Lectures Oncology and Public Health – Vrije Universiteit Amsterdam
Minor: Biomedical Topics in Healthcare
Index
Lecture 1 Introduction........................................................................................................................2
Lecture 2 Public Health Issues in Oncology.........................................................................................2
Lecture 3 Introduction in Oncology....................................................................................................4
Lecture 4 Diagnosis and Treatment....................................................................................................6
Lecture 5 Targeted therapy & immunotherapy..................................................................................7
Lecture 6 Oncogenesis........................................................................................................................9
Lecture 7 Psycho-oncology...............................................................................................................12
Lecture 8 Cancer epidemiology........................................................................................................15
Lecture 9 Late effects after treatment for Hodgkin Lymphoma.......................................................20
Lecture 10 Pain management in oncology........................................................................................22
Lecture 11 Prevention and screening...............................................................................................24
Lecture 12 End-of-life and palliative care.........................................................................................27
Lecture 13 E-health in oncology.......................................................................................................29
Lecture 14 The CNS, chemotherapy, and neurocognitive function..................................................31
Lecture 15 Adolescent and Young Adults.........................................................................................33
Lecture 16 Netherlands Cancer Registry...........................................................................................34
Lecture 17 Nutrition and cancer.......................................................................................................35
Lecture 18 Emotions in patients with cancer....................................................................................38
Lecture 19 Work...............................................................................................................................40
Lecture 20 Rare Cancer.....................................................................................................................42
Lecture 21 Risk communication and population cancer screening decisions: the public health
versus an individual perspective.......................................................................................................44
Lecture 22 Shared decision making..................................................................................................48
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, Lectures Oncology and Public Health
Lecture 1 Introduction
The incidence of cancer is rising with 3000 patients per year. During COVID fewer diagnoses, because
people didn’t show up to their GP.
Men: prostate, skin, lung, bowel. In the beginning, more men had lung cancer, but now also women,
because they started smoking later. Women: breast, skin, lung, bowel, lymph node and leukaemia.
Survival rate (5-year survival) = W 70%, M 66%. 20-year prevalence: in 2032, 1 in 13 will have (a
history of) cancer. Oncology is a public health issue; oncology is the leading cause of death. 1/3 due
to behavioural and dietary risks: high BMI, low fruit and vegetable intake, lack of physical activity,
tobacco use, alcohol use.
Public health: the science and art of preventing disease, prolonging life and promoting health
through the organized efforts of society (Acheson, 1988).
Health is a state of complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity (WHO, 1948).
Focus on prevention (limit risk factors), increase health care capacity (working in health care should
be made more attractive), an efficient organization of health care (use of technology), digitalization,
support the needs of patients and survivors, increase the quality of life and quality of end-of-life.
-More men than women get the diagnosis cancer, live with cancer over the years, and women live
longer with cancer. The incidence was 119.000 and the prevalence is much higher.
-Breast cancer screening is an example of secondary prevention: people have cancer, but focused on
early detection and early prevention of growth of the disease.
-Almost 50% of all new cases receive their diagnosis when they are still at working age (18-65).
-More than 85% of all tumour types can be considered ‘rare’ glioma, tumour in the belly, less than
1000 patients diagnosed with it in one year. 1 in 5 persons is diagnosed with rare cancer.
-From 55 years starts screening for colon cancer in NL. 50 years breast cancer. Cervical cancer 35.
-Palliative care and intensive life-prolonging treatment can be combined.
-The prevalence of distress in patients with cancer is 1/3.
-5-10% of cancer is caused by genetic components.
-Cannabis can be used for palliative care.
Lecture 2 Public Health Issues in Oncology
Public Health: the science and art of preventing disease, prolonging life and promoting health
through the organized efforts and informed choices of society, organisations, public and private,
communities and individuals. Health: is a state of complete physical, mental and social well-begin
and not merely the absence of disease or infirmity. Important: prevention, prolonging life, promoting
health. WHO: all organized measures (whether public or private) to prevent disease, promote health,
and prolong life among the population as a whole.
Oncology and public health: screening, pollution lung cancer. Public health is collective actions
(not one doctor), organized measures.
Three fields of public health research
1. Epidemiology and community diagnosis
2. Collective prevention and health promotion screening
3. Health care organization and performance how is health care (in a city) organized, is it
accessible for everyone (money important)
Public health: population, disease prevention, health promotion, interventions; environment, human
behaviour like swimming. Medical science: individual, diagnosis, treatment, intervention (medical
care).
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, APPLICATION OF PUBLIC HEALTH
-Populations: from local areas to the world population
-Causes of diseases (causes of causes): from behaviours to broader environment. Advertisements for
smoking banned, taxes for cigarettes, because it’s the cause of smoking.
-Prevention of disease: from individual patients to national policies (smoking behaviour)
-General health outcomes: from quality of life to healthy life expectancy (where do we get out gains,
is living longer always better or quality of life?)
MAIN PUBLIC HEALTH FUNCTIONS (WHO):
-Assessment and monitoring of the health of communities and populations at risk to identify health
problems and priorities. At population level, how many people are healthy, or getting cancer,
mesothelioma risk with asbestos? Relation asbestos and mesothelioma = 1 on 1. Working with
asbestos has a huge latency period (can be 40 years) before mesothelioma occurs. 500-600 people
are dying of mesothelioma.
-The formulation of public policies designed to solve identified local and national health problems
and priorities. What kind of policy should be used in asbestos, ban on asbestos.
-Assure that all populations have access to appropriate and cost-effective care, including health
promotion and diseases prevention services.
Major Public Health achievements? Since 1900: vaccination, safer workplaces (50), control of
infectious diseases. Since 1920: safer and healthier foods, healthier mothers and babies, family
planning. Since 1965: fluoridation of drinking water, motor-vehicle safety, recognition of tobacco use
as a health hazard, decline in deaths from coronary heart disease and stroke.
THE BIGGEST SUCCESS in Public Health: improved sewage disposal and clean water supply systems.
Current/future Public Health challenges: infectious diseases (Ebola/Covid19), chronic diseases,
overweight and obesity, mental health, environmental quality, Planetary Health, social issues such as
violence, drug abuse, teenage pregnancy.
Cancer is the leading cause of death. Cancer incidence and mortality increase, but relatively
fewer people die from it. The global burden is increasing, due to: increasing global population,
increasing age, screening more new cases (breast, cervix and colon cancer), and increases in
risk factors (smoking, obesity, physical inactivity, unhealthy diet).
Geographic cancer: stomach cancer occurs much more often in Japan/Korea, consumption of smoked
fish. Breast and prostate cancers: less frequent in Asian vs Caucasian people (Asian vs. Western diet).
Melanoma: Australia + sunny parts of south US. Liver cancer: South-east Asia and east Africa (Hep B).
Thyroid cancer: Swiss Alps, Rocky Mountains (deficiency of iodine in local food and water supply).
PRIMARY PREVENTION : prevent the disease from occurring. Population.
-Encourage healthy lifestyles, legislation: increase tax on tobacco/alcohol, HPV vaccination for
prevention of cervical cancer
SECONDARY PREVENTION : detect and treat the disease in an early phase before symptoms occur
(screening). Individuals
-Screening for breast, cervical or colon cancer
TERTIARY PREVENTION: prevent damage and pain from the disease, slow down the disease and prevent
the disease from causing other problems.
-Survivorship care improve HRQoL, prevention of cancer recurrence
Living healthy helps to prevent cancer, 30-35% reduction in cancer risk by living healthy. Most of it is
by quitting smoking, then diet, overweight, alcohol, inactivity, and sun exposure. The EPIC study
showed a protection of cancer risk for people who were more active, compared to inactive.
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, Cancer risk longitudinal cohort study, the alternative would be a case-control study. More active
better for risk of cancer. Many types of cancer are related to many types of risk factors. What can
you eat and what not, is it a risk factor?
Increasing risk: overweight, weight gain adulthood, salt-preserved foods, alcohol, β-carotene, mate
Decreasing risk: non-starchy vegetables, fruit, physical activity, dietary fibre, breastfeeding, garlic
Recommendations: healthy weight, physically active, limit consumption of sugar-sweetened drinks,
limit alcohol consumption. Stop smoking will reduce your cancer risk most.
Lecture 3 Introduction in Oncology
Patient; heavy smoker, lives in Ijmuiden, shortness of breath, weight loss and pain near left
hip. Based on CT scan alone, cancer diagnosis cannot be made biopsy needed. Diagnosis
lung cancer staging with PET scan. Brain and bladder light always up at PET scan, seen as
control. Lung cancer with bone metastasis (in the left ilium).
Our bodies consist of about 30 trillion cells, in every one of these cells, cancer can occur.
Cancer comprises a large group of diseases characterized by abnormal cells, which: (1) continuously
proliferate, (2) invade local tissue and (3) can spread to other organs (via blood vessels other lymph
nodes). The additional cells form a mass of tissue called tumour.
BENIGN TUMOUR : respects normal borders, relatively normal cells, capture that doesn’t brake
(lipoma). This is a tumour, but it isn’t cancer
MALIGNANT TUMOUR: irregularly shaped, necrosis in tumour, can invade tissue around and blood
vessels.
1.000.000.000 cells are needed to form a shape of a grape. A patient usually has had cancer for
several years before it is detected or causes symptoms.
Carcinoma (85%): -squamous cells or
-Adenocarcinoma (adeno = gland): columnar glandular tissue, most common in carcinoma
-Squamous cell carcinoma: squamous epithelium
Other, less common types:
Sarcoma: bone and soft tissue (mesodermal tissue)
Glioma: glia cells in CNS, brain tumours
Melanoma: melanocytes in the skin
Haematology: -leukaemia originates in the blood-forming tissues of the bone marrow.
-Lymphoma and myeloma: originate in cells of the immune system.
Normally human cells grow and multiply to regenerate tissues. Stem cells differentiate. DNA is
exposed, replicated, two exact copies DNA cells divide each cells contains the same DNA.
The process of DNA replication is complex and vulnerable to: damage by toxins (cigarette smoke,
asbestos) and introduction of errors.
Damage by toxins frequent division increased risk of introduction of errors mistakes in DNA
normally repaired or apoptosis. However, some cells survive with an abnormal change in their DNA
genomic alteration.
Types of genomic alterations: point mutation, deletion, insertion, translocation. The type and
location of the genomic alteration is very important.
Proto-oncogene: acceleration of the division? Tumour suppressor gene: brake system, normally a
brake of cell division. When lost no brake too much cell division.
MUTATION OF PROTO-ONCOGENE oncogene: normally involved in cell division. Mutation more
active protein increased cell growth/division. Growth factor receptor. Ras: normally Ras + GTP
only when GF is around. In cancer: Ras mutated, GTP always bound Ras is always switched on.
HER2 tested in breast and oesophageal cancer. B-Raf, MEK in melanoma.
MUTATION OF TUMOUR SUPPRESSOR; normally blocks cell division. P53 actives damaged DNA
hold cell division, trekt DNA repair, apoptosis triggers. P52 mutated: does not bind DNA
damaged DNA can be passed on. TP53, BRCA1 and BRCA2, breast and ovarian cancer.
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