A better life after breast cancer
Breast cancer patients should be given more control over their own lives, Dr Annemieke Witteveen believes. A better life with fewer complaints and fewer check-ups.
One in seven women is affected by breast cancer. They get yearly follow-up checks after the treatment, to detect recurrence of cancer as early as possible. This group of patients is growing because more women are getting breast cancer and more women survive the disease thanks to better treatment.
During her PhD research, Witteveen found out that these follow-up checks could be better organized. “The checkup is the same for everyone, while the risk of breast cancer returning differs from woman to woman.”
Witteveen developed prediction models and optimal personal schedules so that low-risk women have to visit the hospital less frequent for breast imaging (mammogram). The resulting online tool INFLUENCE (INdividualized FoLlow-Up for brEast CaNCEr)creates a personalized risk profile and optimal testing schedule for each patient. The tool, which is now being used in hospitals, relieves both patients and the healthcare system. If introduced on a national scale in the Netherlands, the number of follow-up checks could be reduced by 9,000 per year, it has been calculated.
“Patients overestimate the risk of cancer recurrence,” Witteveen said. “They think the risk is 30% when it is only 2.5% in five years. If people knew that, it would already make a big difference. The period before a follow-up checkup is always very stressful for women. They are constantly reminded that they are patients. Personalizing the number of follow-up checks would be a huge step forward.”
Although breast cancer is increasingly curable, 20% of women still struggle with extreme fatigue and other symptoms more than ten years after diagnosis. Witteveen: “It is very different from the fatigue after a few nights of bad sleep. It is permanent and severe fatigue that is not in proportion to the physical efforts. It has a major impact on a woman's work, life, and family. An additional problem is that it is underreported. Patients are happy they have survived cancer and take the fatigue for granted. But it is especially important to treat as early as possible because then you can prevent fatigue from becoming chronic.”
The PARTNR project (Personalized cAnceR TreatmeNt and caRe) should do something about this problem. It is set up by the University of Twente, ZiekenhuisGroep Twente, the Helen Dowling Institute, rehabilitation centre 't Roessingh, Roessingh Research and Development, the Netherlands Comprehensive Cancer Organization, Evidencio, Ivido and the University Medical Center of Groningen. Witteveen is developing a self-learning platform to recommend optimal cancer-related fatigue treatment. The goal is a patient-level treatment (such as activity programs or mindfulness exercises) including the monitoring.
Witteveen has received 735,000 euros from the Dutch Cancer Society (KWF) and the Netherlands Organisation for Scientific Research (NWO) for her research in the PARTNR project. In addition, she has been awarded a Veni grant to develop individualized dynamic prediction models and treatment plans for health problems in a broader sense (such as pain, depression, sexual dysfunction). The research should help to remedy existing complaints earlier and prevent new ones. Part of the research will take place at Harvard University.
Witteveen's dream is that women regain more control over their lives after breast cancer. “Our tools put the focus not on being a patient, but on empowering a woman to a 2.0 version of herself. A cancer treatment process is always very intensive with many doctors and other health care providers. Afterwards, patients experience a great dark space. I hope that we can better prepare them for this and provide empowerment for this group. My goal is that these women will have a better quality of life with fewer complaints.”
EHealth is an important theme for Annemieke Witteveen. She previously set up the track Evaluating Future Health Technologies and will be developing a new eHealth course for the Master of Technical Medicine. Personalized eHealth Technology is also the subject of a summer school course she will be teaching.
“The three pillars of my work are prediction, monitoring and optimization. I would like to embed these three phases properly in education. It's about how you can use the information for clinical decision making. As a student, you can gather a lot of theoretical knowledge, but it's especially fun when you see the effect it can have and the clinical problem it can solve. That's what I want to teach students."
Annemieke Witteveen (1987) studied Technical Medicine (bachelor) and Health Sciences (master) at the University of Twente. In 2018 she obtained her PhD on individualizing the breast cancer follow-up, which included the INFLUENCE nomogram, a tool she developed that predicts the risk of breast cancer recurrence. The research was awarded the prize for the best oncology thesis of the year from the Dutch Society for Medical Oncology (NVMO).
Witteveen has been an assistant professor of eHealth Technology for Oncology in the Biomedical Signals and Systems research group since 2021. For her four-year research on fatigue symptoms in breast cancer patients (2020-2023), the Netherlands Organization for Scientific Research (NWO) and the Dutch Cancer Society (KWF) have awarded a grant of 735,000 euros. For her four-year research on predicting, monitoring and recommendations for late effects after breast cancer (2021-2024), she received a prestigious Veni grant of 250,000 euros from the NWO and ZonMw (the Dutch organization for health research and innovation).
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