of non-seminomas were limited to the testis. Ten-year survival was 63% (Estonia) to 94% (Switzerland, Slovenia) for seminoma; 47% (Estonia) to 90% (Yorkshire, UK, The Netherlands) for non-seminoma. Multivariable analysis adjusted for country, age and stage showed that hazard ratios (HRs) of death differed little between western European registries, and were mainly attributable to differing stage at diagnosis. Significantly higher than reference HRs in Estonia and Poland suggest inadequacy or unavailability of treatments.

Adult↗

PubMed2006

Improvement of best practice in early breast cancer: actionable surgeon and hospital factors.

To identify actionable elements for improving best practice, this study examined the relative effects of patient, surgeon and hospital factors on surgical treatment variation of 2,929 early breast cancer patients, diagnosed from January 1998 to January 2002 in the region of the Comprehensive Cancer Centre North-Netherlands. Multilevel logistic regression was used to analyze the hierarchically structured data. Apart from the patient level, 43.3% of the treatment variation was due to the hospital and 56.7% to the surgeon, after adjustment for patient characteristics. Although hospital factors like volume, teaching status, and management and policy contributed to this variation, multidisciplinary care seemed the most important actionable hospital factor. Although the surgeon was shown to be an important starting point for quality improvement, actionable elements seemed difficult to identify as factors like surgeon experience and volume were not conclusive and significant variance on this level remained (sigma2 = 0.149, SE 0.053). We conclude that multidisciplinary care can improve best practice and that further research into actionable surgeon factors is needed.

Adult↗

PubMed2006

The prognostic effect of the number of histologically examined axillary lymph nodes in breast cancer: stage migration or age association?

BACKGROUND: The number of pathologically examined axillary nodes has been associated with breast cancer survival, and examination of >or=10 nodes has been advocated for reliable axillary staging. The considerable variation observed in axillary staging prompted this population-based study, which evaluated the prognostic effect of a variable number of pathologically examined nodes. METHODS: In total, 5314 consecutive breast cancer patients who underwent mastectomy or breast-conserving surgery and axillary dissection between 1994 and 1999 were included. The prognostic effect of the examined number of nodes was assessed with crude and relative survival analysis. RESULTS: A median number of 12 (range, 1-43) nodes were histologically examined, and 59% of the patients had no nodal tumor involvement. The number of examined nodes decreased with age (P<.001) and increased with tumor size (P<.001). Stratified for the number of tumor-positive nodes, overall survival seemed to be worse for patients with <10 compared with patients with >or=10 examined nodes (P<.001), whereas the relative survival did not differ. After adjusting for age, tumor size, number of positive nodes, and detection by screening in a multivariate analysis, the number of examined nodes was not associated with relative survival. CONCLUSIONS: This study shows that the association between the number of pathologically examined axillary nodes and overall survival in node-negative and node-positive patients results from stage migration. The absence of an association between the number of examined nodes and relative survival further indicates that the association between the number of examined nodes and crude survival is confounded by age.

Age Factors↗

PubMed2006

Cancer-related fatigue: predictors and effects of rehabilitation.

BACKGROUND: The aims of the study were to examine the effects of a multidimensional rehabilitation program on cancer-related fatigue, to examine concurrent predictors of fatigue, and to investigate whether change in fatigue over time was associated with change in predictors. METHODS SAMPLE: 72 cancer survivors with different diagnoses. SETTING: rehabilitation center. INTERVENTION: 15-week rehabilitation program. MEASURES: Fatigue (Multidimensional Fatigue Inventory), demographic and disease/treatment-related variables, body composition (bioelectrical impedance), exercise capacity (symptom-limited bicycle ergometry), muscle force (handheld dynamometry), physical and psychological symptom distress (Rotterdam Symptom Check List), experienced physical and psychological functioning (RAND-36), and self-efficacy (General-Self-Efficacy Scale, Dutch version). Measurements were performed before (T0) and after rehabilitation (T1). RESULTS: At T1 (n = 56), significant improvements in fatigue were found, with effect sizes varying from -0.35 to -0.78. At T0, the different dimensions of fatigue were predicted by different physical and psychological variables. Explained variance of change in fatigue varied from 42%-58% and was associated with pre-existing fatigue and with change in physical functioning, role functioning due to physical problems, psychological functioning, and physical symptoms distress. CONCLUSIONS: Within this selected group of patients we found that (a) rehabilitation is effective in reducing fatigue, (b) both physical and psychological parameters predicted different dimensions of fatigue at baseline, and (c) change in fatigue was mainly associated with change in physical parameters.

Academic Medical Centers↗

PubMed2004

Quality of adjuvant CMF chemotherapy for node-positive primary breast cancer: a population-based study.

PURPOSE: Adjuvant 'classical' oral cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) has long been the mainstay of adjuvant chemotherapy for premenopausal breast cancer patients. The Comprehensive Cancer Center North Netherlands (CCCN) breast cancer working group performed a retrospective audit of treatment guideline adherence and quality of CMF in hospitals in the CCCN area. METHODS: The CMF treatment data of 251 consecutive axillary lymph node-positive breast cancer patients <50 years old, diagnosed between 1993 and 1996, were analyzed. RESULTS: Ninety-four patients (42%) completed adjuvant CMF without dose adjustment or delay. Overall median relative dose intensity (RDI) was 92.6 (IQR 85.5-97.7). Sixty patients (24%) had an RDI <85, and 7% had an RDI <65. Myelotoxicity was the main reason for reductions and delays. Of 176 irradiated patients, 96% received radiotherapy simultaneously with CMF. Median CMF dose intensity nor median duration differed between patients who underwent mastectomy, mastectomy and radiotherapy, or breast-conserving therapy. Radiotherapy did not influence the median RDI (94 without versus 92 with radiotherapy). G-CSF, administered at least once to 76 patients, did not result in a higher median RDI. Median RDI was slightly higher when >3 patients/year (P=0.014) were treated by one specialist or >10 patients classified for adjuvant chemotherapy yearly in a hospital (P=0.037). CONCLUSION: The adherence to CMF treatment guidelines was generally good. Simultaneous radiotherapy did not affect the median RDI of CMF. G-CSF had no impact on the median RDI but patient volume did influence the RDI.

Adult↗

PubMed2004

Variability in axillary lymph node dissection for breast cancer.

BACKGROUND: The axillary nodal status may influence the prognosis and the choice of adjuvant treatment of individual breast cancer patients. The variation in number of reported axillary lymph nodes and its effect on the axillary nodal stage were studied and the implications are discussed. METHODS: Between 1994 and 1997, a total of 4,806 axillary dissections for invasive breast cancers in 4,715 patients were performed in hospitals in the North-Netherlands. The factors associated with the number of reported nodes and the relation of this number with the nodal status and the number of positive nodes were studied. RESULTS: The number of reported nodes varied significantly between pathology laboratories, the median number of nodes ranged from 9 to 15, respectively. The individual hospitals explained even more variability in the number of nodes than pathology laboratories (range in median number 8-15, P < 0.0001). The number of reported nodes increased gradually during the study period. A decreasing trend was observed with older patient age. A higher number of reported nodes was associated with a markedly increased chance of finding tumor positive nodes, especially more than three nodes. The frequency of node positivity increased from 28% if less than six nodes to 54% if >/=20 nodes were examined, the percentage of tumors with >/=4 positive nodes increased from 4 to 31%. Multivariate analysis confirmed these results. CONCLUSIONS: This population-based study showed a large variation in the number of reported lymph nodes between hospitals. A more extensive surgical dissection or histopathological examination of the specimen generally resulted in a higher number of positive nodes. Although the impact of misclassification on adjuvant treatment will have varied, the impact with regard to adjuvant regional radiotherapy may have been considerable.

Axilla↗

PubMed2003

Structure and reliability of Ware's Patient Satisfaction Questionnaire III: patients' satisfaction with oncological care in the Netherlands.

BACKGROUND: The present study examined the structure and reliability of the Dutch version of the Patient Satisfaction Questionnaire III (PSQ III). The PSQ III was designed to measure technical competence, interpersonal manner, communication, time spent with doctor, financial aspects, and access to care. In the Dutch version, the financial items were left aside because these are not appropriate for the Dutch socialized system. OBJECTIVES: The main objectives were to assess response bias, the number of dimensions needed to describe the PSQ III items, and the reliability of the scales. In addition, distribution characteristics were examined and norm scores to interpret satisfaction scores in an oncological setting were presented. RESEARCH DESIGN: A cross-sectional survey study.SUBJECTS The study was comprised of 1594 cancer patients from eight hospitals. MEASURES: The Dutch version of the PSQ III. RESULTS: Approximately 14% of the respondents were found to demonstrate considerable response bias. Confirmative factor analyses were performed to test three theoretical models with a varying number of dimensions among those participants who did not demonstrate response bias. The original structure did not fit the data well, but support was found for a three-factor model (with interpersonal manner, communication, and time spent with doctor loading on one factor instead of separate factors) and a one-dimensional model. CONCLUSIONS: The PSQ III seems to be an appropriate measure of cancer patients' satisfaction, with the note that the number of dimensions may vary for different patient groups and/or care settings and that it is important to be aware of response bias.

Aged↗