Quality of care for pancreatic cancer patients, with focus on the elderly

This thesis studies quality of care for patients diagnosed with pancreatic (or periampullary) carcinoma in the Netherlands, using nationwide data in the Netherlands Cancer Registry. Adherence to the national guideline recommendations on surgical and chemotherapeutical treatments are studied, as well as aspects of organisation of care (e.g. multidisciplinary discussion). The centralisation process of pancreatic surgery for cancer is studied at a regional and a national level, following mutual agreements (bottom-up) and a volume standard (top-down), respectively. Furthermore, the well-established volume-outcome relationship after pancreatic resection was also studied at time of surgical exploration with curative intent and after surgery without resection of the primary tumour.
In this era of an aging population, an increasing number of elderly persons is diagnosed with pancreatic cancer. Unfortunately, elderly patients are underrepresented in studies on which the evidence in guidelines is based. Objective information is needed about their short- and long-term benefits and risks compared to younger patients. In this thesis, multiple elderly age groups were distinguished above 70 years of age and nationwide trends in surgical and systemic treatment are described, as well as short-term mortality and long-term survival after treatment.