Care for cancer patients varies between hospitals. This means that the care provided depends on the hospital in which a person happens to be treated and this is not desirable. At the same time our knowledge about cancer is increasing and with new technologies we want to offer more personalized care . This would results in more desirable variation in cancer care. Professor dr. Sabine Siesling of the University of Twente (Health Technology & Services Research department) and senior researcher at the Netherlands Comprehensive Cancer Organization (IKNL), is investigating whether variation affects the quality and outcomes of care. Siesling will hold her inaugural lecture on the 24th of September.
This new chair is focusses on research on variation in care for cancerpatients, variation in the use of new (expensive) technologies and the consequences on, e.g., the course of the disease, quality of life and survival. Finally, aiming for personalized cancer care.
Desirable and undesirable variation
Siesling: “ Variation in cancer care is undesirable if the guidelines do provide clear advice. In that case it is highly likely that an alternative treatment would lead to a less favourable result and a poorer outcome for the patient. Still, the guidelines on treatment are not always based on solid evidence. In casde there is no solid evidence, specialists do not always know which care leads to the best results. If the guidelines do not indicate a clear recommendation, then variation is only to be expected and we can even use it to obtain new ‘evidence’ that can be used to fine-tune guidelines. By investigating the outcomes of variation, it may be possible to identify specific groups of patients for whom a given treatment is more effective than for others. It will also enable us to avoid over-treatment and under-treatment. Desirable variation, on the other hand, means that you are providing personalized and thus customized care.. Other causes of variation, however, are the desires of a patient, the accessibility of guidelines or the lack of them and organizational factors of a given hospital. This is why it is so important to follow all individual patients in Cancer Registration in the Netherlands (NKR). These days this is no longer just about averages, but about the outcomes of individuals.”
New technologies
“Once the variation has been mapped out, and factors that influence this variation have been determined and - with the help of the NKR - we know who benefits from variation, the next question is how to reach personalized cancer care for the individual patients”, according to Siesling. Technology is changing so rapidly that a specialist needs help in making choices when deploying new options for diagnostics and treatment. Improved imaging in diagnostics, genetic profiles and tracing circulating tumour cells in the blood are examples of technologies that are increasingly able to map out cancer and the sensitivity of cancer cells to certain medicines.
Which patients will benefit most from these forms of - often expensive - technology? How big is the specific target group? Does it make the care less onerous or does it just 'add to the burden’? What is its added value? How can we support the care professions and patients in opting for the optimum form of care?
Shared decision-making
The final choice of treatment is determined by the care professional and the patient jointly: shared decision-making. This involves them making a joint choice of treatment that is expected to provide the greatest effect with the most favourable results, the fewest side effects or late effects, and which is in keeping with the patient's possibilities (fitness, home situation and wants). “We are still increasing our knowledge about the various forms of cancer. For instance, we know that breast cancer, the most frequent form of cancer in women, includes all sort of different tumours, each of which demands a different approach. Many common tumours are becoming increasingly specific and unique due to these sub-divisions. In combination with the human being behind the patient, this means that specialists and patients are being confronted with difficult decisions that they increasingly have to make together. The Netherlands Cancer Registry provides the information needed to support these choices,” according to Siesling. For example, together with other scientists, Siesling came up with the INFLUENCE nomogram. A specialist can complete this nomogram, together with a breast cancer patient, in order to determine the risk of the recurrence of the disease. This provides input for the after-care plan.
Care for cancer patients in the Netherlands is good, but in the future it will focus more on individuals. How this will be done is being investigated by the University of Twente and the IKNL in the chair ’Outcomes Research and personalized cancer care’.
More information
Prof. dr. S. Siesling will hold her inaugural lecture on 24 September 2015 at 16:00 hours in the Prof. ir. M.P. Breedveld lecture room and the Foyer of building de Waaier at the UT campus in Enschede. The press are welcome and are invited to report to Martine van Hillegersberg (University of Twente) or Ellen van Rooij (IKNL). Requests can be submitted for the booklet with the inaugural speech, which can be also found on the website www.utwente.nl.
