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2. Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making

Author

S. Mokhles, J. J. M. E. Nuyttens, M. de Mol, J. G. J. V. Aerts, A. P. W. M. Maat, Ö. Birim, A. J. J. C. Bogers, and J. J. M. Takkenberg

Subjects
Cancer patients, Decision-making preferences, Shared decision-making, Surgery, Radiation oncology, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. Methods Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1–5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. Results In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. Conclusions Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.

Published
2018
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3. Long term outcomes of congenital aortic stenosis in adults: preliminary results of a multicentre study

Author

Z Keuning, F Meccanici, F M Sneep, A Hirsch, J J M Takkenberg, A E Van Den Bosch, and J W Roos-Hesselink

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Congenital aortic stenosis (ConAoS) accounts for 4–8% of all congenital cardiac diagnosis and is associated with important morbidity and mortality. However, little is known about the natural history of ConAoS in adult patients. We aim to evaluate disease progression of ConAoS in young adults, describing both ventricular and valvular characteristics. Methods For this retrospective multicentre cohort study, data of one centre is collected up till now. We included ConAoS patients with a valvular stenosis (Vmax ≥2.5 m/s) aged 18–55 years from the Dutch CONCOR national registry from 2001 until 2019, excluding patients with prior aortic valve replacement (AVR) or severe aortic regurgitation. Echocardiographic data was used to determine presence of left ventricular (LV) hypertrophy (LV mass index >115 g/m2 in males and >95 g/m2 in females) and measure aortic jet velocity. Results A total of 92 patients (64% male, median age 24 years) were included with a median follow-up duration of 6.3 years (IQR 2.9–13.3). The median aortic jet velocity was 3.3 m/s (IQR 2.7–3.9) at baseline and significantly increased over time to 3.6 m/s (IQR 2.8–4.3) (p Conclusion Although the progression rate of ConAoS seems to be slow, it is often necessary to perform AVR at a relatively young age. After data collection is completed, this study will enable us to identify risk factors for rapid disease progression and further improve current treatment protocols. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation, Hartekind

Published
2022
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4. Male-female differences in acute type B aortic dissection: the DisSEXion study

Author

F Meccanici, C G E Thijssen, A L Gokalp, J L De Bruin, J A Bekkers, R R J Van Kimmenade, G S C Geuzebroek, P Poyck, F J Ter Woorst, M C Post, R H Heijmen, M M Mokhles, J J M Takkenberg, J W Roos-Hesselink, and H J M Verhagen

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background/Introduction Acute type B aortic dissection (ATBAD) is a cardiovascular emergency with high risk of morbidity and mortality. Elucidating male-female differences in ATBAD might help optimize patient-specific care, while data is scarce on this topic. Purpose The aim of this study was to identify differences between male and female ATBAD patients in presentation, management and outcomes. Methods A retrospective cohort study was conducted including all consecutive patients who presented with ATBAD between 2007–2017 in four tertiary centers. Non-acute, traumatic, and iatrogenic dissections were excluded. We included patients presenting with an intramural hematoma or penetrating aortic ulcer in acute setting. Results The study population consisted of 384 patients, of which 41% (n=156) was female. In comparison to males, females presented at an older age (67 [IQR: 57–73] vs. 62 [IQR: 52–71], p=0.015) and fewer female patients had a history of abdominal aortic aneurysm (6% vs. 15%, p=0.009). Imaging diagnostics revealed a smaller proportion of patients with distally extended dissections in females. DeBakey type IIIb was diagnosed less frequently in females (73% vs. 85%, p=0.008) as was renal artery involvement (48% vs. 66%, p=0.009). Furthermore, classical type B dissection was less often observed in female patients compared to male patients (56% vs. 78%, p Conclusion This study showed that female patients were older at presentation, while male patients more often had distally extended dissections. Although mortality was not significantly different, we encourage male-female specific risk factor studies on late mortality. In this way ATBAD male and female patients at high risk of mortality can be identified and patient-specific care can be implemented. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw

Published
2022
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5. Saturday, 25 August 2012

Author

A. Welz, B. V. Antwerp, A Di Cori, A. Hager, P. Hatzigiannis, R. De Lucia, C. Yu, A. Apor, M. Niemann, R. Sampognaro, M. Fiuza, M. G. Charlot, N. Cortez Dias, A. Nagae, A. Maciag, T. Sato, M. Valgimigli, D. Levorato, S. Herrmann, T. Kimura, M. Luedde, V. Tzamou, M. Iwabuchi, C. Rickers, J. Sobierajski, J. Vecera, C. Vlachopoulos, K. Goscinska-Bis, S. Goldsmith, H. Ueno, J. Sosna, G. Malerba, W. Li, H. W. Lee, K. Bogaard, K. Yamada, A. Mateo-Martinez, J. Navarova, M. Zeman, K. Dimopoulos, M. P. Lopez Lereu, E. Pelissero, B. Gersak, J. M. Tolosana, S Manzano Fernandez, P. Mertens, J. J. M. Takkenberg, J. W. Kim, R.T. van Domburg, G. P. Diller, H. M. Yang, F. Gustafsson, P. G. Golzio, G. S. Hwang, J. Brugada, S. Stoerk, J. Hess, Y. Cavusoglu, L. Segreti, M. E. Trucco, C. Jacoby, I. Bafakis, T. Isshiuki, L. Pulpon, S. Pires, L. Paperini, A. Cremonesi, H. Baumgartner, C. Tsioufis, M. Valdes-Chavarri, S. Schaefer, M. Totzeck, A. Bochenek, F. Saia, P. Carrilho-Ferreira, M. Khatib, E. M. W. J. Utens, G. Zucchelli, R. Jenni, E. Gencer, N. Carter, A. Kovacs, C. Linde, V. Monivas, A. Marzocchi, L. Baerfacker, L. Mont, R. Weber, F. J. Enguita, T. L. Bergemann, M. Chudzik, A. Chernyavskiy, D. Dragulescu, S. Orwat, B. J. Choi, P. Opic, C. Torp-Pedersen, F. Gaita, V. A. W. M. Umans, A. Lopez-Cuenca, S. B. Christensen, E. C. Bertolino, D. Tousoulis, F. Weidemann, H. H. Kramer, J. Greenslade, J Cosin Sales, M. Gonzalez Estecha, W. Grosso Marra, T. Katsimichas, J. Hoerer, S. Mingo, M. Hochadel, M. A. Castel, M. S. Lattarulo, E. Y. Yun, K. Fattouch, H. S. Lim, A. Uebing, T. Ulus, J. Radosinska, A. Castro Beiras, J. Peteiro, M. Koren, C. Prados, A. Nunes, C. Rammos, C. Thomopoulos, T. Kameyama, F. Borgia, I. Voges, J. L. Looi, L. Cullen, C. Campo, J. Bis, S. Shiva, H. Kato, N. Frey, E. Andrikou, G. H. Gislason, J. Ruvira, A. Kasiakogias, S. Robalo Martins, A. M. Zimmer, M. H. Yacoub, M. Nobuyoshi, U. Zeymer, K. Hanazawa, F. J. Broullon, B. Petracci, K. Hu, A. Petrescu, A. M. Maceira Gonzalez, K. Harada, L. Swan, C. Felix, H. Inoue, T. Haraguchi, N. Cortez-Dias, S. Bisetti, P. Mitkowski, C. Daubert, H. J. Heuvelman, M. R. Gold, G. P. Kimman, O. Gaemperli, H. C. Lee, Y. Takasawa, V. Monivas Palomero, A. C. Andrade, S. Maddock, W. Budts, M. Penicka, F. J. Ten Cate, M. Czajkowski, C. D. Nguyen, K. Kaitani, K. Kintis, S. Castrovinci, D. Liu, T. Benova, K. W. Seo, B. A. Herzog, A. Ionac, C. Jorge, M. Iacoviello, S. Kuramitsu, Y. Nakagawa, K. U. Mert, A. Manari, S. Brili, R. Alonso-Gonzalez, A. J. Six, J. S. Mcghie, A. Goedecke, M. Kelm, F. C. Tanner, F. Marin, C. I. Santos De Sousa, L. Kober, M. Frigerio, D. Adam, B. E. Backus, U. Hendgen-Cotta, A. Belo, D. Couto Mallon, M. Dewor, M. Madsen, J. H. Shin, M. H. Yoon, L. Maiz, P. Lancellotti, A. Nunes Diogo, G. Ertl, R. Pietura, A. Mornos, M. Than, C. Andersson, C. Izumi, E. Liodakis, N. van Boven, Y. Y. Lam, T. Hansen, W. Roell, T. J. Hong, P. Luedicke, M. Sanchez-Martinez, L. Ruiz Bautista, E. N. Oechslin, T. Klaas, M. T. Martinez, W. A. Helbing, J. L. Januzzi, S. Parra-Pallares, A. Romanov, B. Sax, D. Prokhorova, P. Guastaroba, D. Silva, A. Karaskov, P. Kolkhof, B. Bouzas Zubeldia, T. Rassaf, M. Costa, C. Viczenczova, V. Antoncecchi, A. Kempny, J. Bartunek, I. Kardys, J. H. Ahn, C. Hart, A. Berruezo, C. Vittori, W. Vletter, M. Shigekiyo, S. Knob, V. Marangelli, R. Borras, A E Van Den Bosch, S. Y. Choi, E. Arbelo, G. Lazaros, T. Arita, G. Suchan, T. Nakadate, D. Van Der Linde, E. Pokushalov, K. Ando, J. Neutel, P. Biaggi, C. Mornos, R. Corti, M. Landolina, B. Merkely, B. Malecka, H. J. Hippe, S. J. Tahk, J. Aguilar, G. Piovaccari, M. Lutz, D. Rizopoulos, N. Alvarez Garcia, M. Cipriani, T. Kumamoto, S. Kubota, M. Sitges, B. K. Fleischmann, G. Caccamo, D. Tsiachris, M. A. Russ, F. Mutlu, A. Menozzi, J. C. Choi, J. V. Monmeneu, J. C. Yanez Wonenburger, N. Tribulova, C. Forleo, M. Vinci, J. W. Roos-Hesselink, O. Bodea, T. Domei, P. W. Lee, A. Puzzovivo, M. Heikenwaelder, F. Ferraris, C. Stefanadis, M. Kempa, M. Vanderheyden, A. Birdane, J. A. A. E. Cuypers, I. Andrikou, G. Casella, P. Stock, S. Favale, B. Bijnens, A. Kretschmer, J. Bernhagen, M. A. Cavero Gibanel, S. Datta, M. E. Menting, S. Viani, T. Heuft, M. Cikes, A. J. J. C. Bogers, J. Estornell, M. Pham, A. Nadir, F. J. Pinto, M. Hyodo, D. Flessas, C. Chrysohoou, O. Dewald, B. Ren, K. Wustmann, J. C. Burnett, T. Noto, G. Ruvolo, M. Witsenburg, E. Soldati, G. D. Duerr, L. Alonso Pulpon, J. H. Oh, A. Zabek, B. Albrecht-Kuepper, V. Antonakis, M. B. Nielsen, T. Huttl, B. Bacova, A. Piorkowski, I. Z. Cabrita, A. Fanelli, M. A. Weber, J. Segovia, A. I. Romero-Aniorte, J. H. Choi, V. Dosenko, C. Wackerl, J. H. Ruiter, H. Yokoi, S. Ghio, V. Knezl, F. Monitillo, M. Morello, M. Jerosch-Herold, M. L. Geleijnse, A. Bouzas Mosquera, R. Fabregas Casal, H. Mudra, J. Gruenenfelder, U. Floegel, L. Petrescu, M. A. Gatzoulis, S. Shizuta, J. Brachmann, M. G. Bongiorni, M. Pringsheim, J. Mueller, A. Nagy, R. Giron, W. T. Abraham, Y. Takabatake, F. Toyota, D. Martinez Ruiz, M. Lunati, S. Vargiu, L E De Groot De Laat, V. Shabanov, L. Lioni, R. Kast, D. Bettex, K. S. Cha, J. L. Diago, D. Cozma, H. Lieu, M. Giakoumis, E. Orenes-Pinero, G. Murana, A. Kutarski, A.P.J. van Dijk, G. Speziale, A. Boem, L. M. Belotti, B. Igual, A. M. S. Olsen, and H. Lue

Subjects
business.industry, Medicine, Ancient history, Cardiology and Cardiovascular Medicine, business
Published
2012
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6. Impact of the definition of renal dysfunction on EuroSCORE performance

Author

M, VAN GAMEREN, L M A, KLIEVERIK, A, STRUIJS, A C, VENEMA, A P, KAPPETEIN, A J J C, BOGERS, and J J M, TAKKENBERG

Subjects
Adult, Male, Adolescent, Kidney, Models, Biological, Risk Assessment, Young Adult, Predictive Value of Tests, Risk Factors, Terminology as Topic, Odds Ratio, Health Status Indicators, Humans, Hospital Mortality, Prospective Studies, Cardiac Surgical Procedures, Aged, Aged, 80 and over, Middle Aged, Logistic Models, ROC Curve, Creatinine, Calibration, Female, Kidney Diseases, Biomarkers, Glomerular Filtration Rate
Abstract

Renal dysfunction is an important variable in the EuroSCORE (European System for Cardiac Operative Risk Evaluation) model and is currently defined as creatinine200 mmol/L. The aim of this study was to examine whether using other definitions of renal dysfunction could improve the predictive ability of the EuroSCORE.Between January 2004 and January 2006, 1 205 patients underwent cardiac surgery. Their preoperative glomerular filtration rate and EuroSCORE were calculated. Four recalibrated EuroSCORE models were constructed using 1) creatinine as a binary variable; 2) creatinine as a continuous variable; 3) glomerular filtration rate as a categorical variable; or 4) glomerular filtration rate as a continuous variable. The predictive ability of these models was assessed using receiver operating characteristic curve analysis.Hospital mortality was 4% (N.=47). Receiver operating characteristic curve values were: 0.78 for the original EuroSCORE, 0.80 for the recalibrated binary creatinine model, 0.83 for the continuous creatinine model, 0.83 for the categorical glomerular filtration rate model, and 0.82 for the continuous glomerular filtration rate model.The use of creatinine as a continuous variable or glomerular filtration rate as a categorical or continuous variable improves the predictive accuracy of the EuroSCORE model for hospital mortality. Given the increasing incidence of preoperative renal dysfunction and its impact on hospital mortality, future risk stratification models should include continuous creatinine or glomerular filtration rate rather than creatinine as a binary variable.

Published
2009

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