Optimizing pre-treatment cancer care Do no harm

Good clinical practice is to abstain from all intentional wrong-doing and harm. This thesis discusses how to prevent and screen for complications in patients that need to be treated for cancer. Three different topics are covered. In the first part hepatitis B screening in patients that will start with chemo- or immunotherapy is discussed. Do we have to screen all patients before start of chemotherapy to prevent hepatitis B reactivation? And how do Dutch medical oncologists behave on this topic? The second part addresses screening for human papillomavirus related anal dysplasia in women with a history of human papillomavirus disease, the value of different screening tests to detect anal dysplasia or cancer and the role of human papillomavirus vaccination as addition to standard treatment for HPV high grade dysplasia or cancer. In the last part pain and fear of pain during a bone marrow aspiration and biopsy is studied. What pain do patients experience during this procedure and what is the influence of fear of pain? Also, the effect of different premedication schemes to reduce pain during a bone marrow aspiration and biopsy is studied in a randomized controlled trial.