Pancreatic cancer treatment A multidisciplinary study towards an evidence-based and patient-centered approach

This doctoral thesis provides a comprehensive exploration of pancreatic cancer, integrating population-based data, clinical trial data, and patient-reported outcomes to better understand disease patterns, evaluate treatment strategies, and examine the well-being of patients throughout the course of the disease.
Chapter 2 analyzes how real-world survival scenarios for pancreatic cancer have evolved over a 16-year period. Chapter 3 investigates the influence of sex and gender on treatment allocation and survival among patients with early-stage (stage I–III) disease in the Netherlands. Chapter 4 presents findings from the international randomized NAPAN trial, which compared second-line treatment strategies for patients with metastatic pancreatic cancer progressing after gemcitabine-based therapy. Chapter 5 describes the study protocol of the PREOPANC-5 trial, designed to improve outcomes for patients with borderline resectable pancreatic cancer. Chapters 6 and 7 focus on patient-reported outcomes. Chapter 6 examines changes in health-related quality of life (HRQoL) over time across different treatment pathways. Chapter 7 assesses the prevalence and development of anxiety and depression and identifies patient and treatment characteristics associated with more severe psychological symptoms.
Overall, this thesis demonstrates the evolving landscape of pancreatic cancer, where survival improvements should progress in parallel with attention to quality of life and psychological wellbeing. It reaffirms the clinical value of established regimens, explores novel strategies, and underscores the need to address treatment disparities and ensure equitable access. As survival gains remain modest, integrating the patient perspective into both research and clinical practice should be considered a key priority for future innovation.