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Simons BCR, Hillen MA, Aarts JWM, Tromp JM, de Heus E, Duijts SFA. Disentangling trust of patients with rare cancer in their healthcare professionals and the healthcare system: a qualitative interview study. J Cancer Surviv 2024:10.1007/s11764-023-01531-w. [PMID: 38225524 DOI: 10.1007/s11764-023-01531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Patients with a rare cancer face challenges, e.g., delayed diagnosis, that may affect trust in the healthcare system and the healthcare professionals (HCPs) involved. This study aimed to explore trust of patients with a rare cancer in their HCPs and the healthcare system. METHODS Semi-structured interviews were conducted with 20 purposively sampled patients with a rare cancer. The interview guide included topics related to trust, including level, development, barriers and facilitators, importance, and trust dimensions. Thematic analysis was conducted with use of Atlas.ti. RESULTS The mean age of patients was 50 years, 60% were female, and 70% were highly educated. Three themes were constructed: (1) "Confirmed expertise is a prerequisite of trust." Patients need confirmation of their HCPs' expertise, as it could not be assumed due to the rarity of their cancer; (2) "Trust depends on the adequacy of information and how it is provided." Limited information about rare cancer reduced patients' trust in health care, whereas interpersonal trust was mainly affected by how HCPs provided information; and (3) "Trust is built on properly coordinated and supportive care." Proper organization and cooperation within and between hospitals, and integration of supportive care, enhanced trust. CONCLUSION Patients with a rare cancer experience challenges that influence trust in HCPs and the healthcare system. Further research should examine trust among subgroups of patients with a rare cancer, to enable development of tailored interventions. IMPLICATIONS FOR CANCER SURVIVORS HCPs may improve trust by focusing on expertise, effective information provision, proper coordination of care, and provision of adequate supportive care.
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Affiliation(s)
- Barbara C R Simons
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Rijnkade 5, 3511 LC, Utrecht, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Johanna W M Aarts
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Gynaecological Oncology, Cancer Center Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Jacqueline M Tromp
- Department of Medical Oncology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Rijnkade 5, 3511 LC, Utrecht, The Netherlands
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Rijnkade 5, 3511 LC, Utrecht, The Netherlands.
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
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de Heus E, van de Camp K, Driehuis E, van der Zwan JM, van Herpen CML, Merkx MAW, Duijts SFA. The solitary versus supported experience: Care inequality between rare and common cancer patients. Psychooncology 2023; 32:1667-1674. [PMID: 37698502 DOI: 10.1002/pon.6216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE Patients with a rare cancer (RC) often have a more complex disease trajectory than patients with a common cancer. Research involving both patient groups is needed to identify differences and resemblances. In this study, we aimed to explore and compare experiences, needs and quality of life of patients with rare and common cancer throughout the disease trajectory. METHODS A qualitative focus group study was conducted, including patients with rare and common cancer (n = 25). Participants were purposively selected to reflect heterogeneity of cancer types. A semi-structured topic list was used. Focus groups (n = 4) were recorded, transcribed verbatim and analysed, using thematic analysis. RESULTS Three themes were identified emphasizing care inequality between patients with rare and common cancer: (1) The solitary experience: lack of information and support impact the RC patient, (2) Sudden impact, but recognition reduces the common cancer burden, and (3) Absence of psychosocial care requires being empowered as a cancer patient. CONCLUSIONS Patients with RC are faced with enormous challenges due to the high impact of their solitary experience on their quality of life, while patients with common cancer generally experience social support and recognition alleviating their burden. Centralisation of care for patients with RC is needed and tailored psychosocial care should be provided to overcome inequalities.
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Affiliation(s)
- Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kalinka van de Camp
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
| | - Esmee Driehuis
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
| | - Jan Maarten van der Zwan
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthias A W Merkx
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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van Dongen J, de Heus E, Eickholt L, Schrieks M, Zantingh I, Brouwer OR, Oonk MHM, Grotenhuis BA, Ezendam NPM, Duijts SFA. Challenges and controversies patients and (health care) professionals experience in managing vaginal, vulvar, penile or anal cancer: The SILENCE study. Eur J Cancer Care (Engl) 2022; 31:e13676. [PMID: 35938519 PMCID: PMC9787908 DOI: 10.1111/ecc.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with vaginal, vulvar, penile or anal cancer experience deteriorated psychosocial functioning and decreased Quality of Life (QoL). The aims of this study were to explore (1) the challenges and controversies patients experience in managing vaginal, vulvar, penile or anal cancer; their unmet needs; and how this affects their psychosocial functioning and (2) the gaps health care professionals (HCPs) experience in providing psychosocial support and potential improvements in care. METHODS Semi-structured interviews with patients with vaginal, vulvar, penile or anal cancer and with HCPs were conducted. All interviews were transcribed verbatim and thematically analysed. RESULTS Fourteen patients (86% female; mean age 55.5) and 12 HCPs (75% female; mean age 46.4) participated. Four themes were identified: (1) recognisable symptoms but unfamiliar diagnosis, (2) 'double hit' has severe impact on psychosocial functioning, (3) personal and tailored information is important but not guaranteed and (4) all-encompassing care to improve psychosocial functioning and QoL. CONCLUSION Patients with vaginal, vulvar, penile or anal cancer encounter a lack of awareness and knowledge about their rare cancer type, difficulties regarding communication and long-term changes in body image and sexuality. Awareness of symptoms should be raised and psychosocial care should be offered on a structural basis.
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Affiliation(s)
- Jessy van Dongen
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands
| | - Eline de Heus
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands,Department of Medical OncologyRadboud University Medical CenterNijmegenNetherlands
| | - Lauren Eickholt
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands
| | - Marga Schrieks
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie van Kankerpatiëntenorganisaties, NFK)UtrechtNetherlands
| | - Ilaniek Zantingh
- Center for Quality of LifeThe Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI‐AvL)AmsterdamThe Netherlands
| | - Oscar R. Brouwer
- Department of UrologyThe Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI‐AvL)AmsterdamNetherlands
| | - Maaike H. M. Oonk
- Department of Obstetrics and GynecologyUniversity Medical Center GroningenGroningenNetherlands
| | - Brechtje A. Grotenhuis
- Department of Surgical OncologyThe Netherlands Cancer Institute – Antoni van Leeuwenhoek (NKI‐AvL)AmsterdamNetherlands
| | - Nicole P. M. Ezendam
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseasesTilburg UniversityTilburgNetherlands
| | - Saskia F. A. Duijts
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL)UtrechtNetherlands,Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamNetherlands
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Olischläger DLT, den Boer LXY, de Heus E, Brom L, Dona DJS, Klümpen HJ, Stapelfeldt CM, Duijts SFA. Rare cancer and return to work: experiences and needs of patients and (health care) professionals. Disabil Rehabil 2022:1-12. [PMID: 35850601 DOI: 10.1080/09638288.2022.2099589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Patients with a rare cancer often face delays in their diagnostic and treatment trajectory, which may affect their work. In this study, we explored experiences and needs of: 1) patients with a rare cancer regarding return to work (RTW) and work retention, and 2) (health care) professionals (HCPs) regarding work-related support of patients with a rare cancer, throughout their disease trajectory. METHODS Semi-structured, in-depth interviews with working-age patients with a rare cancer (n = 16), and HCPs (n = 9) were conducted. During the interviews, a predefined topic list was used. Interviews were transcribed verbatim and analysed by means of thematic analysis. RESULTS In total, three themes emerged from the interviews: 1) Awareness in patients and HCPs as a first step towards work, 2) Being/becoming an expert is a tough job, and 3) Enhancing employability through early personalized guidance. CONCLUSIONS Patients with a rare cancer are confronted with uncertainties regarding work, due to an overall lack of knowledge and experience with these types of cancer. Raising awareness among patients, HCPs and employers about rare cancer and its implications, and providing timely individualized, supportive occupational care are required to improve rare cancer patients' ability to work.Implications for rehabilitationRecognizing and paying attention to the work-related consequences of a rare cancer diagnosis and its treatment is essential to facilitate rare cancer patients' occupational rehabilitation process.Multidisciplinary collaboration and involvement of HCPs specialized in rare cancer are required to provide suitable work-related support.A personalized approach is necessary to adequately address rare cancer patients' RTW and work retention needs.
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Affiliation(s)
- Daphne L T Olischläger
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Li Xiang Y den Boer
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Brom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Desiree J S Dona
- Department of Human Resources, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, The Netherlands
| | | | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Psychology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Cancer treatment and Quality of life, Amsterdam, The Netherlands
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de Heus E, Duijts SFA, van der Zwan JM, Kapiteijn E, Nieveen van Dijkum EJM, van Herpen CML, Merkx MAW. The gap between rare and common cancers still exists: Results from a population-based study in the Netherlands. Eur J Cancer 2022; 167:103-111. [PMID: 35421702 DOI: 10.1016/j.ejca.2022.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Epidemiological discrepancies exist between rare and common cancers. The aim of this population-based study was to compare rare versus common adult solid cancers in the Netherlands, by providing incidence, prevalence and survival rates, evaluating trends in survival and comparing individual entities within domains and families. METHODS All adult patients with malignant solid cancers in the Netherlands between 1995 and 2019 were identified from the Netherlands Cancer Registry. Data on patient, tumour and treatment characteristics were collected, and relative survival and survival trends were analysed. RESULTS A total of 170,628 patients with rare adult solid cancers and 806,023 patients with common adult solid cancers were included. Rare cancers accounted for 18% of all cancer diagnoses (mean incidence), and 15% of the total ten-year cancer prevalence during 2010-2019. Overall 5-year survival was worse for rare cancers than for common cancers (52.0% versus 68.7%). Between 1995-1999 and 2015-2019, 5-year survival rates for rare cancers increased to a lesser extent (from 46.2% to 52.6%, i.e. 6.4%) than for common cancers (56.9%-70.1%, i.e. 13.2%), and for most rare cancer domains compared to common cancer domains. The majority of rare cancer entities did not show an improvement in 5-year survival. Differences for individual entities between domains and families were found. CONCLUSION Differences in survival between rare and common cancers indicate major challenges for rare cancer care and emphasise that improvement is highly needed. Observed inequalities need to be overcome by investing in early diagnosis, novel therapies, scientific research and in establishing centres of expertise.
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Affiliation(s)
- Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, the Netherlands; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, the Netherlands; Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jan Maarten van der Zwan
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, the Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands; Dutch Rare Cancer Platform, the Netherlands
| | - Els J M Nieveen van Dijkum
- Dutch Rare Cancer Platform, the Netherlands; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands; Dutch Rare Cancer Platform, the Netherlands
| | - Matthias A W Merkx
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Integraal Kankercentrum Nederland, IKNL), Utrecht, the Netherlands; Dutch Rare Cancer Platform, the Netherlands; IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
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de Heus E, van der Zwan JM, Husson O, Frissen AR, van Herpen CML, Merkx MAW, Duijts SFA. Unmet supportive care needs of patients with rare cancer: A systematic review. Eur J Cancer Care (Engl) 2021; 30:e13502. [PMID: 34409667 DOI: 10.1111/ecc.13502] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 07/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Patients with rare cancers may experience different unmet needs than those with common cancer. The objective of this systematic review was to (1) investigate unmet supportive care needs of rare cancer patients throughout the disease trajectory and (2) identify predictive factors for these unmet needs. METHODS PubMed, PsycINFO and CINAHL were searched for publications (January 2011 to March 2021) focusing on unmet needs of patients with rare cancer. Two reviewers independently selected studies, extracted data and performed quality assessment. Findings were synthesised. RESULTS The search yielded 4,598 articles, of which 59 articles met eligibility criteria and 57 were of medium or high quality. Rare cancer patients most frequently reported unmet needs in the healthcare system and information domain (up to 95%), followed by the psychological domain (up to 93%) and the physical and daily living domain (up to 80%). Unmet needs were mainly reported in the posttreatment phase. The most frequently identified predictors were higher anxiety, younger age and higher neuroticism. CONCLUSION Patients with rare cancer have unmet needs throughout their disease trajectory. Supportive care needs of rare cancer patients should be addressed individually, depending on the rare cancer subdomain and phase of disease and from diagnosis onwards.
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Affiliation(s)
- Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Maarten van der Zwan
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Olga Husson
- Division of Psychosocial Research and Epidemiology and Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anne-Roos Frissen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthias A W Merkx
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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de Heus E, Engelen V, Dingemans I, Richel C, Schrieks M, van der Zwan JM, Besselink MG, van Berge Henegouwen MI, van Herpen CML, Duijts SFA. Differences in health care experiences between rare cancer and common cancer patients: results from a national cross-sectional survey. Orphanet J Rare Dis 2021; 16:249. [PMID: 34074302 PMCID: PMC8170927 DOI: 10.1186/s13023-021-01886-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background Patients with rare cancers face challenges in the diagnostic and treatment phase, and in access to clinical expertise. Since studies on health care experiences of these patients in comparison to patients with more common cancers are scarce, we aimed to explore these differences. Methods Data were cross-sectionally collected among (former) adult cancer patients through a national online survey in the Netherlands (October 2019). Descriptive statistics were reported and subgroups (rare vs. common patients) were compared. Results In total, 7343 patients (i.e., 1856 rare and 5487 common cancer patients) participated. Rare cancer patients were more often diagnosed and treated in different hospitals compared to common cancer patients (67% vs. 59%, p < 0.001). Rare cancer patients received treatment more often in a single hospital (60% vs. 57%, p = 0.014), but reported more negative experiences when treated in multiple hospitals than common cancer patients (14% vs. 9%, p < 0.001). They also more often received advise from their physician about the hospital to go to for a second opinion (50% vs. 36%, p < 0.001), were more likely to choose a hospital specialized in their cancer type (33% vs. 22%, p < 0.001), and were more willing to travel as long as necessary to receive specialized care than common cancer patients (55% vs. 47%, p < 0.001). Conclusions Rare and common cancer patients differ in their health care experiences. Health care for rare cancer patients can be further improved by proper referral to centers of expertise and building a clinical network specifically for rare cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01886-2.
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Affiliation(s)
- Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands. .,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Vivian Engelen
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie Van Kankerpatiëntenorganisaties, NFK), Utrecht, The Netherlands
| | - Irene Dingemans
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie Van Kankerpatiëntenorganisaties, NFK), Utrecht, The Netherlands
| | - Carol Richel
- Dutch Breast Cancer Association (Borstkankervereniging Nederland, BVN), Utrecht, The Netherlands
| | - Marga Schrieks
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie Van Kankerpatiëntenorganisaties, NFK), Utrecht, The Netherlands
| | - Jan Maarten van der Zwan
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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