PhD defence M.E. (Marloes) Clarijs

Brief summary on the aim of the doctoral thesis:

Against the background of good prognosis and limited local treatment associated morbidity for primary breast cancer patients who undergo curative treatment, attention shifts to maintaining quality of life (QoL) as an important goal of care. Value-based healthcare is an approach to medical care that prioritizes the improvement of patient outcomes and the overall quality of care, rather than the quantity of services provided. In breast cancer, value-based care would aim to provide patients with the most effective treatments, minimize unnecessary procedures, and improve patient experience and satisfaction. This thesis emphasizes that measuring and evaluating outcomes that matter most to patients should be an important focus of breast cancer care. 

PART I focusses on the QoL and patient reported outcomes (PROs) in breast cancer patients. It emphasizes the need for a standardized approach for implementing and measuring PROs and the use of normative PRO data. The QoL between surgical mastectomy techniques and the QoL in caregivers of breast cancer patients were evaluated. PART II illustrates first developments towards the prediction of breast cancer treatment related outcomes. Firstly, the focus lies on a three-dimensional imaging tool used in the preoperative, neo-adjuvant setting to evaluate tumor size and volume with the potential to be used in predicting pathologic tumor response. Secondly, an optimized novel method to measure radiation-induced lymphocyte apoptosis was developed to improve the implementation in clinical practice and enhance predictive modelling in patients with radiation-induced fibrosis. To complete this section, a study protocol about pectoral fascia preservation and its relation to postoperative outcomes was described.