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Slotman E, Weijzen F, Fransen HP, van Hoeve JC, Huijben AMT, Kuip EJM, Jager A, Kunst PWA, van Laarhoven HWM, Tol J, Tjan-Heijnen VCG, Raijmakers NJH, van der Linden YM, Siesling S. Continuity of care for patients with de novo metastatic cancer during the COVID-19 pandemic: A population-based observational study. Int J Cancer 2024; 154:1786-1793. [PMID: 38268393 DOI: 10.1002/ijc.34857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
During the COVID-19 pandemic recommendations were made to adapt cancer care. This population-based study aimed to investigate possible differences between the treatment of patients with metastatic cancer before and during the pandemic by comparing the initial treatments in five COVID-19 periods (weeks 1-12 2020: pre-COVID-19, weeks 12-20 2020: 1st peak, weeks 21-41 2020: recovery, weeks 42-53 2020: 2nd peak, weeks 1-20 2021: prolonged 2nd peak) with reference data from 2017 to 2019. The proportion of patients receiving different treatment modalities (chemotherapy, hormonal therapy, immunotherapy or targeted therapy, radiotherapy primary tumor, resection primary tumor, resection metastases) within 6 weeks of diagnosis and the time between diagnosis and first treatment were compared by period. In total, 74,208 patients were included. Overall, patients were more likely to receive treatments in the COVID-19 periods than in previous years. This mainly holds for hormone therapy, immunotherapy or targeted therapy and resection of metastases. Lower odds were observed for resection of the primary tumor during the recovery period (OR 0.87; 95% CI 0.77-0.99) and for radiotherapy on the primary tumor during the prolonged 2nd peak (OR 0.84; 95% CI 0.72-0.98). The time from diagnosis to the start of first treatment was shorter, mainly during the 1st peak (average 5 days, p < .001). These findings show that during the first 1.5 years of the COVID-19 pandemic, there were only minor changes in the initial treatment of metastatic cancer. Remarkably, time from diagnosis to first treatment was shorter. Overall, the results suggest continuity of care for patients with metastatic cancer during the pandemic.
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Affiliation(s)
- Ellis Slotman
- Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
- Netherlands Association for Palliative Care, Utrecht, Netherlands
| | - Feike Weijzen
- Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
- Netherlands Association for Palliative Care, Utrecht, Netherlands
| | - Jolanda C van Hoeve
- Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Auke M T Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, Netherlands
| | - Evelien J M Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud Medical Center, Nijmegen, Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Peter W A Kunst
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
- Department of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Hanneke W M van Laarhoven
- Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Jolien Tol
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Research Institute GROW, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Natasja J H Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
- Netherlands Association for Palliative Care, Utrecht, Netherlands
| | - Yvette M van der Linden
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, Netherlands
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Sabine Siesling
- Technical Medical Centre, Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
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2
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van Lith PEA, Schreuder K, Jalving M, Reyners AKL, Been LB, Rácz E, Fransen HP, Louwman MWJ. Systemic therapy timing and use in patients with advanced melanoma at the end of life: A retrospective cohort study. J Dermatol 2024; 51:584-591. [PMID: 38078557 DOI: 10.1111/1346-8138.17061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 04/04/2024]
Abstract
Novel systemic therapies for advanced melanoma improve survival, but carry potential serious side effects and high costs. This study aimed to assess the timing and use of systemic therapies in the months before death. Patients diagnosed with advanced melanoma (July 2017-June 2020) who died before July 2020 were selected from the Netherlands Cancer Registry. We evaluated the timing of systemic therapies within 30 days and 3 months before death, and studied patient and tumor characteristics associated with systemic therapy use between diagnosis and death. Out of 1097 patients 68% received systemic therapy. Almost 25% and 10% started a new therapy within 90 days and within 30 days before death, respectively. Female sex, elevated LDH, BRAF mutation, poor ECOG performance status (≥3), and high comorbidity index reduced the odds of receiving immune therapy. Poor performance status and high comorbidity decreased the odds for both therapies. A considerable number of patients started systemic therapy shortly before death, emphasizing the importance of considering potential benefits and drawbacks through shared decision-making.
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Affiliation(s)
- P E A van Lith
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K Schreuder
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - M Jalving
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - L B Been
- Department of Surgical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E Rácz
- Department of Dermatology, University of Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - M W J Louwman
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
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Ham L, Fransen HP, de Graeff A, Hendriks MP, de Jong WK, Kloover J, Kuip E, Mandigers C, Sommeijer D, van de Poll L, Raijmakers N, van Zuylen L. Relatives' Unmet Needs in the Last Year of Life of Patients With Advanced Cancer: Results of a Dutch Prospective, Longitudinal Study (eQuiPe). J Palliat Care 2024:8258597241239614. [PMID: 38515425 DOI: 10.1177/08258597241239614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Objective(s): Unmet needs of relatives of patients with advanced cancer not only reduce their own health-related quality of life, but may also negatively affect patients' health outcomes. The aim of this study was to assess changes in relatives' unmet needs of patients with advanced cancer in the last year of life and to identify differences in unmet needs by gender and type of relationship. Methods: Relatives of patients with advanced cancer in the Netherlands were included in a prospective, longitudinal, observational study. Relatives' unmet needs were measured every 3 months with an adapted version of the Problems and Needs in Palliative Care (PNPC) questionnaire Caregiver form (44 items, 12 domains). Questionnaires completed in the patients' last year of life were analyzed. Change of unmet needs in the last year, and differences in unmet needs by gender and type of relationship were analyzed. Results: A total of 409 relatives were included with a median of 4 unmet needs in the patient's last year. Unmet needs were most prevalent at all time points during the last year in the domains "caring for the patient" (highest need = 35%) and "psychological issues" (highest need = 40%). The number of unmet needs of relatives did not change significantly during the last year of life (P=.807). There were no significant differences in the number of unmet needs between male and female partners and between partners and other relatives. Conclusion: The most unmet needs for relatives were in the domains "caring for the patient" and "psychological issues." Professional support should focus on these items. Within these domains, it seems especially important that relatives get more knowledge and support about what scenarios to expect and how to deal with them.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, the Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Jeroen Kloover
- Department of Pulmonology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Evelien Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Caroline Mandigers
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Dirkje Sommeijer
- Department of Medical Oncology, Flevo Hospital, Almere, the Netherlands
| | - Lonneke van de Poll
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Natasja Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Boddaert MS, Fransen HP, de Nijs EJM, van Gerven D, Spierings LEA, Raijmakers NJH, van der Linden YM. Association between Inappropriate End-of-Life Cancer Care and Specialist Palliative Care: A Retrospective Observational Study in Two Acute Care Hospitals. Cancers (Basel) 2024; 16:721. [PMID: 38398112 PMCID: PMC10886868 DOI: 10.3390/cancers16040721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
A substantial number of patients with life-threatening illnesses like cancer receive inappropriate end-of-life care. Improving their quality of end-of-life care is a priority for patients and their families and for public health. To investigate the association between provision, timing, and initial setting of hospital-based specialist palliative care and potentially inappropriate end-of-life care for patients with cancer in two acute care hospitals in the Netherlands, we conducted a retrospective observational study using hospital administrative databases. All adults diagnosed with or treated for cancer in the year preceding their death in 2018 or 2019 were included. The main exposure was hospital-based specialist palliative care initiated >30 days before death. The outcome measures in the last 30 days of life were six quality indicators for inappropriate end-of-life care (≥2 ED-visits, ≥2 hospital admissions, >14 days hospitalization, ICU-admission, chemotherapy, hospital death). We identified 2603 deceased patients, of whom 14% (n = 359) received specialist palliative care >30 days before death (exposure group). Overall, 27% (n = 690) received potentially inappropriate end-of-life care: 19% in the exposure group, versus 28% in the non-exposure group (p < 0.001). The exposure group was 45% less likely to receive potentially inappropriate end-of-life care (AOR 0.55; 95% CI 0.41 to 0.73). Early (>90 days) and late (≤90 and >30 days) initiation of specialist palliative care, as well as outpatient and inpatient initiation, were all associated with less potentially inappropriate end-of-life care (AOR 0.49; 0.62; 0.32; 0.64, respectively). Thus, timely access to hospital-based specialist palliative care is associated with less potentially inappropriate end-of-life care for patients with cancer. The outpatient initiation of specialist palliative care seems to enhance this result.
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Affiliation(s)
- Manon S. Boddaert
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Heidi P. Fransen
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Ellen J. M. de Nijs
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Dagmar van Gerven
- Department of Medical Oncology, Alrijne Hospital, 2353 GA Leiderdorp, The Netherlands
| | | | - Natasja J. H. Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Yvette M. van der Linden
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Slotman E, Fransen HP, van Laarhoven HWM, van den Beuken-van Everdingen MHJ, Tjan-Heijnen VCG, Huijben AMT, Jager A, van Zuylen L, Kuip EJM, van der Linden YM, Raijmakers NJH, Siesling S. Reduction in potentially inappropriate end-of-life hospital care for cancer patients during the COVID-19 pandemic: A retrospective population-based study. Palliat Med 2024; 38:140-149. [PMID: 38142283 PMCID: PMC10798006 DOI: 10.1177/02692163231217373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life cancer care during the pandemic. AIM To investigate potentially inappropriate end-of-life hospital care for cancer patients before and during the COVID-19 pandemic. DESIGN Retrospective population-based cohort study using data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Potentially inappropriate care in the last month of life (chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission or hospital death) was compared between four COVID-19 periods and corresponding periods in 2018/2019. PARTICIPANTS A total of 112,919 cancer patients (⩾18 years) who died between January 2018 and May 2021 were included. RESULTS Fewer patients received potentially inappropriate end-of-life care during the COVID-19 pandemic compared to previous years, especially during the first COVID-19 peak (22.4% vs 26.0%). Regression analysis showed lower odds of potentially inappropriate end-of-life care during all COVID-19 periods (between OR 0.81; 95% CI 0.74-0.88 and OR 0.92; 95% CI 0.87-0.97) after adjustment for age, sex and cancer type. For the individual indicators, fewer patients experienced multiple or long hospitalizations, intensive care unit admission or hospital death during the pandemic. CONCLUSIONS Cancer patients received less potentially inappropriate end-of-life care during the COVID-19 pandemic. Because several factors may have contributed, it is unclear whether this reflects better quality care. However, these findings raise important questions about what pandemic-induced changes in care practices can help provide appropriate end-of-life care for future patients in the context of increasing patient numbers and limited resources.
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Affiliation(s)
- Ellis Slotman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Hanneke WM van Laarhoven
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Vivianne CG Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Auke MT Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien JM Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud Medical Center, Nijmegen, The Netherlands
| | - Yvette M van der Linden
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Natasja JH Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
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Ham L, Fransen HP, Raijmakers NJH, van den Beuken-van Everdingen MHJ, van den Borne B, Creemers GJ, de Graeff A, Hendriks MP, de Jong WK, van Laarhoven H, van Leeuwen L, van der Padt-Pruijsten A, Smilde TJ, Stellingwerf M, van Zuylen L, van de Poll-Franse LV. Trajectories of emotional functioning and experienced care of relatives in the last year of life of patients with advanced cancer: A longitudinal analysis of the eQuiPe study. Psychooncology 2023; 32:1858-1866. [PMID: 37882097 DOI: 10.1002/pon.6233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Advanced cancer has a major impact on both patients and their relatives. To allow for personalized support, it is important to recognize which relatives will experience a decline in emotional functioning during the patient's last year of life, when this decline will occur, and what factors are associated with it. This study aimed to examine the trajectory of emotional functioning of relatives during that time and the characteristics associated with changes in this trajectory. METHODS A prospective, longitudinal, multicenter, observational study in patients with advanced cancer and their relatives was conducted (eQuiPe). We analyzed relatives' changes in emotional functioning in the patient's last year using the EORTC QLQ-C30 and assessed associations with sociodemographic and care characteristics using multivariable mixed-effects analysis. RESULTS 409 relatives completed ≥1 questionnaires during the patient's last year of life. Mean age was 64 years, 61% were female and 75% were the patient's partner. During this year, mean emotional functioning declined significantly over time from 73.9 to 64.6 (p = 0.023, effect size = 0.43). The type of relationship between relatives and patients (p = 0.002), patient' sleep problems (p = 0.033), and continuity of care (p = 0.002) were significantly associated with changes in emotional functioning. CONCLUSIONS Relatives' emotional functioning declined during the patient's last year of life. Support for them, especially partners and relatives of patients with sleep problems, is important. Relatives who experienced more continuity of care had a less steep decline in emotional functioning.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Marieke H J van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Ben van den Borne
- Department of Pulmonology, Catharina Hospital, Eindhoven, The Netherlands
| | - Geert Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Hanneke van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Lobke van Leeuwen
- Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Tineke J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Margriet Stellingwerf
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lia van Zuylen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Ham L, Slotman E, Burghout C, Raijmakers NJ, van de Poll-Franse LV, van Zuylen L, Fransen HP. Potentially inappropriate end-of-life care and its association with relatives' well-being: a systematic review. Support Care Cancer 2023; 31:731. [PMID: 38055062 DOI: 10.1007/s00520-023-08198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Potentially inappropriate end-of-life cancer care (e.g., frequent hospital admission and emergency room visits in the last month of life) is known to be associated with a poorer quality of life of patients, but research on its association with the well-being of relatives is scarce. The aim of this systematic literature review was to evaluate the association between potentially inappropriate end-of-life cancer care and relatives' well-being. METHODS We conducted a systematic search and review, and reported according to the PRISMA guideline, on the association between potentially inappropriate end-of-life cancer care and well-being of relatives before and after the death of their loved one. Pubmed, PsycInfo, Embase, and CINAHL were searched for studies published from January 2000 to July 2022. Studies' quality was assessed using the Critical Appraisal Checklists from the Joanne Briggs Institute (JBI). RESULTS We identified eight studies including 10,062 relatives (59-79% female, mean age 46-61 years, 29-72% partner). Potentially inappropriate end-of-life cancer care was associated with poorer well-being of relatives including lower quality of life, higher burden of depressive symptoms, more regret, and more feelings of unpreparedness for the patient's death. CONCLUSION Potentially inappropriate cancer care at the end-of-life is associated with poorer well-being of relatives before and after the death of their loved one. This emphasizes the importance of avoiding potentially inappropriate end-of-life cancer care, as it is both associated with poorer outcomes for relatives and patients. However, the number of studies examining this association is small, and more research is needed in this area.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, The Netherlands.
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.
| | - Ellis Slotman
- Department of Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, The Netherlands
| | - Carolien Burghout
- Department of Hemato-Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, Den Bosch, The Netherlands
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Natasja Jh Raijmakers
- Department of Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Heidi P Fransen
- Department of Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, The Netherlands
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Malhotra A, Fransen HP, Quaresma M, Raijmakers N, Versluis MAJ, Rachet B, van Maaren MC, Leyrat C. Associations between treatments, comorbidities and multidimensional aspects of quality of life among patients with advanced cancer in the Netherlands-a 2017-2020 multicentre cross-sectional study. Qual Life Res 2023; 32:3123-3133. [PMID: 37389733 PMCID: PMC10522740 DOI: 10.1007/s11136-023-03460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To investigate associations between quality of life (QoL) and 1) immunotherapy and other cancer treatments received three months before QoL measurements, and 2) the comorbidities at the time of completion or in the year prior to QoL measurements, among patients with advanced cancer. METHODS A cross-sectional study is conducted on patients with advanced cancer in the Netherlands. The data come from the baseline wave of the 2017-2020 eQuiPe study. Participants were surveyed via questionnaires (including EORTC QLQ-C30). Using multivariable linear and logistic regression models, we explored statistical associations between QoL components and immunotherapy and other cancer treatments as well as pre-existing comorbidities while adjusting for age, sex, socio-economic status. RESULTS Of 1088 participants with median age 67 years, 51% were men. Immunotherapy was not associated with global QoL but was associated with reduced appetite loss (odds ratio (OR) = 0.6, 95%CI = [0.3,0.9]). Reduced global QoL was associated with chemotherapy (adjusted mean difference (β) = - 4.7, 95% CI [- 8.5,- 0.8]), back pain (β = - 7.4, 95% CI [- 11.0,- 3.8]), depression (β = - 13.8, 95% CI [- 21.5,- 6.2]), thyroid diseases (β = - 8.9, 95% CI [- 14.0,- 3.8]) and diabetes (β = - 4.5, 95% CI [- 8.9,- 0.5]). Chemotherapy was associated with lower physical (OR = 2.4, 95% CI [1.5,3.9]) and role (OR = 1.8, 95% CI [1.2,2.7]) functioning, and higher pain (OR = 1.9, 95% CI [1.3,2.9]) and fatigue (OR = 1.6, 95% CI [1.1,2.4]). CONCLUSION Our study identified associations between specific cancer treatments, lower QoL and more symptoms. Monitoring symptoms may improve QoL of patients with advanced cancer. Producing more evidence from real life data would help physicians in better identifying patients who require additional supportive care.
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Affiliation(s)
- Ananya Malhotra
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Manuela Quaresma
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Natasja Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Moyke A J Versluis
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Graduate School of Social & Behavioral Sciences, Universiteit Van Tilburg, Warandelaan 2, 5037 AB, Tilburg, Nederland
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Marissa C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Clémence Leyrat
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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9
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Ham L, Fransen HP, van Roij J, van den Borne B, Creemers GJ, Hendriks MP, Kuip E, van Laarhoven HW, van Leeuwen L, van der Padt-Pruijsten A, Smilde T, Stellingwerf M, van Zuylen L, van de Poll-Franse L, Raijmakers NJ. Emotional functioning during bereavement after the death of patients with advanced cancer and associated factors. Psychooncology 2022; 31:1719-1727. [PMID: 36097376 DOI: 10.1002/pon.6031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The death of a loved one is considered to be the most stressful of all life events. However, the impact of bereavement on quality of life varies between individuals. The aim of our study was to assess emotional functioning, which is a domain of quality of life, of bereaved relatives after the death of their loved one and its associated factors. METHOD A prospective, longitudinal, multicenter, observational study on quality of care and quality of life of patients with advanced cancer and their relatives was conducted (eQuiPe). The association between emotional functioning of relatives during bereavement and the following factors was investigated: gender, type of relationship, educational level, pre-bereavement emotional and social functioning and global quality of life, social support pre- and during bereavement, anticipatory complicated grief, support of healthcare professionals during bereavement, age of patient and bereaved relative and duration of survival after primary cancer diagnosis. RESULTS 150 bereaved relatives completed the bereavement questionnaire. In 41% of the bereaved relatives emotional functioning was ≤71, indicating clinically relevant low emotional functioning. Multivariable logistic regression showed that females experienced more often emotional problems (OR=2.82). Emotional functioning pre-bereavement (OR=0.96) and social support during bereavement (OR=0.97) were associated with low emotional functioning during bereavement. CONCLUSIONS Almost half of the bereaved relatives of patients with advanced cancer experienced low emotional functioning and this was associated with low emotional functioning pre-bereavement and low social support during bereavement. Support for relatives should be initiated before the patient's death. Future research is needed to investigate the impact of such support on relatives' wellbeing during bereavement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands
| | - Janneke van Roij
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, the Netherlands
| | - Ben van den Borne
- Department of Pulmonology, Catharina Hospital, Eindhoven, The Netherlands
| | - Geert Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Evelien Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Lobke van Leeuwen
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | | | - Tineke Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Margriet Stellingwerf
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, the Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Utrecht, the Netherlands
| | - Natasja Jh Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands
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10
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Boddaert MS, Pereira C, Adema J, Vissers KCP, van der Linden YM, Raijmakers NJH, Fransen HP. Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study. BMJ Support Palliat Care 2022; 12:e137-e145. [PMID: 33355176 PMCID: PMC9120402 DOI: 10.1136/bmjspcare-2020-002302] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate the impact of provision and timing of palliative care (PC) on potentially inappropriate end-of-life care to patients with cancer in a mixed generalist-specialist PC model. METHOD A retrospective population-based observational study using a national administrative health insurance database. All 43 067 adults in the Netherlands, who were diagnosed with or treated for cancer during the year preceding their death in 2017, were included. Main exposure was either generalist or specialist PC initiated >30 days before death (n=16 967). Outcomes were measured over the last 30 days of life, using quality indicators for potentially inappropriate end-of-life care. RESULTS In total, 14 504 patients (34%) experienced potentially inappropriate end-of-life care; 2732 were provided with PC >30 days before death (exposure group) and 11 772 received no PC or ≤30 days before death (non-exposure group) (16% vs 45%, p<0.001). Most patients received generalist PC (88%). Patients provided with PC >30 days before death were 5 times less likely to experience potentially inappropriate end-of-life care (adjusted OR (AOR) 0.20; (95% CI 0.15 to 0.26)) than those with no PC or PC in the last 30 days. Both early (>90 days) and late (>30 and≤90 days) PC initiation had lower odds for potentially inappropriate end-of-life care (AOR 0.23 and 0.19, respectively). CONCLUSION Timely access to PC in a mixed generalist-specialist PC model significantly decreases the likelihood of potentially inappropriate end-of-life care for patients with cancer. Generalist PC can play a substantial role.
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Affiliation(s)
- Manon S Boddaert
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Centre of Expertise in Palliative Care, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Association for Palliative Care, Utrecht, Netherlands
| | - Chantal Pereira
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Netherlands Association for Palliative Care, Utrecht, Netherlands
| | - Jeroen Adema
- Vektis, Business Intelligence Center for Healthcare, Zeist, Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, Netherlands
| | - Yvette M van der Linden
- Centre of Expertise in Palliative Care, Leiden University Medical Center, Leiden, Netherlands
| | - Natasja J H Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Netherlands Association for Palliative Care, Utrecht, Netherlands
| | - Heidi P Fransen
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Netherlands Association for Palliative Care, Utrecht, Netherlands
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11
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van Roij J, Raijmakers N, Ham L, van den Beuken-van Everdingen M, van den Borne B, Creemers GJ, Cornelis Hunting J, Kuip E, van Leeuwen L, van Laarhoven H, Mandigers C, Nieboer P, van der Velden LA, Zuylen LV, Gelissen J, Zijlstra M, Brom L, Fransen HP, van de Poll-Franse L. Quality of life and quality of care as experienced by patients with advanced cancer and their relatives: A multicentre observational cohort study (eQuiPe). Eur J Cancer 2022; 165:125-135. [DOI: 10.1016/j.ejca.2022.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 11/12/2022]
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12
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Ham L, Fransen HP, van den Borne B, Hendriks MP, van Laarhoven HW, van der Padt-Pruijsten A, Raijmakers N, van Roij J, Sommeijer DW, Vriens BE, van Zuylen L, van de Poll-Franse L. Bereaved relatives' quality of life before and during the COVID-19 pandemic: Results of the prospective, multicenter, observational eQuiPe study. Palliat Med 2021; 35:1502-1507. [PMID: 34282688 DOI: 10.1177/02692163211034120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The death of a loved one is considered as one of the most stressful life events. During the COVID-19 pandemic, grief processes are potentially affected by measures such as social distancing and self-quarantine. AIM The aim of this study was to give insight in the impact of the COVID-19 pandemic on quality of life, social support, and self-care of bereaved relatives of people with advanced cancer in order to evaluate whether care for bereaved relatives during the COVID-19 pandemic should be improved. DESIGN A cross-sectional analysis using data from bereaved relatives of a prospective, longitudinal, multicenter, observational study on quality of care and quality of life of people with advanced cancer and their (bereaved) relatives (eQuiPe). SETTING/PARTICIPANTS Quality of life, social support, and self-care of bereaved relatives who completed a questionnaire within 3-6 months after their relative died during COVID-19 (April-November 2020) were compared with bereaved relatives who completed this questionnaire pre-COVID-19 (April-November 2019). RESULTS Ninety-one bereaved relatives were included in the analysis, 44 bereaved relatives completed the questionnaire pre-COVID-19 and 47 during COVID-19. The median age of the participants was 65 (IQR = 14) years and 58% were female. There were no significant differences between the pre-COVID-19 and during COVID-19 bereaved relatives in quality of life (68 vs 69), social support (17 vs 18), and self-care (20 vs 19). CONCLUSIONS On the short-term, the COVID-19 pandemic did not have significant impact on bereaved relatives' wellbeing. However, long-term impact of the pandemic on their wellbeing should be assessed.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Ben van den Borne
- Department of Pulmonology, Catharina Hospital, Eindhoven, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Natasja Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Janneke van Roij
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS-Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Libra Rehabilitation and Audiology, Tilburg, the Netherlands
| | - Dirkje W Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Oncology, FlevoHospital, Almere, The Netherlands
| | - Birgit Epj Vriens
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, VU Amsterdam, Amsterdam, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS-Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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13
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Ham L, Geijteman ECT, Aarts MJ, Kuiper JG, Kunst PWA, Raijmakers NJH, Visser LE, van Zuylen L, Brokaar EJ, Fransen HP. Use of potentially inappropriate medication in older patients with lung cancer at the end of life. J Geriatr Oncol 2021; 13:53-59. [PMID: 34366274 DOI: 10.1016/j.jgo.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/10/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Medications at the end of life should be used for symptom control. Medications which potential adverse effects outweigh their expected benefits are called 'potentially inappropriate medications' (PIMs). PIMs are related with adverse drug events and reduced quality of life. In this study, we investigated to what extent PIMs are dispensed to older patients with lung cancer in the last month of life. METHODS We selected patients with lung cancer, aged 65+, diagnosed between 2009 and 2014, and who died before April 1st 2015 from the population-based Netherlands Cancer Registry (NCR). The NCR is linked to the PHARMO Database Network, that includes medications dispensed by community pharmacies in the Netherlands. The eight PIM groups were based on the OncPal Deprescribing Guideline: aspirin, dyslipidaemia medications, antihypertensives, osteoporosis medications, peptic ulcer prophylaxis, oral hypoglycaemics, vitamins and minerals. RESULTS Data of 7864 patients with lung cancer were analyzed. Median age was 74 year (IQR = 70-79) and 67% was male. 45% of all patients received at least one PIM in their last month of life. Taking into account all dispensed medications, patients receiving PIMs received more different medications compared to those receiving no PIMs, respectively 10 (SD = 5) vs. 3 (SD = 4) different medications (P < 0.001). CONCLUSION Almost half of the older patients with lung cancer in the Netherlands received PIMs in their last month of life. Since PIM use is associated with reduced quality of life, it is important that health care professionals continue to critically assess which medication can be discontinued at the end of life.
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Affiliation(s)
- Laurien Ham
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), PO box 19079, Utrecht 3501 DB, the Netherlands; Netherlands Association for Palliative Care (PZNL), PO box 19079, Utrecht 3501 DB, the Netherlands.
| | - Eric C T Geijteman
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, PO box 2040, Rotterdam 3000 CA, the Netherlands
| | - Mieke J Aarts
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), PO box 19079, Utrecht 3501 DB, the Netherlands
| | - Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht 3528 AE, the Netherlands
| | - Peter W A Kunst
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), PO box 19079, Utrecht 3501 DB, the Netherlands; Onze Lieve Vrouwe Gasthuis, PO box 9243, Amsterdam 1006 AE, the Netherlands
| | - Natasja J H Raijmakers
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), PO box 19079, Utrecht 3501 DB, the Netherlands; Netherlands Association for Palliative Care (PZNL), PO box 19079, Utrecht 3501 DB, the Netherlands
| | - Loes E Visser
- Department of Hospital Pharmacy, Haga Teaching Hospital, PO box 40551, The Hague 2504 LN, the Netherlands; Department of Epidemiology, Erasmus Medical Centre, PO box 2040, Rotterdam 3000 CA, the Netherlands; Department of Hospital Pharmacy, Erasmus Medical Centre, PO box 2040, Rotterdam 3000 CA, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centre, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Edwin J Brokaar
- Department of Hospital Pharmacy, Haga Teaching Hospital, PO box 40551, The Hague 2504 LN, the Netherlands
| | - Heidi P Fransen
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), PO box 19079, Utrecht 3501 DB, the Netherlands; Netherlands Association for Palliative Care (PZNL), PO box 19079, Utrecht 3501 DB, the Netherlands
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14
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Biesbroek S, Kneepkens MC, van den Berg SW, Fransen HP, Beulens JW, Peeters PHM, Boer JMA. Dietary patterns within educational groups and their association with CHD and stroke in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Br J Nutr 2018; 119:949-956. [PMID: 29644959 PMCID: PMC6088537 DOI: 10.1017/s0007114518000569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 11/07/2022]
Abstract
Higher-educated people often have healthier diets, but it is unclear whether specific dietary patterns exist within educational groups. We therefore aimed to derive dietary patterns in the total population and by educational level and to investigate whether these patterns differed in their composition and associations with the incidence of fatal and non-fatal CHD and stroke. Patterns were derived using principal components analysis in 36 418 participants of the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Self-reported educational level was used to create three educational groups. Dietary intake was estimated using a validated semi-quantitative FFQ. Hazard ratios were estimated using Cox Proportional Hazard analysis after a mean follow-up of 16 years. In the three educational groups, similar 'Western', 'prudent' and 'traditional' patterns were derived as in the total population. However, with higher educational level a lower population-derived score for the 'Western' and 'traditional' patterns and a higher score on the 'prudent' pattern were observed. These differences in distribution of the factor scores illustrate the association between education and food consumption. After adjustments, no differences in associations between population-derived dietary patterns and the incidence of CHD or stroke were found between the educational groups (P interaction between 0·21 and 0·98). In conclusion, although in general population and educational groups-derived dietary patterns did not differ, small differences between educational groups existed in the consumption of food groups in participants considered adherent to the population-derived patterns (Q4). This did not result in different associations with incident CHD or stroke between educational groups.
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Affiliation(s)
- Sander Biesbroek
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
| | - Mirjam C. Kneepkens
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
| | - Saskia W. van den Berg
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
| | - Heidi P. Fransen
- Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Universiteitsweg
100, 3584 CG Utrecht, The
Netherlands
| | - Joline W. Beulens
- Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Universiteitsweg
100, 3584 CG Utrecht, The
Netherlands
- Department of Epidemiology & Biostatistics, EMGO+
Institute for Health and Care Research, VU University Medical
Center, De Boelelaan 1105, 1081 HV
Amsterdam, The Netherlands
| | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Universiteitsweg
100, 3584 CG Utrecht, The
Netherlands
- School of Public Health, Imperial College
London, South Kensington Campus, London
SW7 2AZ, UK
| | - Jolanda M. A. Boer
- National Institute for Public Health and the Environment,
Antonie van Leeuwenhoeklaan 9, 3721 MA
Bilthoven, The Netherlands
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15
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Fransen HP, Boer JMA, Beulens JWJ, de Wit GA, Bueno-de-Mesquita HB, Hoekstra J, May AM, Peeters PHM. Associations between lifestyle factors and an unhealthy diet. Eur J Public Health 2017; 27:274-278. [PMID: 27744349 DOI: 10.1093/eurpub/ckw190] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background : Unhealthy dietary patterns have been associated with other unhealthy lifestyle factors such as smoking and physical inactivity. Whether these associations are similar in high- and low-educated individuals is currently unknown. Methods We used information of the EPIC-NL cohort, a prospective cohort of 39 393 men and women, aged 20-70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at recruitment (1993-97). Low adherence to a Mediterranean-style diet was used to determine an unhealthy dietary pattern. Lifestyle-related factors included body mass index, waist circumference, smoking status, physical activity level, dietary supplement use and daily breakfast consumption. Multivariate logistic regression analyses were performed for the total population and by strata of educational level. Results In total 30% of the study population had an unhealthy dietary pattern: 39% in the lowest educated group and 20% in the highest educated group. Physical inactivity, a large waist circumference, no dietary supplement use and skipping breakfast were associated with an unhealthy dietary pattern in both low and high educated participants. Among low educated participants, current smokers had a greater odds of an unhealthy diet compared with never smokers: OR 1.42 (95% CI: 1.25; 1.61). This association was not observed in the high educated group. Conclusions Most associations between lifestyle-related factors and unhealthy diet were consistent across educational levels, except for smoking. Only among low educated participants, current smokers reported an unhealthier dietary pattern in comparison to never smokers. These results can be used in the development of targeted health promotion strategies.
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Affiliation(s)
- Heidi P Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Joline W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - H Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.,School of Public Health, Imperial College London, London, United Kingdom.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeljer Hoekstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,School of Public Health, Imperial College London, London, United Kingdom
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16
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Douma G, Fransen HP, Venmans BJ, Aarts MJ. End of life treatment of metastatic lung cancer patients in the Netherlands. Lung Cancer 2017. [DOI: 10.1183/1393003.congress-2017.pa4229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sluik D, Jankovic N, O’Doherty MG, Geelen A, Schöttker B, Rolandsson O, Kiefte-de Jong JC, Ferrieres J, Bamia C, Fransen HP, Boer JMA, Eriksson S, Martínez B, Huerta JM, Kromhout D, de Groot LCPGM, Franco OH, Trichopoulou A, Boffetta P, Kee F, Feskens EJM. Alcoholic Beverage Preference and Dietary Habits in Elderly across Europe: Analyses within the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES) Project. PLoS One 2016; 11:e0161603. [PMID: 27548323 PMCID: PMC4993358 DOI: 10.1371/journal.pone.0161603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 08/08/2016] [Indexed: 01/04/2023] Open
Abstract
Introduction The differential associations of beer, wine, and spirit consumption on cardiovascular risk found in observational studies may be confounded by diet. We described and compared dietary intake and diet quality according to alcoholic beverage preference in European elderly. Methods From the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES), seven European cohorts were included, i.e. four sub-cohorts from EPIC-Elderly, the SENECA Study, the Zutphen Elderly Study, and the Rotterdam Study. Harmonized data of 29,423 elderly participants from 14 European countries were analyzed. Baseline data on consumption of beer, wine, and spirits, and dietary intake were collected with questionnaires. Diet quality was assessed using the Healthy Diet Indicator (HDI). Intakes and scores across categories of alcoholic beverage preference (beer, wine, spirit, no preference, non-consumers) were adjusted for age, sex, socio-economic status, self-reported prevalent diseases, and lifestyle factors. Cohort-specific mean intakes and scores were calculated as well as weighted means combining all cohorts. Results In 5 of 7 cohorts, persons with a wine preference formed the largest group. After multivariate adjustment, persons with a wine preference tended to have a higher HDI score and intake of healthy foods in most cohorts, but differences were small. The weighted estimates of all cohorts combined revealed that non-consumers had the highest fruit and vegetable intake, followed by wine consumers. Non-consumers and persons with no specific preference had a higher HDI score, spirit consumers the lowest. However, overall diet quality as measured by HDI did not differ greatly across alcoholic beverage preference categories. Discussion This study using harmonized data from ~30,000 elderly from 14 European countries showed that, after multivariate adjustment, dietary habits and diet quality did not differ greatly according to alcoholic beverage preference.
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Affiliation(s)
- Diewertje Sluik
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
- * E-mail:
| | - Nicole Jankovic
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
- Centre of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Mark G. O’Doherty
- UKCRC Centre of Excellence for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Health Care and Social Sciences, FOM University, Essen, Germany
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Jessica C. Kiefte-de Jong
- Global Public Health, Leiden University College, the Hague, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Toulouse, France
| | - Christina Bamia
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Heidi P. Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jolanda M. A. Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sture Eriksson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Begoña Martínez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.Granada, Hospitales Universitaios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José María Huerta
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | | | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Paolo Boffetta
- Hellenic Health Foundation, Athens, Greece
- Icahn School of Medicine, Mount Sinai School of Medicine, New York, United States of America
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - Edith J. M. Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
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Fransen HP, Peeters PHM, Beulens JWJ, Boer JMA, de Wit GA, Onland-Moret NC, van der Schouw YT, Bueno-de-Mesquita HB, Hoekstra J, Elias SG, May AM. Exposure to Famine at a Young Age and Unhealthy Lifestyle Behavior Later in Life. PLoS One 2016; 11:e0156609. [PMID: 27244088 PMCID: PMC4887008 DOI: 10.1371/journal.pone.0156609] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/17/2016] [Indexed: 01/10/2023] Open
Abstract
Background A healthy diet is important for normal growth and development. Exposure to undernutrition during important developmental periods such as childhood and adolescence can have effects later in life. Inhabitants of the west of the Netherlands were exposed to severe undernutrition during the famine in the last winter of the second World War (1944–1945). Objective We investigated if exposure of women to the Dutch famine during childhood and adolescence was associated with an unhealthy lifestyle later in life. Design We studied 7,525 women from the Prospect-EPIC cohort, recruited in 1993–97 and aged 0–18 years during the Dutch famine. An individual famine score was calculated based on self-reported information about experience of hunger and weight loss. We investigated the association between famine exposure in early life and four lifestyle factors in adulthood: smoking, alcohol consumption, physical activity level and a Mediterranean-style diet. Results Of the 7,525 included women, 46% were unexposed, 38% moderately exposed and 16% severely exposed to the Dutch famine. Moderately and severely exposed women were more often former or current smokers compared to women that did not suffer from the famine: adjusted prevalence ratio 1.10 (95% CI: 1.05; 1.14) and 1.18 (1.12; 1.25), respectively. They also smoked more pack years than unexposed women. Severely exposed women were more often physically inactive than unexposed women, adjusted prevalence ratio 1.32 (1.06; 1.64). Results did not differ between exposure age categories (0–9 and 10–17 years). We found no associations of famine exposure with alcohol consumption and no dose-dependent relations with diet. Conclusions Exposure to famine early in female life may be associated with higher prevalence of smoking and physical inactivity later in life, but not with unhealthy diet and alcohol consumption.
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Affiliation(s)
- Heidi P. Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- School of Public Health, Imperial College London, London, United Kingdom
| | - Joline W. J. Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jolanda M. A. Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G. Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - N. Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H. Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- School of Public Health, Imperial College London, London, United Kingdom
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
- Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeljer Hoekstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sjoerd G. Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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Fransen HP, Beulens JWJ, May AM, Struijk EA, Boer JMA, de Wit GA, Onland-Moret NC, van der Schouw YT, Bueno-de-Mesquita HB, Hoekstra J, Peeters PHM. Dietary patterns in relation to quality-adjusted life years in the EPIC-NL cohort. Prev Med 2015; 77:119-24. [PMID: 26007298 DOI: 10.1016/j.ypmed.2015.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/06/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention. OBJECTIVE The aim of our study was to relate dietary patterns to health expectancy using quality-adjusted life years (QALYs) as outcome parameter. METHODS Data from the EPIC-NL study were used, a prospective cohort study of 33,066 healthy men and women aged 20-70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at study entry (1993-1997). Five dietary patterns were studied: three a priori patterns (the modified Mediterranean Diet Score (mMDS), the WHO-based Healthy Diet Indicator (HDI) and the Dutch Healthy Diet index (DHD-index)) and two a posteriori data-based patterns. QALYs were used as a summary health measure for healthy life expectancy, combining a person's life expectancy with a weight reflecting loss of quality of life associated with having chronic diseases. RESULTS The mean QALYs of the participants were 74.9 (standard deviation 4.4). A higher mMDS and HDI were associated with a longer life in good health. Participants who had a high mMDS score (6-9) had 0.17 [95% CI, 0.05; 0.30] more QALYs than participants with a low score (0-3), equivalent to two months longer life in good health. Participants with a high HDI score also had more QALYs (0.15 [95% CI, 0.03; 0.27]) than participants with a low HDI score. CONCLUSION A Mediterranean-type diet and the Healthy Diet Indicator were associated with approximately 2months longer life in good health.
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Affiliation(s)
- Heidi P Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Joline W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen A Struijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; School of Public Health, Imperial College London, London, United Kingdom; Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeljer Hoekstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; School of Public Health, Imperial College London, London, United Kingdom
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May AM, Struijk EA, Fransen HP, Onland-Moret NC, de Wit GA, Boer JMA, van der Schouw YT, Hoekstra J, Bueno-de-Mesquita HB, Peeters PHM, Beulens JWJ. The impact of a healthy lifestyle on Disability-Adjusted Life Years: a prospective cohort study. BMC Med 2015; 13:39. [PMID: 25858161 PMCID: PMC4362634 DOI: 10.1186/s12916-015-0287-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/03/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The association between single health behaviours and incidence of and premature mortality from major chronic diseases, including myocardial infarction, stroke, diabetes mellitus, and cancer, has been demonstrated thoroughly. However, the association of several healthy behaviours with Disability-Adjusted Life Years (DALYs), which is a measure for total health combining Years Lost due to Disability and the Years of Life Lost due to premature mortality, has not been studied yet. METHODS A prospective cohort study was conducted among 33,066 healthy men and women aged 20 to 70 years recruited into the EPIC-NL study during 1993 to 1997. Participants' smoking status, BMI, physical activity, and adherence to a Mediterranean-style diet (excluding alcohol) were investigated separately and combined into a simple health behaviour score ranging from 0 to 4. Participants were followed until the end of 2007 for occurrence of and mortality from the most important chronic diseases. The association between lifestyle (separate lifestyle factors and a simple health behaviour score) and DALYs were adjusted for relevant confounders. RESULTS After a median follow-up of 12.4 years, 6,647 disease incidences and 1,482 deaths were documented. Non-smoking, low BMI (BMI <25), being physically active, and adherence to a Mediterranean diet were all associated with a significantly lower disease burden. Persons adhering to all four healthy lifestyle characteristics lived a minimum of 2 years longer in good health (DALYs: -2.13; 95% CI: -2.65 to -1.62) than persons with none. Due to our non-extinct cohort, the total number of DALYs, and consequently the estimates, is underestimated. Therefore, true lifetime health benefits of a healthy lifestyle will be even larger. CONCLUSIONS Non-smoking, a low BMI, being physically active, and adherence to a Mediterranean diet were associated with a lower disease burden. Each additional healthy lifestyle factor contributed to a longer life in good health.
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Affiliation(s)
- Anne M May
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
| | - Ellen A Struijk
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
- />National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA The Netherlands
| | - Heidi P Fransen
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
- />National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA The Netherlands
| | - N Charlotte Onland-Moret
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
| | - G Ardine de Wit
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
- />National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA The Netherlands
| | - Jolanda MA Boer
- />National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA The Netherlands
| | - Yvonne T van der Schouw
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
| | - Jeljer Hoekstra
- />National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA The Netherlands
| | - H Bas Bueno-de-Mesquita
- />National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA The Netherlands
- />Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, PO Box 85500, Utrecht, 3508 GA The Netherlands
- />School of Public Health, Imperial College London, London, W2 1PG UK
| | - Petra HM Peeters
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
- />School of Public Health, Imperial College London, London, W2 1PG UK
| | - Joline WJ Beulens
- />Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht, 3508 GA The Netherlands
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Fransen HP, May AM, Beulens JWJ, Struijk EA, de Wit GA, Boer JMA, Onland-Moret NC, Hoekstra J, van der Schouw YT, Bueno-de-Mesquita HB, Peeters PHM. Association between lifestyle factors and quality-adjusted life years in the EPIC-NL cohort. PLoS One 2014; 9:e111480. [PMID: 25369457 PMCID: PMC4219750 DOI: 10.1371/journal.pone.0111480] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/26/2014] [Indexed: 01/10/2023] Open
Abstract
The aim of our study was to relate four modifiable lifestyle factors (smoking status, body mass index, physical activity and diet) to health expectancy, using quality-adjusted life years (QALYs) in a prospective cohort study. Data of the prospective EPIC-NL study were used, including 33,066 healthy men and women aged 20–70 years at baseline (1993–7), followed until 31-12-2007 for occurrence of disease and death. Smoking status, body mass index, physical activity and adherence to a Mediterranean-style diet (excluding alcohol) were investigated separately and combined into a healthy lifestyle score, ranging from 0 to 4. QALYs were used as summary measure of healthy life expectancy, combining a person's life expectancy with a weight for quality of life when having a chronic disease. For lifestyle factors analyzed separately the number of years living longer in good health varied from 0.12 year to 0.84 year, after adjusting for covariates. A combination of the four lifestyle factors was positively associated with higher QALYs (P-trend <0.0001). A healthy lifestyle score of 4 compared to a score of 0 was associated with almost a 2 years longer life in good health (1.75 QALYs [95% CI 1.37, 2.14]).
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Affiliation(s)
- Heidi P. Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Joline W. J. Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen A. Struijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - G. Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jolanda M. A. Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - N. Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeljer Hoekstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H. Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
- School of Public Health, Imperial College London, London, United Kingdom
- Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- School of Public Health, Imperial College London, London, United Kingdom
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Struijk EA, May AM, Beulens JWJ, Fransen HP, de Wit GA, Boer JMA, Onland-Moret NC, Hoekstra J, van der Schouw YT, Bueno-de-Mesquita HB, Peeters PHM. Adherence to the Dutch Guidelines for a Healthy Diet and cancer risk in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort. Public Health Nutr 2014; 17:2546-53. [PMID: 24192305 PMCID: PMC10282203 DOI: 10.1017/s1368980013002966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/02/2013] [Accepted: 10/07/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the association between adherence to the Dutch Guidelines for a Healthy Diet created by the Dutch Health Council in 2006 and overall and smoking-related cancer incidence. DESIGN Prospective cohort study. SETTING Adherence to the guidelines, which includes one recommendation on physical activity and nine on diet, was measured using an adapted version of the Dutch Healthy Diet (DHD) index. The score ranged from 0 to 90 with a higher score indicating greater adherence to the guidelines. We estimated the hazard ratios (HR) and 95 % confidence intervals for the association between the DHD index (in tertiles and per 20-point increment) at baseline and cancer incidence at follow-up. SUBJECTS We studied 35 608 men and women aged 20-70 years recruited into the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study during 1993-1997. RESULTS After an average follow-up of 12·7 years, 3027 cancer cases were documented. We found no significant association between the DHD index (tertile 3 v. tertile 1) and overall (HR = 0·97; 95 % CI 0·88, 1·07) and smoking-related cancer incidence (HR = 0·89; 95 % CI 0·76, 1·06) after adjustment for relevant confounders. Excluding the components physical activity or alcohol from the score did not change the results. None of the individual components of the DHD index was significantly associated with cancer incidence. CONCLUSIONS In the present study, participants with a high adherence to the Dutch Guidelines for a Healthy Diet were not at lower risk of overall or smoking-related cancer. This does not exclude that other components not included in the DHD index may be associated with overall cancer risk.
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Affiliation(s)
- Ellen A Struijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Joline WJ Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Heidi P Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jolanda MA Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jeljer Hoekstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - H Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra HM Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Struijk EA, Beulens JWJ, May AM, Fransen HP, Boer JMA, de Wit GA, Onland-Moret NC, van der Schouw YT, Hoekstra J, Bueno-de-Mesquita HB, Peeters PHM. Dietary patterns in relation to disease burden expressed in Disability-Adjusted Life Years. Am J Clin Nutr 2014; 100:1158-65. [PMID: 25240078 DOI: 10.3945/ajcn.113.082032] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although diet is related to chronic disease risk and mortality, its association with total disease burden is not clear. OBJECTIVE We investigated the minimum impact of different dietary patterns on disability-adjusted life years (DALYs) by using individual longitudinal data. DESIGN A prospective cohort study was conducted in 33,066 healthy men and women aged 20-70 y recruited into the European Prospective Investigation into Cancer and Nutrition-Netherlands study during 1993-1997. We measured adherence to 3 a priori dietary patterns [the modified Mediterranean diet score (mMDS), the WHO-based Healthy Diet Indicator, and the Dutch Healthy Diet index] and 2 a posteriori dietary patterns. Two a posteriori methods were used to extract Western and prudent patterns. Participants were followed until the end of 2007 for the occurrence of and mortality from the most important chronic diseases. The disease burden was expressed in DALYs, which are the sum of Years Lost due to Disability and Years of Life Lost because of premature mortality. The associations between dietary patterns (per SD change in score) and DALYs were estimated by using a 2-part model and adjusted for relevant confounders (sex, age at recruitment, smoking status and intensity, educational level, marital status, job status, energy intake, and physical activity). RESULTS After an average follow-up of 12.4 y, higher adherence to the mMDS or prudent pattern was most strongly associated with healthy survival; per SD higher adherence to the mMDS or prudent pattern, fewer healthy life years were lost [51 d (-0.14 DALYs; 95% CI: -0.21, -0.08 DALYs) and 58 d (-0.16 DALYs; 95% CI: -0.23, -0.09 DALYs), respectively]. CONCLUSION In this Dutch study, of various dietary patterns evaluated, higher adherence to the mMDS or prudent dietary pattern was associated with a lower disease burden as assessed by DALYs.
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Affiliation(s)
- Ellen A Struijk
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - Joline W J Beulens
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - Anne M May
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - Heidi P Fransen
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - Jolanda M A Boer
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - G Ardine de Wit
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - N Charlotte Onland-Moret
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - Yvonne T van der Schouw
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - Jeljer Hoekstra
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - H Bas Bueno-de-Mesquita
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
| | - Petra H M Peeters
- From the Julius Center for Health Sciences and Primary Care (EAS, JWJB, AMM, HPF, GAdW, NCO-M, YTvdS, and PHMP) and the Department of Gastroenterology and Hepatology (HBB-d-M), University Medical Center Utrecht, Utrecht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (EAS, HPF, JMAB, GAdW, JH, and HBB-d-M); and the School of Public Health, Imperial College London, London, United Kingdom (HBB-d-M and PHMP)
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Fransen HP, May AM, Stricker MD, Boer JMA, Hennig C, Rosseel Y, Ocké MC, Peeters PHM, Beulens JWJ. A posteriori dietary patterns: how many patterns to retain? J Nutr 2014; 144:1274-82. [PMID: 24872222 DOI: 10.3945/jn.113.188680] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Principal component analysis (PCA) and cluster analysis are used frequently to derive dietary patterns. Decisions on how many patterns to extract are primarily based on subjective criteria, whereas different solutions vary in their food-group composition and perhaps association with disease outcome. Literature on reliability of dietary patterns is scarce, and previous studies validated only 1 preselected solution. Therefore, we assessed reliability of different pattern solutions ranging from 2 to 6 patterns, derived from the aforementioned methods. A validated food frequency questionnaire was administered at baseline (1993-1997) to 39,678 participants in the European Prospective Investigation into Cancer and Nutrition-The Netherlands (EPIC-NL) cohort. Food items were grouped into 31 food groups for dietary pattern analysis. The cohort was randomly divided into 2 halves, and dietary pattern solutions derived in 1 sample through PCA were replicated through confirmatory factor analysis in sample 2. For cluster analysis, cluster stability and split-half reproducibility were assessed for various solutions. With PCA, we found the 3-component solution to be best replicated, although all solutions contained ≥1 poorly confirmed component. No quantitative criterion was in agreement with the results. Associations with disease outcome (coronary heart disease) differed between the component solutions. For all cluster solutions, stability was excellent and deviations between samples was negligible, indicating good reproducibility. All quantitative criteria identified the 2-cluster solution as optimal. Associations with disease outcome were comparable for different cluster solutions. In conclusion, reliability of obtained dietary patterns differed considerably for different solutions using PCA, whereas cluster analysis derived generally stable, reproducible clusters across different solutions. Quantitative criteria for determining the number of patterns to retain were valuable for cluster analysis but not for PCA. Associations with disease risk were influenced by the number of patterns that are retained, especially when using PCA. Therefore, studies on associations between dietary patterns and disease risk should report reasons to choose the number of retained patterns.
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Affiliation(s)
- Heidi P Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin D Stricker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Christian Hennig
- Department of Statistical Science, University College London, London, UK; and
| | - Yves Rosseel
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Marga C Ocké
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joline W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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25
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Hoekstra J, Fransen HP, van Eijkeren JC, Verkaik-Kloosterman J, de Jong N, Owen H, Kennedy M, Verhagen H, Hart A. Benefit–risk assessment of plant sterols in margarine: A QALIBRA case study. Food Chem Toxicol 2013; 54:35-42. [DOI: 10.1016/j.fct.2012.08.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/06/2012] [Accepted: 08/07/2012] [Indexed: 11/17/2022]
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Fransen HP, Pelgrom SM, Stewart-Knox B, de Kaste D, Verhagen H. Assessment of health claims, content, and safety of herbal supplements containing Ginkgo biloba. Food Nutr Res 2010; 54:5221. [PMID: 20927202 PMCID: PMC2950792 DOI: 10.3402/fnr.v54i0.5221] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/27/2010] [Accepted: 09/01/2010] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND European Regulation 1924/2006 states that all health claims made on foods need to be substantiated scientifically. OBJECTIVE To apply the PASSCLAIM criteria for the scientific substantiation of health claims on foods to herbal supplements containing Ginkgo biloba. Evaluation of three selected claimed health effects for G. biloba (improvement of blood circulation, improvement of symptoms of old age, and improvement of memory) was achieved through review of publicly available scientific data. A total of 35 human intervention studies were evaluated. Commercially available products claimed to contain mainly G. biloba (N=29) were randomly sampled in the Netherlands and analyzed for their content on ginkgo extract. Also, a toxicological risk assessment was performed. RESULTS The three selected health claims investigated could not be substantiated. This was mainly because of a lack of data from studies in healthy volunteers. In most studies results performed with a 24% standardized G. biloba extract were described. However, our chemical analysis showed that 25 of the 29 sampled products did not contain the required minimum 24% standardized extract. Moreover, in most preparations the content of substances typical for G. biloba did not conform to what was declared on the label. Since toxicity data for G. biloba are very limited, a safety limit could not be established. CONCLUSIONS Evidence is lacking for three health claims of herbal products with G. biloba. Neither safety nor efficacy can be guaranteed at the recommended daily dose. The multidisciplinary approach described in this paper provides good insight into issues that are relevant for the evaluation of health claims for herbal food supplements.
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Affiliation(s)
- Heidi P. Fransen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sylvia M.G.J. Pelgrom
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Barbara Stewart-Knox
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, Northern Ireland
| | - Dries de Kaste
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Hans Verhagen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, Northern Ireland
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27
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Hendriksen MA, Tijhuis MJ, Fransen HP, Verhagen H, Hoekstra J. Impact of substituting added sugar in carbonated soft drinks by intense sweeteners in young adults in the Netherlands: example of a benefit-risk approach. Eur J Nutr 2010; 50:41-51. [PMID: 20429009 DOI: 10.1007/s00394-010-0113-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/15/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Substituting added sugar in carbonated soft drinks with intense sweeteners may have potential beneficial, but also adverse health effects. This study assessed the benefits and risks associated with substituting added sugar in carbonated soft drinks with intense sweeteners in young adults in the Netherlands. METHODS A tiered approach was used analogous to the risk assessment paradigm, consisting of benefit and hazard identification, exposure assessment and finally benefit and risk characterization and comparison. Two extreme scenarios were compared in which all carbonated soft drinks were sweetened with either intense sweeteners or added sugar. National food consumption survey data were used, and intake of added sugar and intense sweeteners was calculated using the food composition table or analytical data for sweetener content. RESULTS Reduction in dental caries and body weight were identified as benefits of substituting sugar. The mean difference in total energy intake between the scenarios was 542 kJ per day in men and 357 kJ per day in women, under the assumption that no compensation takes place. In the 100% sweetener scenario, the average BMI decreased 1.7 kg/m(2) in men and 1.3 kg/m(2) in women when compared to the 100% sugar scenario. Risks are negligible, as the intake of intense sweeteners remains below the ADI in the substitution scenario. CONCLUSIONS Substitution of added sugar by intense sweeteners in carbonated soft drinks has beneficial effects on BMI and the reduction in dental caries, and does not seem to have adverse health effects in young adults, given the available knowledge and assumptions made.
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Affiliation(s)
- Marieke A Hendriksen
- National Institute for Public Health and Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands.
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Abstract
PURPOSE OF REVIEW The present review provides an overview of the different dietary quality indices in use. In the first decades, most indices were developed for the general adult population and were based on the American dietary guidelines and the Mediterranean diet. This review focuses on new, other dietary quality indices with special attention to the make-up of the score and methodological issues. RECENT FINDINGS Most of the new diet quality indices are based on the national dietary recommendations in Europe and Australia. In addition, one index is based on international recommendations and two indices use recommendations for the prevention of specific diseases. In addition, there are dietary scores that focus on specific groups (children, pregnant women), and on dietary variety or diversity. SUMMARY The use of diet quality indices becomes more widespread and tailored to the specific purpose and population. However, different approaches are also due to arbitrary choices because of lacking knowledge on healthy diets and unsolved methodological issues. The ways of dealing with differences in energy intake, scoring each component, and combining the different components into one measure are aspects that still need further research.
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Affiliation(s)
- Heidi P Fransen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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29
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Fransen HP, Verhagen H, Plat J, Mensink RP. Reply to Dr. Jones. J Nutr 2007. [DOI: 10.1093/jn/137.11.2486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kloosterman J, Fransen HP, de Stoppelaar J, Verhagen H, Rompelberg C. Safe addition of vitamins and minerals to foods: setting maximum levels for fortification in the Netherlands. Eur J Nutr 2007; 46:220-9. [PMID: 17479209 PMCID: PMC1914246 DOI: 10.1007/s00394-007-0654-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 03/27/2007] [Indexed: 11/04/2022]
Abstract
Background In 2004, the European Court of Justice decided that the prohibition of fortification with vitamin A, vitamin D, folic acid, selenium, copper, and zinc in the Netherlands conflicts with the principle of free movement of goods in the European Union. This decision led to a change in the Dutch policy, resulting in a more flexible handling of requests for exemption from this prohibition to fortify. Therefore, an investigation was proposed in which it would be determined whether a general exemption could be granted for food fortification with a certain maximum safe amount per micronutrient. Aim of the study To develop a risk assessment model to estimate maximum safe fortification levels (MSFLs) of vitamins and minerals to foods on the Dutch market, and to evaluate these levels to derive allowed fortification levels (AFLs), which can be used for a general exemption. Methods We developed a risk assessment model to estimate MSFLs of vitamins and minerals to foods on the basis of existing models. We used European tolerable upper intake levels in combination with national food consumption data to estimate MSFLs for fortification of foods for several age groups. Upon extensive stakeholder dialogue, the risk manager considered these estimated MSFLs and the final AFLs for a general exemption were set. Results For folic acid, vitamin A, and vitamin D, the MSFLs were calculated in the risk-assessment model. Children up to 6-years old were the group most sensitive to folic acid fortification, and they had an MSFL of 0 µg/100 kcal, but following a risk management evaluation, this was upgraded to an AFL of 100 µg/100 kcal. The MSFL for vitamin D was 3.0 µg/100 kcal (children 4–10 years old), and the risk manager increased this to an AFL of 4.5 µg/100 kcal. Children up to 10 years old, men, and postmenopausal women were the groups most sensitive to vitamin A fortification (MSFL = 0 µg/100 kcal). Because these groups represent a large part of the population and because of the seriously harmful effects of excessive vitamin A, the risk manager did not allow a general exemption. Conclusions The combination of a risk assessment model and risk manager evaluation led to the setting of AFLs for general exemption of fortification with folic acid and vitamin D. This model is also applicable for other micronutrients, for which an UL is derived, and in other countries.
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Affiliation(s)
- Janneke Kloosterman
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Heidi P. Fransen
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Joyce de Stoppelaar
- Nutrition, Health Protection and Prevention Dept., Ministry of Public Health, Welfare and Sports, The Hague, The Netherlands
| | - Hans Verhagen
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Cathy Rompelberg
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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Fransen HP, de Jong N, Wolfs M, Verhagen H, Verschuren WMM, Lütjohann D, von Bergmann K, Plat J, Mensink RP. Customary use of plant sterol and plant stanol enriched margarine is associated with changes in serum plant sterol and stanol concentrations in humans. J Nutr 2007; 137:1301-6. [PMID: 17449596 DOI: 10.1093/jn/137.5.1301] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The consumption of products enriched with plant sterol or stanol esters lowers serum total and LDL-cholesterol concentrations, thereby most likely reducing the risk of coronary heart disease. However, using plant sterol (not plant stanol) enriched products elevates serum plant sterol concentrations in humans. This may be unwanted because health effects of elevated serum plant sterol concentrations are still controversial. Within postlaunch monitoring of functional foods, we compared serum plant sterol and plant stanol concentrations among users of plant sterol (n = 67) or plant stanol (n = 13) enriched margarines with those of matched nonusers (n = 81) in the ongoing Dutch Doetinchem cohort study. Subjects (aged 29-67 y) were examined in 1994-1998 (before the introduction of enriched margarines) and re-examined in 1999-2003. Serum concentrations of plant sterols and stanols were measured in samples from nonfasting subjects by GLC-MS. Intake of plant sterols was 1.1 +/- 0.6 g/d and was associated with a decrease of serum total cholesterol concentration of 0.25 +/- 0.91 mmol/L (4%, P < 0.05), a change that differed (P < 0.05) from the nonsignificant increase in nonusers (+2%, 0.12 +/- 0.78 mmol/L, P = 0.16). Cholesterol-standardized serum sitosterol and campesterol increased in plant sterol users by 22% (P < 0.0001) and 103% (P < 0.0001), respectively. Cholesterol-standardized serum sitostanol and campestanol increased in plant stanol users by 197% (P = 0.02) and 196% (P = 0.01). To our knowledge, these data are the first to show changes in serum cholesterol, plant sterol, and plant stanol concentrations after (long-term) consumption of plant sterol and stanol enriched margarines in a free-living population in a nonexperimental setting. Whether the increased serum sterol concentrations result in adverse side effects needs to be investigated in future postlaunch monitoring studies.
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Affiliation(s)
- Heidi P Fransen
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, the Netherlands
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