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Psychosocial Research and Epidemiology: Wim van Harten


Wim van Harten, MD., Ph.D. professorGroup leader, Professor

About Wim van Harten


In this group three research themes are covered: Early Health Technology Assessment, Improving Oncology Services and Cancer Rehabilitation.

Early Health Technology Assessment

Increasing healthcare costs, changing demographics, and rapid technological developments in oncology represent some of the most pressing challenges facing health systems today. Addressing these challenges will ensure the sustainability and accessibility of future oncology services. Health technology assessment (HTA) synthesizes the best available clinical and economic evidence to inform policy and coverage decisions for new medicines, diagnostic tools and medical devices. We are now driving the uptake of HTA in earlier stages of the research process to anticipate future technological and environmental developments and to ensure faster access to innovative oncological interventions. We have been able to help drive innovation, from bench to bedside, through forming close collaborations and partnerships with clinicians and scientists throughout the AvL-NKI, nationally and internationally.

The introduction of the 70-gene signature (MammaPrint®) represented one of the first personalized prognostic tools to help guide adjuvant treatment of node negative breast cancer. As the course of development of technologies in early stages of the translational research and diffusion process are not easy to predict, we developed an early-stage, dynamic evaluation approach using constructive technology assessment (CTA). In addition to health economics, the CTA addressed organizational, ethical and patient related issues evaluated during the prospective RASTER-study. Most recently, a cost-effectiveness analysis was performed based on the European RCT MINDACT trial (Dr. Valesca Retèl and Danalyn Byng).

A multi-national effort to accurately select women most likely to benefit from local treatment for ductal carcinoma in situ is currently underway. PhD candidate Danalyn Byng is leading early HTA projects as part of the Grand Challenges UK and KWF-funded PRECISION consortium.

Currently, PhD candidate Melanie Lindenberg also works on a range of early HTA projects such as Image Guided Surgery, coverage with evidence development in TIL-treatment, and the (cost)-effectiveness of robot assisted prostatectomies.

PhD candidate Nora Franzen explores responsible alternatives to unrestricted drug pricing in oncology. She compares proposals to achieve sustainable drug prices in the research and development, intellectual property, and pricing of pharmaceuticals with methods like simulation modeling, lab experiments (game theory), and scenario discovery.

As a consequence of awarding a number of coverage with evidence development ("voorwaardelijke toelating") programs to the AVL, Joost Verbeek has started a PhD project on early HTA. Treatments under assessment by Joost are high-dose chemotherapy for BRCA-1 like breast cancer patients, HIPEC for patients with stomach cancer, and internet-based cognitive behavioural therapy for breast cancer survivors.

Together with the Head and Neck Oncology department, Ann-Jean Beck performs HTA and health economic studies into innovative medical devices and rehabilitation for head and neck cancer patients.

For a nationwide project on "Technology Assessment of Next Generation Sequencing in Personalized Oncology", Valesca Retèl is overall project coordinator and Wim van Harten HTA-coordinator. Within this project, two PhD students (UT, MUMC+) and one postdoc (Amsterdam UMC location Vumc) are working on the four "HTA" work packages, which are spread over the Netherlands.

Dr. Valesca Retèl was appointed Senior Scientist in the NKI in December 2018, with a focus on early stage HTA and to accompany implementation and coverage decisions. She is jointly employed by the University of Twente (Health Services and Technology Research).   

Operations Improvement in Oncology

In cooperation with the University of Twente, a PhD student (Bruno Vieira) works on  mathematical modelling for patient and staff scheduling within the radiotherapy setting. This 5 year project is intended to lead to implementation efforts in at least 5 RT departments/hospitals.

As part of the Eurocan Platform project, we developed a designation system for excellent Comprehensive Cancer Centers. This project has drafted a pilot Excellence Designation System that was be piloted in 2015 and approved and adopted by the European Academy of Cancer Scientists.

Benchmarking is a possibly powerful tool to inform management on improvement options and patients on the quality of services. Between 2013 and 2016  the EU-subsidized project BENCH-CAN (PhD project by Anke Wind) piloted a European benchmarking system on comprehensive cancer care. The Benchmark system was launched at the OECI annual meeting of 2016. Presently, a 2 year follow up postdoc (Anke Wind) project "ABC benchmarking" intends to further validate the methods and expand into relating outcomes to pathway characteristics.

Rehabilitation, Physical Activity and Cancer

Survivorship care and rehabilitation are important elements of a cancer centre's program. For over a decade, we have remained committed to developing innovative rehabilitation programs incorporating the latest research on physical activity.  In 2009, a multidisciplinary rehabilitation program was started for breast cancer survivors receiving adjuvant treatment. In addition, a rehabilitation program for head-and-neck cancer patients has been approved by health insurers and was rolled out beginning of 2010. Finally, a major Alpe d'Huzes KWF project was started early 2011, focusing on patient empowerment, return to work, tele-monitoring and implementation of relevant findings and programs related to physical exercise and supported by innovative IT (the ACARE2 project). This program totaling up to 2.8 million Euro, ran for 6 years. At present, PhD student (Charlotte IJsbrandy) is working on an implementation project aiming to introduce the R&D results from the ACARE2 project in up to 10 Dutch hospitals. The direct supervision is done by R. Hermens PhD, located at IQ HealthCare UMC St Radboud, Nijmegen. Wim van Harten is the first supervisor.

PhD-candidate Hester van de Wiel investigates the effect of an online physical activity intervention, offered as blended care or without supervision of a physical therapist in breast and prostate cancer survivors (the PABLO-trial). This randomized controlled trial (RCT), granted by the Dutch Cancer Society, is conducted in the NKI and Rijnstate Hospital. As one of the Principe Investigators (PI) of the project, Senior Postdoc Wim Groen fulfills the role of daily supervisor.

In collaboration with the UMC Utrecht, Wim Groen (project leader) and Willeke Naaktgeboren (PhD candidate) are working on the Pact-Paces-Heart study. In this study, the potential cardioprotective effect of an exercise intervention during chemotherapy for breast cancer is evaluated with cardiac imaging (MRI and echocardiography) and VO2max testing.   in participants of the previous PACT study (UMC Utrecht) and PACES study (NKI-AVL).


Wim Groenfoto

Dr. Wim Groen

Postdoctoral fellow



Wim was trained as a human movement scientist (VU Amsterdam) and completed his PhD at the University of Utrecht (topic: physical acitivty in hemophilia). In the position of senior postdoc his current research interests are in the area of exercise physiology and -behavior and cancer survivorship. he is leading and conducting several studies on the physical activity and exercise programs for cancer survivors, for which he (co)secured funding. He initiated a state of the art exercise testing facility that is used for measurement of cardiorespiratory fitness for clinical and research purposes.


  • Exercise Physiology
  • Physical activity behaviour
  • E-health
  • Clinical Trials


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Valesca (postdoc)

Valesca Retèl, Ph.D.

Postdoctoral fellow


Valesca Retèl has a PhD degree in Health Economics and a MSc degree in Health Sciences. Currently, she is working as a senior scientist for 50% at the PSOE department and 50% at the University of Twente (department of Health Technology and Services Research (HTSR)). Her research is focused on early Health Technology Assessments regarding amongst others Next Generation Sequencing, Immunotherapy, big data, Image Guided Surgery and cancer survivorship, all in the field of oncology. Some of these projects are part of a Coverage with Evidence Development program, which she coordinates within the NKI-AVL.
Valesca uses mathematical modeling to combine information on besides cost-effectiveness, organizational issues, ethical-legal, and patient related aspects of promising new technologies in early stages of development. In the early stages, broad spectrum scenario drafting is a key element in these early assessments. She currently supervises 9 PhD students.
Nationally, Valesca is project leader of the €1,8M "Technology Assessment of Next Generation sequencing of personalized Oncology" (TANGO) project.
On an international level, she is coordinator of the Cost-benefit working group of the Organization of European Cancer Institutes (OECI)

- Markov modeling
- Constructive Technology Assessment
- Scenario drafting


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Ann -Jean Beck

Ann-Jean Beck



In 2014 Ann-Jean obtained her medical degree at the University of Leiden. She started working as a resident at the Department of Surgery of the BovenIJ Hospital in Amsterdam. In September 2015 Ann-Jean started her PhD project in the NKI-AVL at the Psychosocial and Epidemiology department (PSOE) and Department of Head and Neck Surgery. Her PhD project concerns  a broad Health Technology Assessment (HTA) of the rehabilitation of head and cancer patients in Europe and the US. The project focusses mainly on reimbursement of medical devices, cost-effectiveness analysis of head and neck cancer treatment and rehabilitation modalities, and quality of life of head and neck cancer patients (with special attention to laryngectomy patients). In addition, she works as a resident at the outpatient clinic of the Department of Head and neck Surgery.


  • Health technology assessment
  • Cost-effectiveness analyses
  • Reimbursement issues
  • Head and neck cancer
  • Medical devices
  • Patient access to healthcare
  • Quality of care


Beck A. C. C., Retèl, V. P., van den Brekel, M. W. M., & van Harten, W. H. (2019). Patient access to voice prostheses and heat and moisture exchangers: Factors influencing physician's prescription and reimbursement in eight European countries. Oral oncology, 91, 56-64.

Beck, A. C. C., Passchier, E., Retel, V. P., Stuiver, M. M., van der Molen, L., Klop, W. M., ... & van den Brekel, M. W. (2019). Study protocol of a prospective multicenter study comparing (cost-) effectiveness of a tailored interdisciplinary head and neck rehabilitation program to usual supportive care for patients treated with concomitant chemo-or bioradiotherapy. BMC cancer, 19(1), 655.

Klop, W. M. C., Elshot, Y. S., Beck, A. C. C., Brandsen, R. E., & Lohuis, P. J. (2019). Oncodermatology of the Head and Neck. Facial Plastic Surgery, 35(04), 368-376. h  ttps://

Beck, Ann-Jean CC, et al. "Salivary duct carcinoma: evaluation of treatment and outcome in a tertiary referral institute." European Archives of Oto-Rhino-Laryngology 275.7 (2018): 1885-1892.

Boogerd, L. S., Boonstra, M. C., Beck, A. C.C., Charehbili, A., Hoogstins, C. E., Prevoo, H. A., ... & Vahrmeijer, A. L. (2016). Concordance of folate receptor-α expression between biopsy, primary tumor and metastasis in breast cancer and lung cancer patients. Oncotarget, 7(14), 17442. h ttps://  Concordance_of_folate_receptor-a_expression_between_biopsy_primary_tumor_and_metastasis_in_breast_cancer_and_lung_cancer_patients

Beck, A. C. C., Hagemeijer, A., Tortolani, B., Byrd, B. A., Parekh, A., Datillo, P., & Birkhahn, R. (2015). Comparing an Unstructured Risk Stratification to Published Guidelines in Acute Coronary Syndromes. Western Journal of Emergency Medicine, 16(5), 683.

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529024 Lindenberg Nw

Melanie Lindenberg

Ph.D. student



Melanie finished the master Health Sciences  at the University of Twente (Health Services and Management) after the bachelor Healthcare and Technology (BN) . In September 2015 she started her PhD project "Health Technology Assessments on Early Stage Innovative Technology used in Oncology" which focuses on three main project: a Coverage with Evidence Development (CED) program for Tumor Infiltrating Lymphocytes (TIL) treatment in advanced melanoma (TIL study), the use of image-guided surgical technologies used in oncologic interventions and the evaluation of robot-assisted surgery in prostate cancer (CERA-PRO study). This PhD project aims to conduct (early) Health Technology Assessments in which they will focus on organizational, ethical, societal, clinical, safety, financial and technological issues in order to facilitate the translational process (from bench to bedside) of these technologies.


  • Constructive Technology Assessment
  • Markov Modeling



1: Lindenberg MA, Retèl VP, van den Berg JH, Geukes Foppen MH, Haanen JB, van

Harten WH. Treatment With Tumor-infiltrating Lymphocytes in Advanced Melanoma:

Evaluation of Early Clinical Implementation of an Advanced Therapy Medicinal

Product. J Immunother. 2018 Nov/Dec;41(9):413-425.  doi:10.1097/CJI.0000000000000245. PubMed PMID: 30300260; PubMed Central PMCID: PMC6200372.


2: Lindenberg MA, Miquel-Cases A, Retèl VP, Sonke GS, Wesseling J, Stokkel MPM,

van Harten WH. Imaging performance in guiding response to neoadjuvant therapy

according to breast cancer subtypes: A systematic literature review. Crit Rev

Oncol Hematol. 2017 Apr;112:198-207. doi: 10.1016/j.critrevonc.2017.02.014. Epub

2017 Feb 17. Review. PubMed PMID: 28325260.

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532309 Franzen

Nora Franzen




Nora Franzen has started working at the NKI as a PhD student in September 2017. Her research focuses on the issue of high drug prices in the field of oncology. She is using dynamic simulation modeling to explore quantitatively sustainable and innovative solutions in the intellectual property, pricing, and R&D environment. She combines methods of multi-agent modeling, game theory, decision analysis, and scenario drafting to increase the knowledge of potential outcomes in the political decision making process.

Nora Franzen has obtained an MSc in Health Sciences from Maastricht University and a BA in Public Health from the University of California, Berkeley. Prior to joining the Prof. van Harten group, she has worked for 4 years as an analyst for healthcare systems at McKinsey & Co.


  • Pharmaceutical regulation
  • Drug prices, Dynamic simulation
  • Multi-Agent Modeling
  • Game theory
  • Decision analysis
  • Scenario drafting



1: Franzen N, van Harten WH, Retel VP, Loskill P, van den Eijnden-van Raaij J, IJzerman M. Impact of organ-on-a-chip technology on pharmaceutical R&D costs. Drug Discovery Today.

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Vieira, Bruno Soares (web).jpg

Bruno Vieira




Bruno received a BSc degree in Electrical Engineering and Computer Science in 2011, and a MSc degree in Systems Engineering and Industrial Planning in 2013, both from the Polytechnic Institute of Porto. His research interests are about applying Operations Research (OR) methods to solve complex real-life decision-making problems. After working 2 years in INESC Porto as a research assistant, he started a PhD project (February 2015) called 'Advanced Logistical Optimization of the Radiotherapy Treatment' (ALORT). In cooperation with the University of Twente, he works on the development of mathematical optimization models to study how operations, personnel and equipment can be efficiently coordinated to ensure patient-centeredness and timeliness when delivering radiotherapy. This 5-year project is intended to lead to implementation efforts amongst 5 radiotherapy centers in the Netherlands.


  • Mathematical programming
  • Discrete-event simulation
  • Constructive heuristics and meta-heuristics
  • Statistical analysis
  • Multi-criteria decision making
  • Radiotherapy planning and scheduling


1: Vieira B, Hans EW, van Vliet-Vroegindeweij C, van de KramerJ, van Harten WH. Operations research for resource planning and -use in radiotherapy: a literature review BMC Medical Informatics and Decision Making volume 16, Article number: 149 (2016)

2: Vieira B, Demirtas D, van de Kramer J, Hans EW, van Harten WH. A mathematical programming model for optimizing the staff allocation in radiotherapy under uncertain demand. European Journal of Operational Research. Volume 270, Issue 2, 16 October 2018, Pages 709-722

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Byng, Danalyn

Danalyn Byng




Danalyn Byng is an internationally trained epidemiologist and health services researcher. She began working with the NKI in September 2017. Her research involves various interdisciplinary research projects across the complete translational research chain in Health Technology Assessment (HTA). Working closely with Dr. Retèl, she has analyzed the cost-effectiveness of the 70-gene signature, a gene expression profile for breast cancer. She is also conducting analyses on further clinical applications of the 70-gene signature in using data from the MINDACT RCT. As a collaborator within the Cancer Research UK Grand Challenges-funded multinational PRECISION consortium, Danalyn is responsible for a number of HTA and economic evaluation projects. She is investigating the economic feasibility of implementing active surveillance as an alternative to breast surgery for women with low-risk ductal carcinoma in situ (DCIS).

Danalyn holds an MSc in Epidemiology from the Ludwig Maximilians University of Munich (Germany), specializing in Clinical Epidemiology. She has also completed graduate training in Health Services Research and Pharmacoeconomics at the University of Toronto and McGill University (Canada). She is coming to the NKI with work experience from the academic, governmental, and private sectors.


  • Health technology assessment
  • Cost-effectiveness and budget-impact analyses
  • Economic impact analyses (cost of illness)
  • Biostatistical modeling (survival analysis, regression analysis)
  • Clinical epidemiology
  • Pharmaceutical policy


1: Byng, D., Lutter, J. I., Wacker, M. E., Jörres, R. A., Liu, X., Karrasch, S., Holle, R. (2019). Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET. International Journal of Chronic Obstructive Pulmonary Disease, 14, 1423-1439. doi:10.2147/COPD.S201899

2: Kohler, J. C., Mitsakakis, N., Saadat, F., Byng, D., & Martinez, M. G. (2015). Does Pharmaceutical Pricing Transparency Matter? Examining Brazil's Public Procurement System. Globalization and Health, 11, 34. doi:10.1186/s12992-015-0118-8

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532599 Naaktgeboren

Willeke Naaktgeboren




Willeke Naaktgeboren started working in the NKI in September 2017, after obtaining her MSc degree in Medicine from Utrecht University. Her research interests are physical activity and cardio-oncology, an interdisciplinary field that focuses on optimizing cardiovascular health in cancer patients and survivors. 

Main project during of her PhD is the Pact-Paces-Heart study, a combined project with the Julius Center from the University Medical Center Utrecht (UMCU), in which the potential cardioprotective effects of physical activity during adjuvant chemotherapy in breast cancer patients are assessed.

As part of her training, she participates in an MSc Epidemiology Postgraduate program at Utrecht University.  


  • Cardio-oncology
  • Physical activity


1: Naaktgeboren WR, Linschoten M, de Graeff A, van Rhenen A, Cramer MJ, Asselbergs FW, Maas AHEM, Teske AJ. Long-term cardiovascular health in adult cancer survivors. Maturitas Volume 105, November 2017, Pages 37-45.

2: Teske AJ, Linschoten M, Kamphuis JAM, Naaktgeboren WR, Leiner T, van der Wall E, Kuball J, van Rhenen A, Doevendans PA, Cramer MJ, Asselbergs FW. Cardio-oncology: an overview on outpatient management and future developments. Netherlands Heart Journal. November 2018, Volume 26, Issue 11, PP 521-532. /article/10.1007%2Fs12471-018-1148-7

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534558 Verbeek2

Verbeek, Joost




Joost Verbeek holds a master's degree in Health Sciences and is specialized in the area of Health Technology Assessment. He started working at the NKI as a PhD student in health economics, October 2018. Prior to his PhD, Joost received training in a Hospital-Based Health Technology Assessment unit in Rome and at the Health Services Research department of Maastricht University.

His research at the NKI will focus on bringing (cost)-effective innovations to the patient in an early stage of development by using decision-analytic models, identifying barriers and facilitators for implementation, and conducting scenario analyses. Moreover, he will investigate the role and impact of Coverage with Evidence Development (CED) programs on realizing this goal.

The treatments that will undergo (early) Health Technology Assessments conducted by Joost Verbeek as part of his PhD are high-dose chemotherapy with autologous stem cell transplantation for the treatment of metastatic breast cancer, hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with stomach cancer, and internet-based cognitive behavioural therapy for breast cancer survivors with treatment-induced menopausal symptoms.


  • Decision-analytic modeling
  • Coverage with evidence development
  • Scenario analysis
  • Constructive technology assessment
  • Health services research
  • Health technology assessment
  • Health policy

1: Verbeek JGE, Atema V, Mewes JC, van Leeuwen M, Oldenburg HSA, van Beurden M, Hunter MS, van Harten WH, Aaronson NK, Retèl VP. Cost-utility, cost-effectiveness, and budget impact of Internet-based cognitive behavioral therapy for breast cancer survivors with treatment-induced menopausal symptoms. Breast Cancer Research Treatment, Augustus 2019, pp1-13. doi: 10.1007/s10549-019-05410-w.

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Silhouette _geen _foto _thumb _vrouw _thumb

Kooij, Laura




Laura has a background in Communication Science and received her Master's degree in 2010 from the University of Amsterdam. She started a PhD with the Wim van Harten group in February 2015.  Her research focuses on the development, implementation and evaluation of eHealth and Information Technology (IT) services in health care. Laura conducted a systematic review on the effectiveness of IT-supported shared care and a qualitative study about the barriers and facilitators for patient portal implementation. She is currently leading a number of ongoing projects, including: an RCT on the effects of video consultation on CPAP use for patients with sleep apnea; a feasibility study of a self-management application for patients with COPD; and a study on the effect of tele-monitoring for health care professionals. She is also collaborating on a systematic review on the effects of telehealth applications.

Since February 2018 Laura has been working as Program Manager Information- and Medical Technology Innovations at Rijnstate hospital in Arnhem. From 2010 until 2018 she was working as a senior eHealth advisor and project leader at the NKI-AVL.                       


  • Kooij L, Groen, WG, Van Harten WH. (2017). The effectiveness of information technology-supported shared care for patients with chronic disease: a systematic review. Journal of medical Internet research, 19(6), e221.

  • Kooij L, Groen WG, Van Harten WH. (2018). Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study. Journal of medical Internet research, 20(5), e183.

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Inge Eekhout

Inge Eekhout

Project coordinator / Research assistant


In my career, I have worked several times in the NKI-AVL. Immediately after obtaining my Nurse diploma I went to work in the NKI-AVL at the head / neck and internal department. After working for 5 years, I changed the AVL for the AMC to work on the neonatology department and did the training neonatology. Soon I missed the contact with the oncology patient and the VUMC became my new employer. Through the VUMC food team, I came in contact with Sorgente (specialist in food care at home), where I started as a nurse practitioner (actually specialist nurse) to organize the nursing care. With the emergence of the function of a nursing practitioner, I decided to do this training and I came back to the NKI-AVL. 12.5 years I worked as a nurse practitioner with specialism breast cancer surgery. Within this 12.5 year I was for approximately 4 years coordinator of the MINDACT study, together with Stella Mook. Through the MINDACT study I came in contact with science. After my trip outside the hospital last year as location manager of a private small elderly house, I am back in the NKI-AVL again. Over the next 2 years, I will be a research assistant / project coordinator of the TANGO study where Valesca Retèl as a project manager is working.

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Recent publications View All Publications

  • The impact of organisational external peer review on colorectal cancer treatment and survival in the Netherlands

    (2014) British Journal of Cancer

    Kilsdonk MJ, van Dijk BA, Otter R, Siesling S, van Harten WH.

    Link to Pubmed
  • Assessing excellence in translational cancer research: a consensus based framework

    (2013) Journal of Translational Medicine

    Rajan A, Caldas C, van Luenen H, Saghatchian M, van Harten WH.

    Link to Pubmed


'Research for the benefit of cancer patients'

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