Renate’s Diary
Renate Heine-Bröring, PhD student
Wageningen University
Renate Heine-Bröring is a PhD student working with Prof. Ellen Kampman, who is leading the WCRF Project Group. Renate’s diary entries track the progress of the project on a quarterly basis.
December 2011
It has already been half a year ago that I wrote my last update. It is time for some new impressions of my work as a PhD student. In June I had my first oral and poster presentation at a Dutch epidemiological congress (WEON). I presented the design and progress of the COLON study, and showed preliminary results of the analyses in the POLIEP study, a study among sporadic colorectal adenoma patients, on a poster. It was also a good opportunity to get to know other researchers in this field of research.
Figure 1. Poster presentation at the WEON
The summer months July and August I was busy with writing my first scientific article on dietary supplement use and colorectal adenoma recurrence. Together with my supervisors we had lots of discussions about the data-analyses, because they were quite challenging. At the moment I am finishing the writing, and I hope I can submit my article to a scientific journal soon!
In September I joined the 3rd International Course in Nutritional Epidemiology at Imperial College in London. I was honoured to receive a WCRF-fellowship, which covered the course fee. Together with six other WCRF fellows, I was invited at the office of WCRF in London. WCRF presented their work and their research, and all the fellows received a certificate. The course helped me to extend my knowledge and methodological skills in aspects related to nutritional epidemiology. Furthermore, I had the possibility to interact with other professionals in this research area. I gained a lot of new ideas, which I can apply in my current research and in my future career.
Figure 2. As a WCRF fellow, I received a certificate from Dr. Kate Allen
When I was back in Holland in October and November I finished the medical follow up of the GeoLynch study, a cohort study among patients with Lynch syndrome. After that I started to find out which people we can approach for the extension of the GeoLynch cohort in cooperation with the Netherlands Foundation of Hereditary Tumours. In the current cohort around 500 patients with Lynch syndrome are included. We will extend the number of patients to 750 in total, so that means that around 250 new patients have to be included in the study. Hopefully we can start soon with the new recruitment!
Last but not least, the recruitment of the COLON study is still on-going. We included almost 200 colorectal cancer patients in five participating hospitals. However, we have contacted two other hospitals to participate in the recruitment of the study since we need 1000 colorectal cancer patients in total. Thus, still a lot of work to do!
Keep you informed!
Figure 3. Meeting with the team of the COLON study to make a plan for the recruitment
June 2011
It is time for a new update of my PhD project! Currently, 81 patients with colorectal cancer participate in the COLON study, and their median age is 67 years. Almost two third of this population are men. Up until now recruitment of participants takes place in five hospitals. We have also contacted four other hospitals in the region. Hopefully, we reach the 1,000 participants as soon as possible. Since February Moniek van Zutphen, my research assistant, started to help me with the practical and administrative work in the COLON study. I am very glad that I can collaborate with her, because with the growing number of participants it was not possible to do all the practical work on my own anymore. Some participants already started with the second measurement of the study, namely the 6 months follow up. Those participants will donate blood, and will get questionnaires half a year after their diagnosis with colorectal cancer. Last period I systematized the blood samples from the participants in our freezer together with Moniek van Zutphen.
Some impressions of systematizing blood samples in the freezer
together with Moniek van Zutphen
Since May 2011 I started with an update of the medical follow up of participants of the GeoLynch study, a prospective cohort study among Lynch syndrome patients. The Netherlands Foundation of Hereditary Tumours, located in the western part of the Netherlands, registers all hereditary tumours and mutations in a large database, and they provided me with an update of medical information between 2008 and 2010. At the moment I check which participants have new colorectal adenomas and/or cancer. The current cohort contains 500 participants, and we will enlarge this cohort to 750 participants by the end of this year.
Finally, I did my first analyses in the POLIEP study, another cohort study among patients with a colorectal adenoma. I investigated whether dietary supplement use is associated with recurrence of colorectal adenomas, and whether this association differs for number of adenomas, adenoma size, histological type and location in the bowel. This month I will present some preliminary results on a poster at a Dutch epidemiological congress. In my next update I expect to show you some first results of my analyses! I will keep you informed!
February 2011
At the moment the COLON study, a cohort study among colorectal cancer patients, has started in a third and fourth regional hospital, and hopefully a fifth and a sixth hospital will follow soon. Around 50 colorectal cancer patients are included in the study up until now. In figure 1, a graph of the recruitment of participants is shown. We expect to have 1,000 colorectal cancer patients included in the study by the end of 2012 or the beginning of 2013 (see red line). The green line depicts the recruitment of participants up until now. In February, a research assistant started to help me with the recruitment of participants and the practical preparations.
Figure 1. Recruitment of participants in the COLON study
I will start with the recruitment and follow up of another existing cohort, the GeoLynch Study soon. In this study, around 500 patients with Lynch syndrome, which is an inherited form of colorectal cancer, are included. We will extend the number of patients to 750 in total, so that means that around 250 new patients have to be included in the study. Furthermore, we will update their medical information and dietary and lifestyle data.
Besides those practical activities, I will focus on analyses of data in the POLIEP study, a prospective cohort study among participants with a colorectal adenoma. I will investigate whether dietary supplements, and multivitamins specifically, are associated with colorectal adenoma recurrences.
October 2010
Good news! The recruitment of participants in the COLON study started in a regional hospital in August and in an academic hospital in October! We now have 26 participants! We are planning to extend the COLON study to other hospitals, with an aim to include 1,000 patients who have been diagnosed with colorectal cancer recently. In July and August, I was working on the COLON study’s practical preparations.
Some impressions of the practical preparations for the COLON study
Together with two students of mine, I started with the initial search for publications for the systematic literature review on dietary supplements and colorectal cancer risk. This means that we review all the scientific publications on the subject. I also checked data of the POLIEP study, a cohort study among people who have colorectal adenomas. After this data check is finished I can with my analyses on dietary supplement use and colorectal adenoma recurrence.
In the first week of September, I participated in the new VLAG course ‘Exposure Assessment in Nutrition Research’ where I refreshed my knowledge on dietary assessment methods, measurement errors, and biomarkers. (And on my summer holidays in September/October, I got married and went on my honeymoon!)
June 2010
Last period I travelled a lot. In March I went to the German Cancer Research Center in Heidelberg where I stayed for three days. My supervisors and I had nice meetings with other researchers and PhD-students. The purpose of this visit was to talk about a possible cooperation with the Colocare consortium, a comparable study to the COLON study, so that we will have higher numbers of participants.
Furthermore, I joined the PhD-week in April where other PhD-students from VLAG, my graduate school, met each other. We had a nice week in Kasteel de Berkt in Baarlo where we learned the basic things about scientific writing, presentation techniques, time management, cultural differences, and how to handle the press. And of course we enjoyed the nice weather and environment!
Last but not least I went to Imperial College in London in May for a week to learn how to perform a meta-analysis. A meta-analysis combines the results of several studies on the same topic. In this way you get a more powerful estimate of the true effect size than those derived in a single study.The other good thing is that the Medical Ethical Committee approved the COLON-study! So we hope to get started soon with the recruitment of participants in an academic and regional hospital!
Logo of the COLON study
February 2010
Time flies when you are doing research! Since the start of my PhD-project I have done so many things. In October I joined the PhD-tour to Denmark, Sweden and Finland. This journey is a great opportunity to increase and strengthen my knowledge in nutrition research as well as to broaden my network. We went to several interesting institutes in Denmark, Sweden and Finland, and we visited the beautiful cities Copenhagen, Stockholm, and Helsinki in our spare time. At the moment, I know most of my colleagues much better!
Back in Holland I was especially working on a dietary supplement questionnaire which we will use in the COLON-study, a cohort study among colorectal cancer patients. Together with two MSc-students we performed many 24h-recalls, which are telephone interviews to assess the diet of participants during the previous day. At the moment we are evaluating if and how the dietary supplement questionnaire has to be adapted. It is very difficult to adequately assess dietary supplement use, because participants find it hard to report their habitual intake of supplements. Furthermore, it is important to include questions on dosage, duration and seasonal influences to get a complete overview of a person’s habitual intake.
I had my first presentation about the design of our COLON-study at the WCRF-NL office in Amsterdam. In the mean time I prepared the documents (e.g. research protocol, questionnaires, patient information, informed consent) for the Medical Ethical Committee and we have to wait to see if the committee gives its approval. I am looking forward to this exciting period!
Our students made a pie with ‘dietary supplements’ to thank us for our supervision!
October 2009
Since 1 September 2009 I started as a PhD-student directly after finishing my master in Nutrition and Health. I did my bachelor in Nutrition and Dietetics at Hanze University Groningen. Nutrition in health and disease has always been an interest of mine. I was always interested in how we could (beneficially) influence our health by means of food and nutrition.
My PhD-project focuses on diet, dietary supplements and body fatness in colorectal tumour recurrence and survival in cooperation with and funded by the World Cancer Research Fund NL. Associations will be evaluated using data from three prospective cohort studies among colorectal cancer survivors (COLON-study), patients with hereditary colorectal cancer, also called Lynch Syndrome (GEOLYNCH-study), and patients with sporadic colorectal adenomas (POLIEP-study).
I will be involved in the start and the recruitment of participants of the COLON-study, a new prospective cohort study among colorectal cancer patients. In this study we are trying to determine if colorectal cancer patients could benefit from being slimmer, eating healthy food, and taking vitamin and mineral supplements. Furthermore, I will be responsible for the follow-up and data-collection of the existing POLIEP-follow up study and the GEOlynch-study. I will be supervised by Ellen Kampman, Professor in Diet and Cancer, who has experience in observational epidemiologic studies as well as intervention studies on diet and cancer. My daily supervisor is Dr. Ir. Renate van den Borne-Winkels, nutritionist and specialized in B-vitamins/folate metabolism.
During the first four weeks of my PhD-period my activities consisted of lots of reading of scientific articles and background information on dietary supplement use and colorectal cancer and supervising MSc-students who are working on their thesis on dietary supplement use and colorectal adenomas.
Furthermore, I looked up some blood samples for the POLIEP study that were stored in the freezer of Wageningen University. The white blood cells had to be prepared for transportation to a laboratory where they will perform measurements on DNA. I am very excited about what this project will bring!
WCRF project group, from left to right: Prof. Ellen Kampman; Renate Heine-Bröring, MSc; Renate Winkels, PhD; and one of our students.
