PhD defence M.C.P. (Malou) Kuppen

Dissertation in short:

Quality of care is of increasing interest, especially when treatments are expensive and the incidence of disease high as for example in prostate cancer. In the last years new, expensive, life prolonging treatments were introduced in the Netherlands. We evaluated treatments, outcomes and resource use in 3,600 castration resistant prostate cancer (CRPC) patients from 20 different hospitals in the CAPRI registry. These registries are important, since patients from daily practice have different patient- and disease characteristics (and thus different outcomes) than patients treated in clinical trials. In the Netherlands, overall survival of CRPC patients increased with the introduction of new treatments, but during follow-up the quality of life decreased.  We also found that a prior treatment influenced the outcomes of later treatments. On the one hand, this could be explained due to the fact that treatments have similar mechanisms of resistance. On the other hand, performance status of patients in later treatment lines is often worse than in earlier lines. The disease eventually leads to death and the care near the end of life is often (too) intensive. Results from real-world studies can point out problems in order to optimize care.