[Implementing new interventions and indications: the possible role for real world data]. / De mogelijke rol van 'real world data'.

In advising the preferred therapy for the individual patient the expected results of the proposed intervention and possible side effects are the most relevant considerations. However, predicting the results of an intervention is difficult, especially when well designed randomized clinical trials (RCT's) are lacking or not conclusive. Artificial intelligence (AI) algorithms based on routine clinical data (real world data) can support clinical decision making, but in daily practice AI is still scarcely used. In this article one large radiotherapy facility and two health insurers describe their joint opinion on the possible role of AI based on real world data as an aid in clinical decision making when evidence from RCT's is not available. The introduction of proton radiotherapy in The Netherlands is being used as case model for AI model based clinical decision making.

Employment and insurance outcomes and factors associated with employment among long-term thyroid cancer survivors: a population-based study from the PROFILES registry.

PURPOSE: To obtain insight into employment and insurance outcomes of thyroid cancer survivors and to examine the association between not having employment and other factors including quality of life. METHODS: In this cross-sectional population-based study, long-term thyroid cancer survivors from the Netherlands participated. Clinical data were collected from the cancer registry. Information on employment, insurance, socio-demographic characteristics, long-term side effects, and quality of life was collected with questionnaires. RESULTS: Of the 223 cancer survivors (response rate 87 %), 71 % were employed. Of the cancer survivors who tried to obtain insurance, 6 % reported problems with obtaining health care insurance, 62 % with life insurance, and 16 % with a mortgage. In a multivariate logistic regression analysis, higher age (OR 1.07, CI 1.02-1.11), higher level of fatigue (OR 1.07, CI 1.01-1.14), and lower educational level (OR 3.22, CI 1.46-7.09) were associated with not having employment. Employment was associated with higher quality of life. CONCLUSIONS: Many thyroid cancer survivors face problems when obtaining a life insurance, and older, fatigued, and lower educated thyroid cancer survivors may be at risk for not having employment.

[Surgery and follow-up 131I therapy in patients with differentiated thyroid carcinoma in the south-east of the Netherlands, 1983-1996, compliance with the 1987 consensus guidelines: additional data]. / Chirurgie en 131I-nabehandeling bij patiënten met gedifferentieerde schildklierkanker in Zuidoost-Nederland, 1983-1996, vergeleken met de consensusrichtlijnen uit 1987: aanvullende gegevens.

In a previous study using data from the regional cancer registry of the Comprehensive Cancer Centre South, Eindhoven, The Netherlands, we concluded that in the majority of cases surgical treatment was in accordance with the consensus recommendations, but that about 40% of patients with differentiated thyroid cancer from a number of regional hospitals had not been referred for 131I therapy. However, in a subsequent study using patient data from these hospitals, it became clear that almost all patients had in fact been referred for therapy but to centres outside the 131I therapy region. The conclusion of the study should therefore be altered: the great majority of patients with differentiated thyroid cancer in the south-east of The Netherlands (1983-96) were referred for 131I treatment and therefore the primary surgical and the follow-up treatment complied with the 1987 consensus guidelines.

[Surgery and referral for subsequent 131I therapy for patients with differentiated thyroid carcinoma in the south-east of the Netherlands, 1983-1996, compared to the consensus guidelines from 1987]. / Chirurgie en 131I-nabehandeling bij patiënten met gedifferentieerde schildklierkanker in Zuidoost-Nederland, 1983-1996, vergeleken met de consensusrichtlijnen uit 1987.

OBJECTIVE: To evaluate the treatment of patients with differentiated (papillary or follicular) thyroid cancer in general hospitals in the south-east of the Netherlands during the period 1983-1996, in relation to the 1987 national consensus recommendations. DESIGN: Population-based, retrospective, descriptive. METHOD: For the period 1 January 1983-31 December 1996, data on the histology, TNM-stage and treatment (hospital, specialist, type of operation, referral for 131I therapy) of all 236 patients with differentiated thyroid cancer were obtained from the cancer registry of the Comprehensive Cancer Centre South, Eindhoven, the Netherlands. The treatment was compared with the recommendations from the consensus meeting in 1987. RESULTS: Data on 219 patients (137 papillary, 82 follicular thyroid carcinoma) treated in the general hospitals in the region were studied; the 17 remaining patients had been referred from outside the region. Patients were treated at all hospitals in the region; the number of specialists per hospital able to treat thyroid carcinoma (internist and/or surgeon) was limited. In total 79% of the patients underwent a (near-)total thyroidectomy, half of them in two phases, and in 12% of the cases combined with regional lymph node dissection. In the majority of cases, surgical treatment was in accordance with the consensus recommendations: 65-100% of the cases per hospital. The proportion of patients referred for 131I therapy varied from 17% to 90%; referral was more frequent in the case of larger tumours and/or metastases. Of the 24 patients with a small papillary carcinoma without metastases, 79% were not referred for 131I therapy. CONCLUSIONS: The recommendations laid down in the consensus meeting in 1987 were known and appeared to be followed for surgical treatment but for subsequent 131I therapy they appeared to be interpreted differently. A review of the consensus guidelines seems to be worthwhile.