Background: Follow‑up of curatively treated primary breast cancer patients consists of surveillance and aftercare and is currently mostly the same for all patients. A more personalized approach, based on patients’ individual risk of recurrence and personal needs and preferences, may reduce patient burden and reduce (healthcare) costs. The NABOR study will examine the (cost‑)effectiveness of personalized surveillance (PSP) and personalized aftercare plans (PAP) on patient‑reported cancer worry, self‑rated and overall quality of life and (cost‑)effectiveness. Methods: A prospective multicenter multiple interrupted time series (MITs) design is being used. In this design, 10 participating hospitals will be observed for a period of eighteen months, while they ‑stepwise‑ will transit from care as usual to PSPs and PAPs. The PSP contains decisions on the surveillance trajectory based on individual risks and needs, assessed with the ‘Breast Cancer Surveillance Decision Aid’ including the INFLUENCE prediction tool. The PAP contains decisions on the aftercare trajectory based on individual needs and preferences and available care resources, which decision‑making is supported by a patient decision aid. Patients are non‑metastasized female primary breast cancer patients (N= 1040) who are curatively treated and start follow‑up care. Patient reported outcomes will be measured at five points in time during two years of follow‑up care (starting about one year after treatment and every six months thereafter). In addition, data on diagnostics and hospital visits from patients’ Electronical Health Records (EHR) will be gathered. Primary outcomes are patient‑reported cancer worry (Cancer Worry Scale) and over‑all quality of life (as assessed with EQ‑VAS score). Secondary outcomes include health care costs and resource use, health‑related quality of life (as measured with EQ5D‑5L/SF‑12/EORTC‑QLQ‑C30), risk perception, shared decision‑making, patient satisfaction, societal participation, and cost‑effectiveness. Next, the uptake and appreciation of personalized plans and patients’ experiences of their decision‑making process will be evaluated. Discussion: This study will contribute to insight in the (cost‑)effectiveness of personalized follow‑up care and contributes to development of uniform evidence‑based guidelines, stimulating sustainable implementation of personalized surveillance and aftercare plans. Trial registration: Study sponsor: ZonMw. Retrospectively registered at ClinicalTrials.gov (2023), ID: NCT05975437.
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Abstract Objectives The aim of this review is to establish the effectiveness of psychological relapse prevention interventions, as stand-alone interventions and in combination with maintenance antidepressant treatment (M-ADM) or antidepressant medication (ADM) discontinuation for patients with remitted anxiety disorders or major depressive disorders (MDD). Methods A systematic review and a meta-analysis were conducted. A literature search was conducted in PubMed, PsycINFO and Embase for randomised controlled trials (RCTs) comparing psychological relapse prevention interventions to treatment as usual (TAU), with the proportion of relapse/recurrence and/or time to relapse/recurrence as outcome measure. Results Thirty-six RCTs were included. During a 24-month period, psychological interventions significantly reduced risk of relapse/recurrence for patients with remitted MDD (RR 0.76, 95% CI: 0.68–0.86, p<0.001). This effect persisted with longer follow-up periods, although these results were less robust. Also, psychological interventions combined with M-ADM significantly reduced relapse during a 24-month period (RR 0.76, 95% CI: 0.62–0.94, p = 0.010), but this effect was not significant for longer follow-up periods. No meta-analysis could be performed on relapse prevention in anxiety disorders, as only two studies focused on relapse prevention in anxiety disorders. Conclusions In patients with remitted MDD, psychological relapse prevention interventions substantially reduce risk of relapse/recurrence. It is recommended to offer these interventions to remitted MDD patients. Studies on anxiety disorders are needed.
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ObjectivesThe existing studies among workers with a past cancer diagnosis have rarely focused on workers confronted with cancer recurrence or metastases specifically, so knowledge is lacking. The aim of this study, therefore, was to investigate the work functioning (work ability, burnout complaints, and work engagement) of workers with recurrent or metastasized cancer. Furthermore, the association of psychological capital (hope, optimism, resilience, and self-efficacy) with work functioning was studied.MethodsData from a survey study among workers 2–10 years past cancer diagnosis were used (N = 750); 73% reported a diagnosis of breast cancer and 27% a diagnosis of cancer other than breast cancer. Analysis of variance was used to compare participants with and without cancer recurrence or metastases regarding work functioning (work ability, burnout complaints, and work engagement) and psychological capital (hope, optimism, resilience, and self-efficacy). Multivariate regression analyses were used to analyze the association of type of cancer and psychological capital with work functioning among workers with cancer recurrence or metastatic cancer (n = 54), controlling for age.ResultsWork ability is significantly lower among workers with cancer recurrence or metastases (controlling for age); however, burnout complaints and work engagement are at comparable levels. Among workers with cancer recurrence or metastases, a higher level of hope is positively associated with work ability and work engagement, and a higher level of hope or resilience is negatively associated with burnout complaints.Significance of resultsAmong workers with cancer recurrence or metastases, work ability needs attention. Furthermore, especially the element hope of psychological capital is important to focus on because of the association with more favorable work functioning in general. The clinical psycho-oncological practice may benefit from these insights in guiding this vulnerable group of workers who are living with active cancer and many uncertainties.
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Laboratory study using a repeated measures design. The aim of this study was to determine if ankle proprioception is targeted in exercises on unstable surfaces. Lateral ankle sprain (LAS) has recurrence rates over 70%, which are believed to be due to a reduced accuracy of proprioceptive signals from the ankle. Proprioceptive exercises in rehabilitation of LAS mostly consist of balancing activities on an unstable surface. The methods include 100 healthy adults stood barefoot on a solid surface and a foam pad over a force plate, with occluded vision. Mechanical vibration was used to stimulate proprioceptive output of muscle spindles of triceps surae and lumbar paraspinal musculature. Each trial lasted for 60 s; vibration was applied from the 15th till the 30th second. Changes in mean velocity and mean position of the center of pressure (CoP) as a result of muscle vibration were calculated. Results show that on foam, the effect of triceps surae vibration on mean CoP velocity was significantly smaller than on a solid surface, while for paraspinal musculature vibration the effect was bigger on foam than on solid surface. Similar effects were seen for mean CoP displacement as outcome. Exercises on unstable surfaces appear not to target peripheral ankle proprioception. Exercises on an unstable surface may challenge the capacity of the central nervous system to shift the weighting of sources of proprioceptive signals on balance.
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Wanneer patiënten hersteld zijn van een angststoornis of depressie, hebben zij een hoge kans terug te vallen. De onderzoekers ontwikkelden een terugvalpreventieprogramma. De interventie werd aangeboden aan patiënten die eerder behandeling ontvingen voor een angststoornis of depressie in de basis of specialistische GGZ en daarna in volledige of gedeeltelijke remissie waren. De praktijkondersteuner huisarts GGZ (POH-GGZ) begeleidde patiënten bij het volgen van deze interventie. Dit artikel biedt inzicht in de toepassing van en ervaringen met dit terugvalpreventieprogramma.
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Na curatieve behandeling voor niet-gemetastaseerde borstkanker krijgen patiënten nacontrole (detectie van mogelijke terugkeer van borstkanker in het borstgebied) en nazorg ondersteuning bij mogelijke gevolgen van de ziekte en/of behandeling). Tot nu toe kregen alle patiënten vijf jaar lang een jaarlijks mammogram ongeacht hun risico op een recidief. Binnen de NABOR-studie worden in gedeelde besluitvorming nacontroleplannen gepersonaliseerd met behulp van de Borstkanker Nacontrolekeuzehulp, waarbij het individuele risico op recidief wordt berekend met het gevalideerde INFLUENCE-voorspellingsmodel. Gepersonaliseerde nazorgplannen worden ondersteund door de Nazorgkeuzehulp. Het doel van de studie is het bepalen van de (kosten)effectiviteit van gepersonaliseerde nacontrole en nazorg op zorgen van terugkeer van kanker en kwaliteit van leven. Het design is een ‘multiple interrupted time series’, waarbij ziekenhuizen via een transitiefase overstappen op het gebruik van beide keuzehulpen. De studie beoogt in 10 ziekenhuizen 1.040 patiënten te includeren die twee jaar worden gevolgd. Met toestemming overgenomen van NED TIJDSCHR ONCOL 2025;22:138-42. Summary: After curative treatment for non-metastatic breast cancer, patients receive surveillance (detection of possible recurrence of breast cancer in the breast area) and aftercare (support for possible consequences of the disease and/or treatment). Until now, all patients received an annual mammogram for five years, regardless of their risk of recurrence. Within the NABOR study, surveillance plans are personalized in shared decision-making using Breast Cancer Surveillance decision aid, in which the individual risk of recurrence is calculated using the validated INFLUENCE prediction model. Personal aftercare plans are supported by the Breast Cancer Aftercare decision aid. The aim of the study is to determine the (cost-)effectiveness of personalized surveillance and aftercare on patient-reported concerns about cancer recurrence and quality of life. The design is a multiple interrupted time series, in which hospitals switch to using both decision aids via a transition phase. The study aims to include in 10 hospitals 1,040 patients who will be followed for two years.
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Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice.
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Atrial fibrillation (AF) is the most common clinical tachyarrhythmia associated with significant morbidity and mortality and is expected to affect approximately 30 million North Americans and Europeans by 2050. AF is a persistent disease, caused by progressive, often age-related, derailment of proteostasis resulting in structural remodeling of the atrial cardiomyocytes. It has been widely acknowledged that the progressive nature of the disease hampers the effective functional conversion to sinus rhythm in patients and explains the limited effect of current drug therapies. Therefore, research is directed at preventing new-onset AF by limiting the development of substrates underlying AF promotion. Upstream therapy refers to the use of drugs that modify the atrial substrate- or target-specific mechanisms of AF, with the ultimate aim to prevent the occurrence (primary prevention) and recurrence of the arrhythmia following (spontaneous) conversion and to prevent the progression of AF (secondary prevention). Recently, we observed that heat shock protein (HSP)-inducing drugs, such as geranylgeranylacetone, prevent derailment of proteostasis and remodeling of cardiomyocytes and thereby attenuate the AF substrate in cellular, Drosophila melanogaster, and animal experimental models. Also, correlative data from human studies were consistent with a protective role of HSPs in preventing the progression from paroxysmal AF to permanent AF and in the recurrence of AF. In this review, we discuss novel HSP-inducing compounds as emerging therapeutics for the primary and secondary prevention of AF. © 2012 Elsevier Inc.
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