Can you tell us something about yourself? What is your position within the Amsterdam University Medical Centre (AUMC)?
‘My name is Roos Pouw and I work at the Amsterdam University Medical Centre as a gastroenterologist. I focus on patients with oesophageal and stomach cancer, especially the early forms of cancer and their precancerous stages. This subject has had my attention for a long time, because in 2006 I did my doctoral research on this subject at the Amsterdam University Medical Centre. I enjoy getting to the bottom of a subject and really immersing myself in something. After my PhD, I continued to work here and do research, largely with the same team. That is also what makes my work extra enjoyable: my colleagues."
How are people with early oesophageal cancer treated?
‘People with early oesophageal cancer are treated endoscopically, where we cut away the unruly cells. After that, the oesophagus is cleaned. These people have what is known as Barrett's oesophagus, which is a risk factor for oesophageal cancer. This mucous membrane is caused by backflowing stomach acid. If you do not remove it, cancer can develop in that mucous membrane again. Fortunately, the oesophagus has a self-healing capacity. Usually two to three treatments are needed to remove all the Barrett's mucosa. If antacids are then taken, normal oesophageal mucosa can grow back. This treatment has been carried out in this way since 2008.’
What does the research involve?
‘Officially, our research project is called ‘Early detection of the return of oesophageal cancer after successful treatment: towards personalised care.’ The research focuses on people who have undergone this treatment for oesophageal cancer. In the beginning, we did not know what the long-term effects of this treatment would be. Could Barrett's oesophagus or even cancer return once the oesophageal mucosa had been repaired? That is why patients had to return annually for check-ups, even if their oesophageal mucosa had since returned to normal. We still do this today.
But for the research, we want to know if these annual check-ups are really necessary. We now know from research that the chance of cancer or Barrett's oesophagus returning is very low in people who have been treated. So low, in fact, that we wonder if we should be examining these people every year. After all, there are shortages in healthcare and we can save money and manpower if these check-ups are not necessary. On the other hand, there are also people who are at risk of the cancer returning. In the future, we want to spend more time on those people and less time on people who no longer need check-ups. That is why we now want to investigate how we can personalise the aftercare of these patients.’
What I really like is that Roos Pouw's team has the ability to give me enough confidence.
What does the research involve?
‘First of all, we use a mathematical model. We want to use this to calculate how we can focus the checks on the individual. What is the chance that someone will get Barrett's oesophagus or cancer again? So we look very carefully at the risks for each patient, at the chance of other diseases, but also at their personal experience. How does the patient experience the annual endoscopy, and what impact does it have on their quality of life?
Because an endoscopy is no small matter. Most endoscopies are performed under sedation. The risk is very small, but it is still a procedure. Moreover, the examination is stressful for the patient. You have to come to the hospital for it and you cannot go home on your own afterwards. Furthermore, you must rest for the rest of the day.
We already know that the annual check-ups give many patients peace of mind and confidence because they know that everything still looks normal. That is why it is very important that we inform patients properly. We know that the chance of recurrence is low for them, but we must also convey that confidence to the patient. But that is also possible without the annual check-up.
The aim of the research is therefore to personalise the examination of these patients. For which patients can we responsibly do less examination while still being safe? And for which patients do we need to carry out regular check-ups? For this latter group, we will then have more time and space. We also want to examine how we can best provide information so that the patient retains confidence.’
How will you involve patients in the study?
‘This study is unique on several fronts. First of all, we have a very good database in the Netherlands with data on people with Barrett's oesophagus. This is truly unique in the world and it provides a wealth of data. Secondly, we are collaborating with the Public Health department of Erasmus MC on this study. Thirdly, we want to involve patients in this research through focus groups. Quality of life for patients is an important factor. Involving patients is not yet common in similar scientific research.’
Why is it important that the donor gives money for this research?
‘Ultimately, this will enable us to create a safe aftercare programme for early oesophageal cancer based on scientific evidence. We can avoid performing unnecessary endoscopies. And we will be able to give more attention to people at high risk. This will ultimately result in better care.’
Dr Roos Pouw is conducting the research together with Dr Sanne van Munster (post doc. training to become a gastroenterologist). She is also working with Vincent Bos (PhD) and Wilda Rosmolen (nurse specialist). Iris Lansdorp-Vogelaar, Esther Toes-Zoutendijk, Amir Omidvari and Ida Korfage are also involved from Erasmus MC.