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PhD Defence Kelly de Ligt

Towards personalised breast cancer care: variation in treatment and follow-up from the patients’ perspective

Kelly de Ligt is a PhD student in the research group Health Technology and Services Research (HTSR). Her supervisor is prof.dr. S. Siesling from the faculty of Behavioural, Management and Social sciences (BMS).

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in women worldwide. In general, non-metastasized breast cancer is treated by local surgical intervention, supplemented by radiotherapy, chemotherapy, anti-hormonal therapy, and/or targeted therapy, followed by a minimum of five years of follow-up care at the hospital. Within treatment and follow-up decision-making, several options are available, that each have their own benefits and risks, as well in disease free prognosis as in the risk on side and/or late effects of treatment. An individualised treatment plan is developed in dialogue between the physician and patient. When personalised care is provided, i.e., care that is in line with the patients characteristics and preferences, this may cause treatment variation. On the one hand, variation is thus an indication of personalised care. However, on the other hand, it can also be an indication for suboptimal quality of care or unequal access to care.

This thesis describes whether patient preferences, needs, experiences, outcomes, and shared decision-making can explain the variation observed within treatment for breast cancer in the Netherlands. Three aspects of care were investigated: timing of chemotherapy treatment (either before or after surgery, respectively), application of breast reconstruction, and personalised follow-up for breast cancer.

The data for this thesis was gathered through patient-reported surveys and merged with data on cancer diagnosis and treatment available in the Netherlands Cancer Registry (NCR). Data is stored at the Netherlands Cancer Registry, that manages the NCR, and is available on reasonable request.