Relatieve dosisintensiteit als maat voor kwaliteit en prognose bij adjuvante chemotherapie voor mammacarcinoom in de klinische praktijk.

Schraa, S. (Suzanna) (2015) Relatieve dosisintensiteit als maat voor kwaliteit en prognose bij adjuvante chemotherapie voor mammacarcinoom in de klinische praktijk. thesis, Medicine.

Text SchraaS.pdf Restricted to Registered users only Download (865kB)

Abstract

In Dutch guidelines, established by the NABON Breast Cancer Audit (NBCA), indicators for treatment with adjuvant chemotherapy in breast cancer are established to improve quality. The guideline state that adjuvant chemotherapy should start within 5 weeks after last surgery or radiotherapy. Furthermore a relative dose intensity (RDI), a frequently used measure of optimal dosage of chemotherapy, of at least 85% is required. Due to toxicity of chemotherapy treatment it is not always possible to comply with the guidelines. This study examined to what extent guidelines are met in St Antonius Hospital. For this purpose 605 patients treated with adjuvant chemotherapy for breast cancer between 2008 and 2013 were included. When chemotherapy was started after treatment with radiotherapy, the interval of 5 weeks was met in 98.6%, but 35% of patients exceeded the 5-week interval between surgery and chemotherapy. However, this interval seems insufficiently evidence based in the guideline. In this study no effect of an interval longer than 5 weeks on outcome was found as well. Therefore the relevance of this guideline is questionable. Of all patients 9.6% did not attain RDI of 85% or higher. Predictive factors included age, treating physician and episodes of febrile neutropenia. Other adverse events did not affect RDI. No relationship between RDI and (disease-free) survival was found for the limited median follow-up of 38 months. It would be advised to study this relationship in several years for the same cohort. Apart from disease stage, obesity is a predictor of poor outcome.

Item Type:	Thesis (Thesis)
Supervisor name:	Nijholt, dr. I. Isala te Zwolle and Jong, dr P.C. de and St Antonius te Nieuwegein, afd oncologie
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:43
Last Modified:	25 Jun 2020 10:43
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/413

Actions (login required)

View Item