A float from the China Cultural Center in The Hague is seen during the annual Flower Parade of the Bollenstreek in Bennebroek The Netherlands hosted its annual Flower Parade of the Bollenstreek on Saturday featuring dozens of vibrantly decorated floats that attracted crowds lining the streets People watch the annual Flower Parade of the Bollenstreek in Bennebroek A float is seen during the annual Flower Parade of the Bollenstreek in Bennebroek please click the box below to let us know you're not a robot Get the most important global markets news at your fingertips with a Bloomberg.com subscription. Volume 14 - 2023 | https://doi.org/10.3389/fendo.2023.1225734 This article is part of the Research TopicRecent Advances in Pediatric CraniopharyngiomaView all 5 articles with a fifth cystic progression of an adamantinomatous craniopharyngioma after multiple surgeries and previous local radiotherapy panhypopituitarism including diabetes insipidus and several components of hypothalamic damage including morbid obesity and severe fatigue To prevent further late effects hampering her quality of survival she was treated biweekly with intravenous tocilizumab which stabilized the cyst for a prolonged time Based on the biology of adamantinomatous craniopharyngioma this immune-modulating treatment seems promising for the treatment of this cystic tumor in order to reduce surgery and delay or omit radiotherapy We present the case of a 15-year-old girl with multiple cystic progressions of ACP limiting local therapeutic possibilities and describe the results of systemic tocilizumab therapy A 15-year-old girl showed ongoing cystic progression of residual ACP with treatment interventions shown in Figure 1 Her initial presentation was at 11 years of age in the emergency room of a general hospital with severe complaints of headache and vomiting The family history was negative for brain tumors with a decrease in height standard deviation (SD) from 0 SD to −2SD Her psychomotor development was normal with excellent school results without visual impairment or history of ocular abnormalities A CT scan of the brain demonstrated a large suprasellar mass growing into the third ventricle causing biventricular enlargement She developed convulsions and became obtunded She was transferred to the neurosurgery department of a university medical center for release of the hydrocephalus by external ventricular drainage Figure 1 Treatment timeline in a girl with progressive adamantinomatous craniopharyngioma The timeline for treatment interventions for progressieve adamaninomatous craniopharyngioma from 11 till 16,5 years old is shown in the graph Four neurosurgical interventions are shown with arrows while the radiotherapy period is depicted with a lightning bold pictogram The systemic treatment was composed of biweekly 800 mg tocilizumab intravenously Figure 2 Course of craniopharyngioma on MR imaging The MRI at diagnosis performed in a child of 11 years old shows a suprasellar and sellar cystic-solid lesion with calcifications measuring a maximum of 5,2 cm in cranio-caudal direction visible on a sagittal image a T1 3 mm 0,3 gap with gadolinium (A) and on a coronal image T2 TSE 3 mm 0,3 gap (B) consistent with the diagnosis of a craniopharyngeoma After four previous neurosurgical resections a cystic lesion close to the right optic nerve increases up to 1,1 cm visible on a sagittal image after contrast (C) and on the axial image T2 TSE Figure 3 Visual field changes in a patient with cystic craniopharyngioma Visual field of the left eye restricted to the inferionasal kwadrant measured with Goldman method at start of treatment (A) with tocilizumab and at end of treatment (B) The first cystic progression of the craniopharyngioma occurred after 4 months when the MRI showed cysts up to 1.6 cm in diameter No clinical signs occurred; the Lansky score was 80 Growth hormone therapy had not been started yet This cystic progression was the reason to perform local radiotherapy with 54 Gy at the age of 11.5 years The cystic progression re-occurred up to 1.4 × 2.0 × 2.4 cm with a crucial location in the proximity of the chiasm To prevent further deterioration of her severely reduced vision repeated neurosurgical interventions were deemed necessary a transsphenoidal neurosurgical attempt at complete resection was made; however a fibrotic remnant in the left cavernous sinus could not be removed a transcranial third subtotal resection was performed for the recurrent cystic part of the tumor Large amounts of cystic parts of the tumor were removed; however suspected intrasellar tumor remnants could still not be reached a ventriculoperitoneal shunt was placed for complaints of reduced vision due to communicating hydrocephalus without tumor growth the vision improved to her baseline after first surgery a fourth subtotal resection was performed via a combined left transcranial and transsphenoidal approach The tumor was found to be severely adherent to all vascular and nerve structures of the skull base One tumor remnant under the functional left optic nerve was not deemed resectable without harming this optic nerve and possibly causing further visual deterioration; therefore Extensive histopathological analysis of the ACP was performed with the tissue of the latest surgery showing confluent epithelial fields of multilayer and matured squamous epithelial cells with basal palisades and variable degrees of keratinization and focal calcification (Figure 4) The epithelium showed extensive spongiosis with the formation of microcystic regions (stellate reticulum) Whole exome sequencing analysis and RNA sequencing showed a CTNBB1 mutation in exon 3 (c.98CT p.S33F) in 34% of the reads and no relevant mutations in exons 11 and 15 of the BRAF gene Overexpression of FGF3/FGF4 N was detected with a Z-score of 4.004/5.598 compared to the other samples in the database and no mRNA expression of Programmed death-ligand 1 (PD-L1) was observed Figure 4 (A–C) (HE): histological features adamantinomatous craniopharyngioma (A): squamous epithelial tumour with basal palisading of tumour cells (B): prominent calcifications in the cyst wall (arrows) (C): interface of adamantinomatous craniopharyngioma and brain tissue with Rosenthal fibers present in the reactive piloid gliosis surrounding the tumor (arrows and insert) F) (CD68) shows macrophages (arrows) in the cyst wall (E) and around the tumor (F) H) (CD3): T-lymphocytes (arrows) located around and focally (H) within the tumor hypothalamic damage became increasingly apparent as evidenced by morbid obesity with BMI increasing up to 36.5 kg/m2 despite strict dietary regulations her resting energy expenditure was only 51% of the expected value in 2019 She had panhypopituitarism with diabetes insipidus but with adequate thirst regulation She suffered from temperature dysregulation with extreme color changes of the hands and neuropathic pain required treatment with amitriptyline Her sleeping pattern was disturbed with repeated nightly awakenings partially based on the hypothalamic damage in combination with acquired brain injury Lansky score she switched to a school for visually impaired and blind children where she could follow age-appropriate high school with good results The patient and parents experienced no significant negative side effects besides a stiff arm for 1–2 days they experienced that desmopressin for diabetes insipidus seemed less effective within the first 24 h after each treatment day They experienced a further lack of energy during the 9-month treatment already present in her pre-existent medical status since it was uncertain whether the treatment would be effective and how long the treatment would be necessary they are very pleased that the therapy appears to have had an inhibitory impact on the tumor cyst there were four episodes of cystic growth of ACP with maximum intervals of 9 months after each neurosurgical procedure both the residual cystic and solid components of the craniopharyngioma have remained stable with no requirement for further local treatment for almost 3 years until now We suggest that treatment with TCZ has effectively stabilized cystic parts of ACP in our patient and prevent a fifth tumor surgery in this vulnerable and complex suprasellar area; however there was a mild decrease in visual function Future cohort studies on treatment of ACP with TCZ are needed to confirm our experience Our case report illustrates TCZ’s possible effectiveness in interrupting ACP’s repeated cystic growth This phenomenon may offer new insight into the possibility of systemic treatment of cystic ACP Inhibition of this pathway in human and murine ACP tumor tissue ex vivo reduces proliferation and increases apoptosis This may suggest that targeting this pathway can be therapeutic for ACP while PD-L1 and/or PD-1 might be relevant immunotherapeutic targets The strength of this case is that earlier repeated cystic growth was evident and was interrupted successfully The patient had benefitted from 9 months of TCZ treatment and for whom further local interventions have been deferred for almost 3 years since last neurosurgery Lack of treatment data on more patients still remains a major limitation for regular clinical application of tocilizumab in aCP systemic therapy for ACP can be potentially helpful for tumor reduction or stabilization to refrain from further harmful local therapies in progressive disease Future clinical research is necessary to define the duration of therapy and response Clinical trials should also focus to identify which biological subtypes of ACP benefit from the diverse options for targeted systemic therapy The original contributions presented in the study are included in the article/supplementary material Further inquiries can be directed to the corresponding author Written informed consent was obtained from the minor(s)’ legal guardian for the publication of any potentially identifiable images or data included in this article The study was conducted in accordance with the local legislation and institutional requirements All authors listed have made a substantial and intellectual contribution to the work and approved it for publication The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher J Clin Endocrinol Metab (2021) 106:e3820–36 PubMed Abstract | CrossRef Full Text | Google Scholar Contemporary biological insights and clinical management of Craniopharyngioma Excess mortality and morbidity in patients with craniopharyngioma especially in patients with childhood onset: A population-based study in Sweden J Clin Endocrinol Metab (2015) 100:467–74 Hypothalamic-Pituitary outcome after treatment for childhood Craniopharyngioma Childhood craniopharyngioma: Hypothalamus-sparing surgery decreases the risk of obesity J Clin Endocrinol Metab (2013) 98:2376–82 Patterns of care in pediatric Craniopharyngioma: Outcomes following definitive radiotherapy Global pediatric craniopharyngioma management modalities and outcomes CrossRef Full Text | Google Scholar Limited surgery and conformal photon radiation therapy for pediatric craniopharyngioma: Long-term results from the RT1 protocol PubMed Abstract | CrossRef Full Text | Google Scholar High prevalence of long-term cardiovascular neurological and psychosocial morbidity after treatment for craniopharyngioma Clin Endocrinol (Oxf) (2005) 62:197–204 Interferon-alpha and cancer: mechanisms of action and new perspectives of clinical use Mechanisms of type-I- and type-II-interferon-mediated signalling PubMed Abstract | CrossRef Full Text | Google Scholar Craniopharyngiomas: Intratumoral chemotherapy with interferon-alpha: A multicenter preliminary study with 60 cases Intracystic interferon-alpha in pediatric craniopharyngioma patients: An international multicenter assessment on behalf of SIOPE and ISPN Phase II study of peginterferon alpha-2b for patients with unresectable or recurrent craniopharyngiomas: A Pediatric Brain Tumor Consortium report Single-cell RNA sequencing highlights intratumor heterogeneity and intercellular network featured in adamantinomatous craniopharyngioma Tumour compartment transcriptomics demonstrates the activation of inflammatory and odontogenic programmes in human adamantinomatous craniopharyngioma and identifies the MAPK/ERK pathway as a novel therapeutic target Multiplexed immunofluorescence reveals potential PD-1/PD-L1 pathway vulnerabilities in craniopharyngioma Integrated proteogenomic characterization across Major histological types of pediatric brain cancer CD47 promotes the proliferation and migration of adamantinomatous craniopharyngioma cells by activating the MAPK/ERK pathway and CD47 blockade facilitates microglia-mediated phagocytosis Neuropathol Appl Neurobiol (2022) 48:e12795 Targeting IL-6 Is a potential treatment for primary cystic Craniopharyngioma Interleukin−6 induces an epithelial−mesenchymal transition phenotype in human adamantinomatous craniopharyngioma cells and promotes tumor cell migration The role of inflammation in the genesis of the cystic component of craniopharyngiomas Investigating the protein signature of Adamantinomatous Craniopharyngioma pediatric brain tumor tissue: Towards the comprehension of its aggressive behavior Molecular analyses reveal inflammatory mediators in the solid component and cyst fluid of human Adamantinomatous Craniopharyngioma J Neuropathol Exp Neurol (2017) 76:779–88 Epithelial-mesenchymal transition and clinicopathological correlation in craniopharyngioma Immune microenvironment of primary and recurrent Craniopharyngiomas: A study of the differences and clinical significance Interleukin-6 cytokine: An overview of the immune regulation In silico analyses on the comparative potential of therapeutic human monoclonal antibodies against newly emerged SARS-CoV-2 variants bearing mutant spike protein The therapy of autoimmune diseases by anti-interleukin-6 receptor antibody Expert Opin Biol Ther (2005) 5:683–90 Interleukin-6: A masterplayer in the cytokine network PubMed Abstract | CrossRef Full Text | Google Scholar Management of adverse events in young adults and children with acute B-cell lymphoblastic leukemia receiving anti-CD19 chimeric antigen receptor (CAR) T-cell therapy 35. ACTEMRA. Available at: https://clinicaltrials.gov/ct2/show/NCT05233397 (Accessed May 2023) Google Scholar Phase 0 and feasibility single-institution clinical trial of intravenous tociluzimab for adamantinomatous craniopharyngioma Keywords: adamantinomatous craniopharyngioma van Santen HM and Schouten-van Meeteren AYN (2023) Tocilizumab for the fifth progression of cystic childhood craniopharyngioma—a case report Received: 19 May 2023; Accepted: 12 September 2023;Published: 11 October 2023 Copyright © 2023 de Vos-Kerkhof, Buis, Lequin, Bennebroek, Aronica, Hulleman, Zwaveling-Soonawala, van Santen and Schouten-van Meeteren. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Evelien de Vos-Kerkhof, RS5kZXZvc2tlcmtob2ZAcHJpbnNlc21heGltYWNlbnRydW0ubmw= Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish Metrics details and cancer-related fatigue are prevalent symptoms among cancer survivors adversely affecting patients’ quality of life and daily functioning Effect sizes of interventions targeting these symptoms are mostly small to medium Personalizing treatment is assumed to improve efficacy thus far the empirical support for this approach is lacking The aim of this study is to investigate if systematically personalized cognitive behavioral therapy is more efficacious than standard cognitive behavioral therapy in cancer survivors with moderate to severe fear of cancer recurrence multicenter randomized controlled trial with two treatment arms (ratio 1:1): (a) systematically personalized cognitive behavioral therapy and (b) standard cognitive behavioral therapy patients receive an evidence-based diagnosis-specific treatment protocol for fear of cancer recurrence treatment is personalized on four dimensions: (a) the allocation of treatment modules based on ecological momentary assessments (c) patients’ needs regarding the symptom for which they want to receive treatment 190 cancer survivors who experience one or more of the targeted symptoms and ended their medical treatment with curative intent at least 6 months to a maximum of 5 years ago will be included Primary outcome is limitations in daily functioning Secondary outcomes are level of fear of cancer recurrence Participants are assessed at baseline (T0) and after 6 months (T1) and 12 months (T2) this is the first randomized controlled trial comparing the efficacy of personalized cognitive behavioral therapy to standard cognitive behavioral therapy in cancer survivors The study has several innovative characteristics among which is the personalization of interventions on several dimensions the results of this study provide a first step in developing an evidence-based framework for personalizing therapies in a systematic and replicable way The Dutch Trial Register (NTR) NL7481 (NTR7723) in which a CBT program was tailored by using diagnostic profiles in patients with cancer-related pain showed greater improvement in patients receiving personalized CBT immediately after treatment 1 month after treatment and at 6 months follow-up To determine if personalized CBT has added value over standard CBT more studies are needed in which a head-to-head comparison is made we compare the efficacy of personalized CBT to standard CBT in cancer survivors with moderate to severe fear of cancer recurrence depressive symptoms and/or cancer-related fatigue CBT can be personalized in several ways and on various dimensions CBT is personalized on multiple dimensions in order to create maximal contrast between personalized and standard CBT: (1) the allocation of treatment modules based on ecological momentary assessments (3) patients’ needs regarding the symptom for which they want to receive treatment these dimensions are described in more detail EMA delivers personalized and contextualized information EMA is suited for systematically personalizing interventions and adjusting treatment on an individual level As the specific maintaining factors in a specific individual can be identified and targeted the associated treatment modules can be more confidently assigned to the patient This level could be determined by both the patient and the therapist for example by evaluating to what extent goals have been reached or by evaluating the progress that has been made Treatment duration and/or focus of treatment could be adjusted accordingly The aim of this study is to investigate if personalized CBT is more efficacious than standard CBT in cancer survivors with moderate to severe fear of cancer recurrence Secondary outcomes are symptoms of fear of cancer recurrence and cancer-related fatigue; quality of life; goal attainment; drop-out rates; and therapist time needed for treatment delivery in this study defined as an intervention tailored to characteristics and needs of the individual patient will lead to fewer limitations in daily functioning than standard CBT We also expect that personalized CBT will lead to less symptoms of fear of cancer recurrence and cancer-related fatigue; better quality of life; higher goal attainment scores; and lower drop-out rates than standard CBT we hypothesize that personalized CBT will not increase the time spent by therapists to deliver the intervention Patients are referred for participation in this study via their treating physician or via self-referral Patients are recruited by medical professionals (physicians and nurses) at the outpatient cancer clinics of four academic hospitals and four general hospitals in the Netherlands Medical professionals verbally inform eligible patients about the study during regular medical follow-up consultations If a patient agrees to be contacted by the researcher for further information about the study the medical professional sends the contact information to the researcher The researcher calls the patient to give a detailed explanation about the study and addresses questions An information package is sent by mail to the patient Patients are asked to sign and return the informed consent form in order to participate in the study Patients are also recruited through a psycho-oncological mental health care center (Helen Dowling Institute Bilthoven) and a tertiary treatment center for chronic fatigue (Nederlands Kenniscentrum voor Chronische Vermoeidheid Eligible patients are identified and informed about the study by employees of the two centers If a patient agrees to be informed about the study by the researcher the aforementioned procedure for referral and obtaining informed consent is followed Patients are also informed about the study by leaflets and notifications on social media of cancer patient associations in the Netherlands Interested patients can contact the research team by phone or e-mail the researcher contacts patients by phone to inform them about the study and to address questions Patients are asked to sign and return the informed consent form after a reflection period of 7 days in order to participate in the study The research team also checks if the patient is currently receiving psychological or psychiatric treatment The research team verifies the patient’s most burdensome symptom for which he/she would like to receive psychological treatment in the study In case patients score below the cutoff score on the corresponding symptom questionnaire (e.g. fatigue) but above the cutoff on one or both of the other two symptoms (e.g. patients are informed about this and provided with the option of receiving treatment for the latter symptom and follow-up assessments (T1 and T2) online Participants are randomized after completing all questionnaires at screening and baseline (T0) preventing missing data at these important moments the therapists announce the first follow-up assessment to participants at the end of treatment The research assistant also contacts the participants by email or phone to introduce the last follow-up assessment participants will be contacted by email or phone by the research assistant if they have not completed the questionnaires within 1 week Personal data will be handled confidentially and in a coded way and comply with the Dutch Personal Data Protection Act (in Dutch: De Wet Bescherming Persoonsgegevens Patient identification will be coded for all study procedures Only researchers directly involved in the project are allowed to access the codes and participant data Codes and participant data will be stored in password-protected files the key to the code will be safeguarded by the coordinating investigator Data will be stored by the Department of Medical Psychology of Amsterdam UMC location AMC for 15 years following completion of the project Professional secrecy and confidentiality will be maintained at all times are entered in an electronic case report file (eCRF) This study will be subject to on-site monitoring in accordance with the quality assurance advice of the Netherlands Federation of University Medical Centres (NFU) regarding research involving human subjects On-site monitoring will be based on the risk-classification (negligible) At the time of our approval of the Medical Ethics Committee it was established that due to the low risk of our study a data monitoring committee was not needed The research team will submit a summary of the progress of the trial to the Medical Ethics Committee of Amsterdam UMC Information will be provided on the date of inclusion of the first subject numbers of subjects included and numbers of subjects that have completed the trial serious adverse events/ serious adverse reactions As severity and type of psychological symptoms in this study will differ among patients (fear of cancer recurrence cancer-related fatigue) and mere presence of psychological symptoms is not an indicator for psychological treatment limitations in daily functioning are the primary outcome of this study The SIP-8 total score is measured at baseline (T0) The mean difference on the SIP-8 (total score) from T0 to T1 and T2 is compared between both groups The mean difference of fatigue severity (total score on subscale) from T0 to T1 and T2 is compared between both groups The mean difference on the BDI-PC (total score) from T0 to T1 is T2 is compared between both groups Fear of cancer recurrence is measured at T0 The mean difference on the CWS (total score) from T0 to T1 and T2 is compared between both groups The mean difference on the EORTC QLQ-C30 version 3.0 (total score) from T0 to T1 and T2 is compared between both groups This assessment method is included as it concerns a personalized outcome measurement in which treatment is evaluated based on outcomes specifically relevant and important to the individual patient Goal attainment is measured at the end of treatment the mean score is compared between both groups Therapists register their time spent on each patient during treatment registration time in the patient data files (summarizing session) and time needed to formulate e-consults or feedback in Internet-based or blended therapy Therapist time is assessed after end of treatment the average time is compared between both groups Drop-out rates are collected for both treatment arms a drop-out is defined as patients who discontinue the intervention before the planned end of the intervention Patients’ reasons for discontinuing the intervention or declining to fill out follow-up questionnaires will be collected Drop-out rates at T1 and T2 are compared between both groups The following data is extracted from patients’ medical files: cancer diagnosis After completion of the baseline assessment each patient is randomly assigned by the researcher (SH) or research assistant who both are not involved in patient treatment to either the personalized or standard treatment arm we use a variable block randomization model of an electronic data capture system (Castor EDC) with a 1:1 allocation using variable block sizes of 4 Stratification by treatment center and referral type is applied Participants and therapists are blinded for the randomization process Statistical analysis will be done by a statistician blinded for randomization outcome 3 treatment centers and 7 therapists participated These therapists were randomly allocated to either the personalized treatment arm or the standard treatment arm as every participating center needed at least one therapist for the standard treatment arm and one therapist for the personalized treatment arm we took years of work experience into account to reach an equal distribution of work experience between the two groups as possible (more and less experienced) We divided the 7 therapists (anonymized) in two groups (group A and B) before the randomization taking the two factors mentioned above into account (treatment center and work experience) The toss of a coin by an independent researcher determined which group was the intervention group and the control group more treatment centers and therapists were added to the study To keep an equal distribution of work experience between the two groups and always have one therapist in the personalized treatment arm and one therapist in the standard treatment arm per center therapists were added to a group based on the distribution as established at the start of inclusion If a therapist went with maternity leave or stopped participating in the study because of a new job a new therapist was trained to replace him or her patients receive a personalized version of one of the evidence-based diagnosis-specific treatment protocols Treatment is systematically personalized on four dimensions: Most burdensome symptom: the goal of this dimension of personalization is to explicitly discuss with the patient from which symptom the patient experiences the most burden and for which symptom the patient would like to receive treatment Patients can receive treatment for a symptom if they score above the predetermined cutoff on the corresponding symptom questionnaire it is decided based on the preference of the patient which treatment protocol to start Treatment delivery: patients choose for either face-to-face the psychologist asks the patient what he or she prefers Treatment modules: specific factors that maintain the treated symptom in a specific individual are identified with EMA The identified maintaining factor(s) correspond(s) to different treatment modules of the protocol the most relevant treatment modules are selected for the patient This procedure is further explained in the section “Ecological momentary assessments (EMA).” Therapists are trained in the treatment protocols by experienced clinical psychologists Adherence to intervention protocols and treatment integrity will be evaluated with registration forms on which therapists register which treatment components were discussed during each treatment session as well as the time they spent on each session The supervision sessions in group format will also improve treatment integrity as cases are discussed in the presence of the same experienced clinical psychologists who provided the training drop-outs from the intervention are registered In addition, the secure web-based environment in which patients receive blended or online treatment was developed (Minddistrict; www.minddistrict.com) The format of existing online therapies was adapted for this specific study A master’s degree in Psychology and clinical experience as a therapist are two minimum requirements for participating as a therapist in the study All participating therapists are trained in working with the treatment protocols (total of 5 training days) and with the online environment therapists allocated to the intervention group are separately trained in working with the four dimensions of personalization in the treatment protocol all therapists (in both groups) receive group supervision by experienced clinical psychologists by phone or video-calls every 2 weeks therapists from the intervention group have supervision sessions separate from the therapists from the control group For the EMA assessments, an existing online electronic diary system is used, designed to monitor patients in their natural environment (http://roqua.nl) Assessments are prompted five times a day for fourteen consecutive days (E0 and E1) The exact time points are adapted to patients’ sleep-wake schedule Patients receive a text message on their smartphone with a link to a questionnaire They are asked to fill out the questionnaire immediately after the alert If the patient does not complete the questionnaire within 30 min after the alert the questionnaire can no longer be accessed It takes approximately 2 min to complete the questionnaire and it is not possible to skip questions Every treatment protocol was divided into multiple modules, based on the maintaining factors these modules aim at. Table 4 presents the individual modules and targeted maintaining factors based on previous EMA surveys where possible traditional surveys that measured the maintaining factor in which case the wording of the question was adjusted to reflect the nature of EMA with one or more questions linked to each of the modules and corresponding maintaining factors The initial set of EMA questions was piloted by a small group of researchers and patients (n=4) and adjusted according to the feedback The psychometric properties of these questionnaires were found to be sufficient Descriptive statistics will be used to describe baseline characteristics of the experimental and control group and a chi-square test or independent t-test will be used to compare baseline characteristics of dropouts and completers in the total sample Intention to treat analyses will be conducted all randomized patients are included and are analyzed in their randomly assigned treatment group linear mixed-model analyses will be performed to evaluate changes in patient functioning from baseline to 6 and 12 months of follow-up (T1 and T2) and differences therein between the experimental group and the control group and a group × time interaction will be added to the model (as fixed effects) to test for differences between the groups in treatment effects over time a random intercept will be used to allow individuals to differ in the level of their outcome variables Treatment center and manner of referral (self-referral versus referral by treating doctor) will be used as covariates Based on pooled pre-test standard deviations effect sizes will be calculated for the estimated differences between T0 A significance level of p<0.05 is used in all analyses Since linear mixed model analysis can handle missing observations due to dropout (assuming data are missing at random) imputation of missing values will not be needed patterns of missing data will be explored and predictors of missing data analyzed If the primary analysis shows significant effects of personalized CBT additional sensitivity analyses will be conducted using different assumptions about the value of missing values Statistical analyses will be performed using SPSS 24.0 The statistical procedure as described above will also be followed for secondary study parameters (fatigue fear of cancer recurrence and quality of life) without the sensitivity analyses The independent t-test will be used to analyze differences between both groups with respect to goal attainment and therapist time Power analyses for MANOVA were conducted with G*power 3.1.9.2 We want to be able to demonstrate an effect size of 0.25 (partial eta squared) on the primary outcome while setting the alpha = 0.05 (two tailed) and power = 0.80 With two groups and three measurements each Taking into account a dropout rate of approximately 20% a sample size of 190 (95 patients per condition) will be included at baseline this is the first study comparing the efficacy of personalized CBT to standard CBT in cancer survivors with moderate to severe fear of cancer recurrence personalized CBT was compared to a wait list group or another intervention such as a psycho-education To determine if and the extent to which personalized CBT has added value over standard CBT in cancer survivors more studies with a head-to-head comparison are needed we decided to personalize CBT on multiple dimensions to maximize the contrast between personalized CBT and standard CBT we further concretize how EMA can be used for personalizing psychological treatment in clinical practice by presenting care providers with prospective information on patients’ psychological symptom patterns Individual symptom patterns over time will be identified and thereby the factors that maintain symptoms in specific individuals The use in clinical practice is promising and a logical next step but is also new and innovation comes with vulnerabilities as a result of which no valid EMA models can be formed we solved this potential problem by having questionnaires as a back-up the presence of a maintaining factor identified with a questionnaire does not automatically imply that the factor influences symptom level EMA seems the most desirable approach to determine the maintaining factors which subsequently inform the direction for treatment The current study will provide additional information on the needed treatment duration in personalized CBT compared to standard CBT and on the extent to which treatment duration differs within the personalized CBT group Although we will not conduct cost effectiveness analyses we will have an indication of the costs by therapist time and number of treatment sessions The explicitly operationalized personalization dimensions in this study have the potential to provide the first step in developing this kind of framework Recruitment of participants for this study started in February 2019 and is scheduled to finish in June 2022 The dataset belonging to this study is not available yet Krebber AM, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23(2):121–30. https://doi.org/10.1002/pon.3409 Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300–22. https://doi.org/10.1007/s11764-013-0272-z Servaes P, Verhagen C, Bleijenberg G. Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer. 2002;38(1):27–43. https://doi.org/10.1016/S0959-8049(01)00332-X Abrahams HJ, Gielissen MF, Schmits IC, Verhagen CA, Rovers MM, Knoop H. Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol. 2016;27(6):965–74. https://doi.org/10.1093/annonc/mdw099 Mehnert A, Brahler E, Faller H, Harter M, Keller M, Schulz H, et al. Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol. 2014;32(31):3540–6. https://doi.org/10.1200/JCO.2014.56.0086 Brown LF, Kroenke K. Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics. 2009;50(5):440–7. https://doi.org/10.1016/S0033-3182(09)70835-7 Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, et al. Effect of psychological intervention on fear of cancer recurrence: a systematic review and meta-analysis. J Clin Oncol. 2019;37(31):2899–915. https://doi.org/10.1200/JCO.19.00572 Osborn RL, Demoncada AC, Feuerstein M. Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med. 2006;36(1):13–34. https://doi.org/10.2190/EUFN-RV1K-Y3TR-FK0L The effectiveness of psychological interventions for fatigue in cancer survivors: systematic review of randomised controlled trials Serfaty M, King M, Nazareth I, Moorey S, Aspden T, Mannix K, et al. Effectiveness of cognitive–behavioural therapy for depression in advanced cancer: CanTalk randomised controlled trial. Br J Psychiatry. 2019;216(4):213–21. https://doi.org/10.1192/bjp.2019.207 Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol. 2013;31(6):782–93. https://doi.org/10.1200/JCO.2011.40.8922 Brebach R, Sharpe L, Costa DS, Rhodes P, Butow P. Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psychooncology. 2016;25(8):882–90. https://doi.org/10.1002/pon.4099 van Beugen S, Ferwerda M, Hoeve D, Rovers MM, Spillekom-van Koulil S, van Middendorp H, et al. Internet-based cognitive behavioral therapy for patients with chronic somatic conditions: a meta-analytic review. J Med Internet Res. 2014;16(3):e88. https://doi.org/10.2196/jmir.2777 Krebber AM, Jansen F, Witte BI, Cuijpers P, de Bree R, Becker-Commissaris A, et al. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized, controlled trial. Ann Oncol. 2016;27(9):1754–60. https://doi.org/10.1093/annonc/mdw230 Visie psychosociale oncologische zorg op maat - kansen en knelpunten; 2014 Chambers SK, Ritterband LM, Thorndike F, Nielsen L, Aitken JF, Clutton S, et al. Web-delivered cognitive behavioral therapy for distressed cancer patients: randomized controlled trial. J Med Internet Res. 2018;20(1):e42. https://doi.org/10.2196/jmir.8850 Dalton JA, Keefe FJ, Carlson J, Youngblood R. Tailoring cognitive-behavioral treatment for cancer pain. Pain Manag Nursing. 2004;5(1):3–18. https://doi.org/10.1016/S1524-9042(03)00027-4 Greer JA, Jacobs J, Pensak N, MacDonald JJ, Fuh CX, Perez GK, et al. Randomized trial of a tailored cognitive-behavioral therapy mobile application for anxiety in patients with incurable cancer. Oncologist. 2019;24(8):1111–20. https://doi.org/10.1634/theoncologist.2018-0536 Kyriazakos S, Valentini V, Cesario A, Zachariae R. FORECAST - A cloud-based personalized intelligent virtual coaching platform for the well-being of cancer patients. Clin Transl Radiat Oncol. 2018;8:50–9. https://doi.org/10.1016/j.ctro.2017.11.006 Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-Carnahan L, Baum LD. Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology. 2012;21(7):695–705. https://doi.org/10.1002/pon.1969 Semple CJ, Dunwoody L, Kernohan WG, McCaughan E. Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer. Support Care Cancer. 2009;17(4):379–88. https://doi.org/10.1007/s00520-008-0480-7 van Helmondt SJ, van der Lee ML, van Woezik RAM, Lodder P, de Vries J. No effect of CBT-based online self-help training to reduce fear of cancer recurrence: First results of the CAREST multicenter randomized controlled trial. Psychooncology. 2020;29(1):86–97. https://doi.org/10.1002/pon.5233 Willems RA, Bolman CA, Mesters I, Kanera IM, Beaulen AA, Lechner L. Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial. Psychooncology. 2017;26(2):222–30. https://doi.org/10.1002/pon.4113 Ng MY, Weisz JR. Annual Research Review: Building a science of personalized intervention for youth mental health. J Child Psychol Psychiatry. 2016;57(3):216–36. https://doi.org/10.1111/jcpp.12470 Wentzel J, van der Vaart R, Bohlmeijer ET, van Gemert-Pijnen JE. Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care. JMIR Ment Health. 2016;3(1):e9. https://doi.org/10.2196/mental.4534 Dekker J, Braamse A, Schuurhuizen C, Beekman ATF, van Linde M, Sprangers MAG, et al. Distress in patients with cancer - on the need to distinguish between adaptive and maladaptive emotional responses. Acta Oncol. 2017;56(7):1026–9. https://doi.org/10.1080/0284186X.2017.1280848 van Scheppingen C, Schroevers MJ, Smink A, van der Linden YM, Mul VE, Langendijk JA, et al. Does screening for distress efficiently uncover meetable unmet needs in cancer patients? Psychooncology. 2011;20(6):655–63. https://doi.org/10.1002/pon.1939 Braamse AM, van Meijel B, Visser O, Huijgens PC, Beekman AT, Dekker J. Distress, problems and supportive care needs of patients treated with auto- or allo-SCT. Bone Marrow Transplant. 2014;49(2):292–8. https://doi.org/10.1038/bmt.2013.155 Stiles WB, Barkham M, Connell J, Mellor-Clark J. Responsive regulation of treatment duration in routine practice in United Kingdom primary care settings: replication in a larger sample. J Consult Clin Psychol. 2008;76(2):298–305. https://doi.org/10.1037/0022-006X.76.2.298 Barkham M, Connell J, Stiles WB, Miles JN, Margison F, Evans C, et al. Dose-effect relations and responsive regulation of treatment duration: the good enough level. J Consult Clin Psychol. 2006;74(1):160–7. https://doi.org/10.1037/0022-006X.74.1.160 Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346(jan08 15):e7586. https://doi.org/10.1136/bmj.e7586 Vercoulen JH, Swanink CM, Fennis JM, Galama JM, van der Meer JW, Bleijenberg G. Dimensional assessment of chronic fatigue syndrom. J Psvchosomotic Res. 1994;38(5):383–92. https://doi.org/10.1016/0022-3999(94)90099-X Beck AT, Guth D, Steer RA, Ball R. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Behav Res Ther. 1997;35(8):785–91. https://doi.org/10.1016/S0005-7967(97)00025-9 Steer RA, Cavalieri TA, Leonard DM, Beck AT. Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders. Gen Hosp Psychiat. 1999;21(2):106–11. https://doi.org/10.1016/S0163-8343(98)00070-X Custers JAE, Kwakkenbos L, van de Wal M, Prins JB, Thewes B. Re-validation and screening capacity of the 6-item version of the Cancer Worry Scale. Psychooncology. 2018;27(11):2609–15. https://doi.org/10.1002/pon.4782 Mundt JC, Marks IM, Greist JH, Shear K. The Work and Social Adjustment Cale: A simple accurate measure of impairment in functioning. Br J Psychiatry. 2002;180(5):461–4. https://doi.org/10.1192/bjp.180.5.461 Mataix-Cols D, Cowley AJ, Hankins M, Schneider A, Bachofen M, Kenwright M, et al. Reliability and validity of the work and social adjustment scale in phobic disorders. Compr Psychiatry. 2005;46(3):223–8. https://doi.org/10.1016/j.comppsych.2004.08.007 Graham L, Wikman A. Toward improved survivorship: supportive care needs of esophageal cancer patients, a literature review. Dis Esophagus. 2016;29(8):1081–9. https://doi.org/10.1111/dote.12424 Kim R, Son KL, Lee KM, Choi Y, Hong J, Shin DY, et al. Temporal trajectory of quality of life and its predictors in recipients of hematopoietic stem cell transplantation. Ann Hematol. 2018;97(8):1407–15. https://doi.org/10.1007/s00277-018-3319-4 Castor EDC. Castor Electronic Data Capture 2019 [27 Aug. 2019]. Available from: https://castoredc.com Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981;19(8):787–805. https://doi.org/10.1097/00005650-198108000-00001 de Bruin AF, de Witte LP, Stevens F, Diederiks JP. Sickness Impact Profile: the state of the art of a generic functional status measure. Soc Sci Med. 1992;35(8):1003–14. https://doi.org/10.1016/0277-9536(92)90240-Q Beurskens AJ, Bultmann U, Kant I, Vercoulen JH, Bleijenberg G, Swaen GM. Fatigue amon working people: validity of a questionnaire measure. Occup Environ Med. 2000;57(5):353–7. https://doi.org/10.1136/oem.57.5.353 Moran PJ, Mohr DC. The validity of Beck Depression Inventory and Hamilton Rating Scale for Depression items in the assessment of depression among patients with multiple sclerosis. J Behav Med. 2005;28(1):35–41. https://doi.org/10.1007/s10865-005-2561-0 Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009;23(4):362–70. https://doi.org/10.1177/0269215508101742 Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, et al. Randomized trial of ConquerFear: a novel, theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066–77. https://doi.org/10.1200/JCO.2017.73.1257 Protocollaire behandelingen voor volwassenen met psychische klachten van der Krieke L, Emerencia AC, Bos EH, Rosmalen JG, Riese H, Aiello M, et al. Ecological momentary assessments and automated time series analysis to promote tailored health care: a proof-of-principle study. JMIR Res Protoc. 2015;4(3):e100. https://doi.org/10.2196/resprot.4000 Brandt PT, Williams JT. Multiple time series models. Thousand Oaks: Sage Publications; 2007. https://doi.org/10.4135/9781412985215 Emerencia AC, van der Krieke L, Bos EH, de Jonge P, Petkov N, Aiello M. Automating vector autoregression on electronic patient diary data. IEEE J Biomed Health Inform. 2016;20(2):631–43. https://doi.org/10.1109/JBHI.2015.2402280 Honaker J, King G, Blackwell M. Amelia II: A Program for Missing Data. J Stat Softw. 2011;45(7):1–47. https://doi.org/10.18637/jss.v045.i07 Krieke LV, Jeronimus BF, Blaauw FJ, Wanders RB, Emerencia AC, Schenk HM, et al. HowNutsAreTheDutch (HoeGekIsNL): a crowdsourcing study of mental symptoms and strengths. Int J Methods Psychiatr Res. 2016;25(2):123–44. https://doi.org/10.1002/mpr.1495 van Helmondt SJ, van der Lee ML, de Vries J. Translation and validation of the Dutch version of the Fear of Cancer Recurrence Inventory (FCRI-NL). J Psychosom Res. 2017;102:21–8. https://doi.org/10.1016/j.jpsychores.2017.09.001 Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). J Psychosom Res. 1999;46(5):437–43. https://doi.org/10.1016/S0022-3999(99)00004-5 Nederlands Tijdschrift voor de Psychologie Servaes P, Verhagen S, Bleijenberg G. Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol. 2002;13(4):589–98. https://doi.org/10.1093/annonc/mdf082 Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. The Lancet. 2001;357(9259):841–7. https://doi.org/10.1016/S0140-6736(00)04198-2 Ray C, Weir W, Stewart D, Miller P, Hyde G. Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire. Soc Sci Med. 1993;37(3):385–91. https://doi.org/10.1016/0277-9536(93)90268-9 Andrykowski MA, Donovan KA, Laronga C, Jacobsen PB. Prevalence, predictors, and characteristics of off-treatment fatigue in breast cancer survivors. Cancer. 2010;116(24):5740–8. https://doi.org/10.1002/cncr.25294 Jacobsen PB, Andrykowski MA, Thors CL. Relationship of catastrophizing to fatigue among women receiving treatment for breast cancer. J Consult Clin Psychol. 2004;72(2):355–61. https://doi.org/10.1037/0022-006X.72.2.355 Gielissen MF, Verhagen CA, Bleijenberg G. Cognitive behaviour therapy for fatigued cancer survivors: long-term follow-up. Br J Cancer. 2007;97(5):612–8. https://doi.org/10.1038/sj.bjc.6603899 Het meten van sociale steun met de Sociale Steun Lijst-Interacties (SLL-I) en Sociale Steun Lijst–Discrepanties (SSL-D): een handleiding Groningen: Noordelijk Centrum voor Gezondheidsvraagstukken (NCGv) Guo Y, Logan HL, Glueck DH, Muller KE. Selecting a sample size for studies with repeated measures. BMC Med Res Methodol. 2013;13(1):100. https://doi.org/10.1186/1471-2288-13-100 Ghaderi A. Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) cognitive behavior therapy for bulimia nervosa. Behav Res Ther. 2006;44(2):273–88. https://doi.org/10.1016/j.brat.2005.02.004 Berger T, Boettcher J, Caspar F. Internet-based guided self-help for several anxiety disorders: a randomized controlled trial comparing a tailored with a standardized disorder-specific approach. Psychotherapy (Chic). 2014;51(2):207–19. https://doi.org/10.1037/a0032527 Kerns RD, Burns JW, Shulman M, Jensen MP, Nielson WR, Czlapinski R, et al. Can we improve cognitive-behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy. Health Psychol. 2014;33(9):938–47. https://doi.org/10.1037/a0034406 Collins LM, Murphy SA, Strecher V. The Multiphase Optimization Strategy (MOST) and the Sequential Multiple Assignment Randomized Trial (SMART) - new methods for more potent eHealth interventions. Am J Prev Med. 2007;32(5):S112–S8. https://doi.org/10.1016/j.amepre.2007.01.022 van Os J, Verhagen S, Marsman A, Peeters F, Bak M, Marcelis M, et al. The experience sampling method as an mHealth tool to support self-monitoring, self-insight, and personalized health care in clinical practice. Depress Anxiety. 2017;34(6):481–93. https://doi.org/10.1002/da.22647 Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: a randomized clinical trial Kazdin AE. Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. Am Psychol. 2008;63(3):146–59. https://doi.org/10.1037/0003-066X.63.3.146 Download references The sponsor of this study is Amsterdam University Medical Center Other participating hospitals and centers are as follows: Amsterdam University Medical Center VU University; Leiden University Medical Center; Utrecht University Medical Center; Flevoziekenhuis; Hospital Amstelland; Helen Dowling Institute; Expert Center for Chronic Fatigue; VieCuri Medical Center; and Rijnstate Hospital We would like to thank the Conquer Fear Authorship group for making available the content for the FCR treatment This study is funded by the Dutch Cancer Society (Project number: 11351) The Dutch Cancer Society will not be involved in the analysis and interpretation of data or in deciding to submit manuscripts for publication Results of this study will be disseminated regardless of the magnitude or direction of the effect Amsterdam Public Health Research Institute Faculty of Behavioural and Social Sciences Department of Medical and Clinical Psychology Center of Research on Psychological and Somatic disorders (CoRPS) Tilburg University Tilburg School of Social and Behavioral Sciences Neuro and Developmental Psychology & Amsterdam Public Health Research Institute SH is the coordinating researcher and responsible for recruitment and LS designed and provided the training for participating therapists and SW have contributed to study conception and design and SB designed the EMA procedure and analyses All authors have read and edited the manuscript The study protocol has been approved by the Medical Ethics Committee of Amsterdam UMC All study protocol amendments have been (1-6) or will be reviewed and approved by the Medical Ethics Committee of Amsterdam UMC All participating hospitals require site-specific approval before opening to patient recruitment All participants have to sign a written informed consent from to participate in the study Participants will be informed that they are free to end study participation at any time without consequence To all eligible participants will be explained that individual details will be de-identified and stored in password-protected files only accessible by the research team Participants will be informed that collected data will be intended for publication The authors declare that they have no competing interests Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations unless otherwise stated in a credit line to the data Download citation DOI: https://doi.org/10.1186/s13063-021-05657-z Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article and opaque tights — get inspired to leave the bedroom in full glam with this beauty-meets-fashion editorial from our Summer 24 issue Jeske wears top and skirt WE11DONE; gloves C’EST JEANNE; tights OROBLU; shoes EVA MARIE LOUISE Make-up: Mac Face and Body; Byredo eyeshadow 5 Colours Syrene; Dior Backstage Palette Amber Neutrals Left: Jenn wears dress RVDK RONALD VANDER KEMP; shorts EVA MARIE LOUISE; shoes YUME YUME Make-up: Mac Face and Body; Byredo eyeshadow; Makeup Forever lip liner Full Red 714; Mac Cosmetics Pro Concealer Palette in Light Right: Make-up: Mac face and body; Makeup forever lip liner in 606 Wherever walnut; Fenty Beauty glossbomb Glass slipper; Pretty little glow lip liner nr2 Left: Jenn wears shirt DREAMING ELI; Make-up: Mac Face and Body; Byredo eyeshadow; Makeup Forever lip liner Full Red 714; Mac Cosmetics Pro Concealer Palette in Light Right: Make-up: Makeup Forever lip liner Full Red 714; Mac Cosmetics Pro Concealer Palette in Light Left: Jeske wears top JEAN PAUL GAULTIER; dress ANIYE RECORDS; purse LA MANSO; earrings SUOT STUDIO; Make-up: Mac Face and Body; Byredo eyeshadow 5 Colours Syrene; Dior Backstage Palette Amber Neutrals Pre-order the issue here. View upcoming auction estimates and receive personalized email alerts for the artists you follow Following the major donation in 2018 by art collector Els Blokker-Verwer Singer Laren has once again received a substantial art collection