Cover Page The handle http://hdl.handle.net/1887/32765 holds various files of this Leiden University dissertation. Author: Glas, Nini Aafke de (Nienke) Title: Treatment of older patients with breast cancer : improving the evidence Issue Date: 2015-04-15 Treatment of older patients with breast cancer Improving the evidence Nienke A. de Glas Lay-out: Lesley van den Brink & Nienke de Glas Cover design: Lesley van den Brink Printed by: Gildeprint, Enschede Treatment of older patients with breast cancer – improving the evidence Thesis, Leiden University Medical Center, the Netherlands, 2014. © Nienke A. de Glas, The Netherlands 2014. ISBN: 978-94-6108-908-3 The research described in this thesis was made possible by the Dutch Cancer Foundation (2007-3968) and the Alpe d’Huzes Foundation (2011-5263). Printing of the thesis was supported by Erbe Nederland BV, Tromp Medical BV, AbbVie BV, Chipsoft, GSK, Promis Electro Optics, Olympus, Pfizer, Celgene, and Janssen-Cilag. Treatment of older patients with breast cancer Improving the evidence Proefschrift ter verkrijging van de graad van Doctor aan de Universiteit Leiden, op gezag van Rector Magnificus prof. Mr. C.J.J.M. Stolker, volgens besluit van het College voor Promoties te verdedigen op woensdag 15 april 2015 klokke 15.00 uur door Nini Aafke de Glas Geboren te Amsterdam in 1987. Promotiecommissie Promotor: Prof. dr. C.J.H. van de Velde Copromotores: dr. G.J. Liefers dr. J.E.A. Portielje Overige leden: Prof. dr. S. C. Linn, Netherlands Cancer Institute Prof. dr. J. P. Vandenbroucke Prof. dr. J.J.M. van der Hoeven Contents Introduction Chapter 1: General introduction and outline 7 Part I: Choosing the right treatment for the right patient Chapter 2: Chapter 3: Chapter 4: Chapter 5: Chapter 6: Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands: population based study Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis Impact of omission of surgery on survival of older patients with breast cancer Survival of older patients with metastasized breast cancer lags behind despite evolving treatment strategies: a population-based study Validity of Adjuvant! Online program in older patients with breast cancer: a population-based study 17 33 49 65 79 Part II: Methodological aspects of research in older breast cancer patients Chapter 7: Chapter 8: Chapter 9: Choosing relevant endpoints for older breast cancer patients in clinical trials: an overview of all current clinical trials on breast cancer treatment Performing survival analyses in the presence of competing risks: a clinical example in older breast cancer patients Assessing treatment effects in older breast cancer patients: systematic review of observational research methods 103 119 133 Summary & Discussion Chapter 10: Summary, general discussion and future perspectives 153 Appendices Dutch Summary167 List of contributing authors180 List of publications182 Curriculum Vitae184 Acknowledgements185
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