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Background: A prediction tool was developed and internally validated to aid the diagnosis of Cushing's syndrome in dogs attending UK primary‐care practices. External validation is an important part of model validation to assess model performance when used in different populations. Objectives: To assess the original prediction model's transportability, applicability, and diagnostic performance in a secondary‐care practice in the Netherlands. Animals: Two hundred thirty client‐owned dogs. Methods: Retrospective observational study. Medical records of dogs under investigation of Cushing's syndrome between 2011 and 2020 were reviewed. Dogs diagnosed with Cushing's syndrome by the attending internists and fulfilling ALIVE criteria were defined as cases, others as non‐cases. All dogs were scored using the aforementioned prediction tool. Dog characteristics and predictor‐outcome effects in development and validation data sets were compared to assess model transportability. Calibration and discrimination were examined to assess model performance. Results: Eighty of 230 dogs were defined as cases. Significant differences in dog characteristics were found between UK primary‐care and Dutch secondary‐care populations. Not all predictors from the original model were confirmed to be significant predictors in the validation sample. The model systematically overestimated the probability of having Cushing's syndrome (a = −1.10, P <.001). Calibration slope was 1.35 and discrimination proved excellent (area under the receiver operating curve = 0.83). Conclusions and Clinical Importance: The prediction model had moderate transportability, excellent discriminatory ability, and overall overestimated probability of having Cushing's syndrome. This study confirms its utility, though emphasizes that ongoing validation efforts of disease prediction tools are a worthwhile effort. [ABSTRACT FROM AUTHOR]

The article presents information on a research on the treatment for hairy cell leukemia (HCL) and the overall survival (OS) of patients in The Netherlands. The authors collected details on HCL patients diagnosed between 1989 and 2015 from the Netherlands Cancer Registry (NCR). The topics include the methodology followed, the strength and limitation of the study. It revealed that the majority of HCL patients in The Netherlands can enjoy a normal life expectancy.

Background: The aim of this study was to gain insight into the experience of time of terminal patients with cancer. Experience of time is relevant in palliative care in both policy and practice. On a policy level, the Quality Adjusted Life Year (QALY), the most used outcome measure for cost-effectiveness analysis in healthcare, assumes time to be a linear and additive variable, which is one of the reasons that its applicability in palliative care is questioned. On a practice level, a better understanding of the experience of time of patients with limited time left, could help to recognize if and how these patients can have a more meaningful use of time. The main focus of this study was to discover whether time perception of these patients in their last months of life had changed as compared to earlier periods of time in their lives in good physical health. The pace of time and time dominance (comparison of past, present and future) were investigated. Methods: In several hospices and palliative care units in the Netherlands, twelve semi-structured interviews were conducted with terminal patients with cancer. Results: Time perception at the end of life had changed for most participants. They all lived on a day-to-day basis in the terminal phase, independent of their way of life in the healthy phase. Furthermore, the experienced duration of a day turned out to be very different between patients, but also between days, depending on daily activities. Besides, for most patients for whom the future was the dominant period of time in the healthy phase, the dominant period of time in the terminal phase had become the past. Conclusions: Time perception of terminal patients with cancer differed from the time perception in their relatively healthy phase of life. This suggests that the LY part of the QALY is not comparable for all phases of life. [ABSTRACT FROM AUTHOR]

Management of patients with chronic lymphocytic leukemia (CLL) is changing due to considerable advances in the therapeutic armamentarium, and new therapies will possibly continue to emerge in the near future. Therefore, the CLL working group of the Dutch-Belgium Haemato-Oncology Cooperative Group for Adults in the Netherlands (HOVON) necessitated revising the Dutch CLL guidelines. The current guideline is based on the expert opinion of the HOVON CLL working group members and focusses on well-designed clinical trials taking into account efficacy with special emphasis on toxicity, treatment duration and treatment intensity. This article provides recommendations on diagnosis, treatment strategies in front-line and relapsed setting and provides supportive care measurements during novel-based therapies as well as for infectious CLL-related complications. The recommendations presented here are intended to provide guidance for the management of CLL patients in the Netherlands, and take into account the availability of treatment strategies at the time of this publication. [ABSTRACT FROM AUTHOR]

Summary: Studies on the conditional life expectancy of patients with chronic myeloid leukaemia (CML) are lacking. Using data from the Netherlands Cancer Registry, we examined the life expectancy of patients with CML in the Netherlands diagnosed during 1989–2018. As of the early 2010s, the life expectancy of patients with CML who survived several years after diagnosis came narrowly close to the general population's life expectancy, regardless of age. This finding can essentially be ascribed to the introduction and broader application of tyrosine kinase inhibitors (TKIs) and provide optimism to patients with CML who can look forward to a near‐normal life expectancy in a modern TKI era. [ABSTRACT FROM AUTHOR]

Summary: Contemporary diagnosed WM patients, compared to the general population, continue to experience excess mortality regardless of having survived up to 15 years post‐diagnosis. This gradual increase in excess mortality might result from the incurable nature of this disease characterized by multiple relapses throughout the disease course with limited efficacious treatment options in the released/refractory setting. [ABSTRACT FROM AUTHOR]

Summary: It is unclear how treatment advances impacted the population‐level survival of patients with lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia (LPL/WM). Therefore, we assessed trends in first‐line therapy and relative survival (RS) among patients with LPL/WM diagnosed in the Netherlands between 1989 and 2018 (N = 6232; median age, 70 years; 61% males) using data from the nationwide Netherlands Cancer Registry. Patients were grouped into three age groups (<65, 66–75 and >75 years) and four calendar periods. Overall, treatment with anti‐neoplastic agents within 1 year post‐diagnosis gradually decreased over time, following a broader application of an initial watch‐and‐wait approach. Approximately 40% of patients received anti‐neoplastic therapy during 2011–2018. Furthermore, use of chemotherapy alone decreased over time, following an increased application of chemoimmunotherapy. Detailed data among 1596 patients diagnosed during 2014–2018 revealed that dexamethasone‐rituximab‐cyclophosphamide was the most frequently applied regimen; its use increased from 14% to 39% between 2014 and 2018. The 5‐year RS increased significantly over time, particularly since the introduction of rituximab in the early–mid 2000s. The 5‐year RS during 1989–1995 was 75%, 65%, and 46% across the age groups compared to 93%, 85%, and 79% during 2011–2018. However, the survival improvement was less pronounced after 2011. Collectively, the impressive survival improvement may be accounted for by broader application of rituximab‐containing therapy. The lack of survival improvement in the post‐rituximab era warrants studies across multiple lines of therapy to further improve survival in LPL/WM. [ABSTRACT FROM AUTHOR]

Survival continues to increase in chronic lymphocytic leukaemia: a population-based analysis among 20 468 patients diagnosed in the Netherlands between 1989 and 2016 Keywords: chronic lymphocytic leukaemia; survival; cancer epidemiology; population-based; registry EN chronic lymphocytic leukaemia survival cancer epidemiology population-based registry 574 577 4 04/30/20 20200501 NES 200501 Chronic lymphocytic leukaemia (CLL) is the most frequently diagnosed and prevalent form of leukaemia among adults in Western countries (Brenner I et al. i , [2]; Kristinsson I et al. i , [6]; Van den Broek I et al. i , [9]). Relative survival (RS) is the overall survival (OS) in the patient cohort divided by the expected OS of an equivalent group from the general population, matched to the patient group by age, sex, and period (Dickman & Adami, [3]). Furthermore, the incidence of CLL might be overestimated, because most patients diagnosed with Rai stage 0 or I before 2008 can be reclassified into monoclonal B-cell leukaemia according to the most recent diagnostic criteria (Hallek I et al. i , [5]). [Extracted from the article]

Background: Older people have the highest incidence of melanoma and the population in most Western countries is ageing. We evaluated how the gap in incidence and survival between younger and older patients has developed during the past decades. Material and methods: All patients diagnosed with cutaneous melanoma between 1989 and 2015 (n = 84,827) were identified from the Netherlands Cancer Registry. Elderly were defined as aged ≥70 years. Differences in patient and tumor characteristics were described, age-specific incidence rates were calculated, and relative survival (RS) and multivariable analyses estimating the Relative Excess Rate of dying (RER) were conducted Results: In older men, the melanoma age-standardized incidence increased from 18 to 103/100,000 person-years (py) between 1989 and 2015 and in older women from 23 to 70/100,000 py. In younger men and women, it increased from 8 to 21 and from 13 to 28/100,000 py, respectively. Median Breslow thickness declined from 1.8 to 1.1 mm and from 1.6 to 1.1 mm in older men and women (2003 versus 2015), and from 1.1 to 0.9 mm and 0.9 to 0.8 mm in younger men and women. In older men, 5-year RS increased from 67% (95% CI: 63%–72%) in 1989–1997 to 85% (95% CI: 83%–87%) in 2007–2015 and in older women from 81% (95% CI: 78%–85%) to 89% (95% CI: 87%–91%). In younger men and women, RS increased from 82% (95% CI: 81%–83%) to 90% (95% CI: 90%–91%) and from 92% (95% CI: 92%–93%) to 96% (95% CI: 95%–96%). After case-mix correction , older men and women no longer showed an improved survival over time (RER 2010–2015 versus 2003–2009: 0.97; 95% CI: 0.81–1.16 and 0.95; 95% CI: 0.79–1.16). Whereas in younger men and women survival remained improved (RER 0.75; 95% CI: 0.67–0.83 and 0.77; 95%CI: 0.67–0.89). Conclusion: The gap in melanoma incidence between younger and older people is increasing due to a strong increase in incidence in older adults. Disparities in survival are declining, related to a narrowing gap in Breslow thickness. [ABSTRACT FROM AUTHOR]

Objectives: Assessment of "real‐world" treatment strategies and outcome in Dutch polycythemia vera (PV) patients. Methods: Retrospective chart review in 150 patients with PV (WHO 2008 diagnostic criteria) from 10 major non‐academic hospitals in the Netherlands. Results: Patients (median age 64 years, 49% male) frequently had cardiovascular risk factors (56%) and prior vascular events (31%). About 70% of patients were high‐risk, based on ELN criteria. However, the majority of patients were treated with phlebotomies alone (55%). Cytoreduction with hydroxyurea (HU) was received by 44% as part of their initial therapy, with or without phlebotomies. The time to achieve the 45% hematocrit target was shortest in patients treated with phlebotomies with or without HU (125 ± 99 and 197 ± 249 days, respectively) compared to patients treated with only HU (232 ± 216 days). Leukocyte and platelet levels were lower in HU‐treated patients, and ELN response targets were more often reached. During the median follow‐up period of 4.1 years, 14 patients (9%) suffered a thrombotic vascular event. Conclusions: In Dutch clinical practice, there is major clinical variation in treatment strategies for PV. Phlebotomizing patients shorten the time to achieve hematocrit control, while HU better controls platelet and leukocyte levels. The thrombotic vascular event rate remains clinically significant. [ABSTRACT FROM AUTHOR]

The article discusses the creation of a national program for Hodgkin lymphoma (HL) survivorship care in the Netherlands as of August 2019. Topics covered include the steps in screening of late adverse events like cardiovascular disease, thyroid dysfunction, and reduced fertility, the development of guidelines for the most frequent ones, and the flow of data from and to various sources and their use. Also noted are the BETER clinics' coordination with the patients' general practitioners (GP).

Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) may be underreported in cancer registries such as the Netherlands Cancer Registry (NCR). Analysis of Dutch medical claims can complement NCR data on MDS and CMML. We analyzed data on 3681 MDS patients and 235 CMML patients aged ≥18 years with initial claims for MDS or CMML from the Dutch nationwide medical claims-based Diagnosis Treatment Combination Information System (DIS) between 2008 and 2010. Clinical information was available in the DIS. MDS and CMML were diagnosed without a bone marrow (BM) examination in almost half of the patients. The age-standardized incidence rate (ASR) per 100,000 in the cohort that underwent BM examinations compared with NCR data was 2.8 vs . 3.3 for MDS and 0.2 vs. 0.4 for CMML in 2008–2010. A conservative treatment approach was associated with increasing age and absence of BM examination in MDS ( p < 0.001 for both) and CMML patients ( p < 0.033 for both). In conclusion, the ASR of MDS in the cohort that underwent BM examinations was comparable with the NCR. The majority of elderly patients, either with or without BM examinations, received no therapy. Together, MDS and CMML may be misdiagnosed and inappropriately managed without a BM confirmation. [ABSTRACT FROM AUTHOR]