Ietje Perfors

8 Chapter 1 The changing perspective of cancer care Due to improvements in healthcare, the number of people surviving into old age is steadily increasing. Since cancer is a disease that comes with age, currently over 18 million people are diagnosed with cancer worldwide. 1 It is estimated that in 2040 the number of newly diagnosed cancer patients will reach 30 million. 1 Due to improved diagnostics, an increasing number of patients is detected in an earlier stage of disease. 2 This early diagnosis, combined with therapeutic advances in cancer treatments, result in a higher number of patients with prolonged survival. 3 Even though the improved treatment regimens do benefit cancer outcome, they also result in side effects, sometimes long-lasting. 4–6 The acute and long-termburden of cancer are particularly challenging, since cancer patients are mostly elderly who frequently suffer from comorbidities. 7, 8 These changes transform the nature of cancer treatment towards chronic disease management. In addition, the spectrum of treatment options for cancer increasingly demand for a personalised approach, in which the optimal treatment plan is fitted to cancer characteristics and to the individual preferences of the patient. Personalised cancer care and shared decision making Personalised care Today, personalised care is an important focus in healthcare, advocated by policy makers, healthcare professionals and patients. 9 Personalised care is defined according to the National Health Service (NHS) in the United Kingdomas care were “people have choice and control over the way their care is planned and delivered”. 10 It is based on “what matters’ to them and their individual strengths and needs” 10 given their comorbidities and underlying diseases. The NHS states that personalised care will improve people’s health and wellbeing, make care more efficient and reduce pressure on the current healthcare system. 10 Personalised cancer care has several dimensions. First of all, the broadening spectrum of treatment options facilitates detailing of treatment to each individual type and stage of cancer. Individual treatment replaces the