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Initial experience of an algorithm‐based protocol for the community follow‐up of men with prostate cancer
Author(s) -
Goodall Philip P.,
Little Jessica,
Robinson Eleanor,
Trimble Ian,
Cole Owen J.,
Walton Thomas J.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13446
Subject(s) - medicine , watchful waiting , prostate cancer , referral , prostatectomy , androgen deprivation therapy , radiation therapy , cancer , prostate specific antigen , family medicine , oncology
Objective To evaluate the implementation of a novel algorithm‐based discharge programme for the community follow‐up of men with prostate cancer. Patients and Methods Men with prostate cancer considered suitable for discharge were identified from consultant‐led and clinical nurse‐specialist telephone clinics at Nottingham University Hospitals National Health Service Trust. Patients were discharged on to one of four discharge pathways: watchful waiting, androgen‐deprivation therapy ( ADT ), post‐prostatectomy, and post‐radiotherapy. Primary care providers were asked to adhere to specific surveillance measures and refer patients back to secondary care after breach of pre‐defined prostate‐specific antigen ( PSA ) level threshold criteria. Reasons for non‐compliance, re‐referral, and cause of death were determined for all discharged men. Results In all, 573 men were discharged across all four pathways; 169 on the watchful‐waiting pathway, 229 on the ADT pathway, 95 on the post‐prostatectomy pathway, and 80 on the post‐radiotherapy pathway. All patients had ≥12 months of follow‐up. In all, 48 of 54 (88.9%) men were re‐referred promptly after a PSA ‐threshold breach. Of the remaining six patients there were three refusals, one unrelated death before referral, and two late referrals at 4 months. Three patients were lost to follow‐up due to database non‐registration and were subsequently recalled, none of whom had a PSA ‐threshold breach. There were three unexpected deaths attributed to prostate cancer: two were community deaths with no biochemical or clinical evidence of prostate cancer progression, while one was due to a likely progressive PSA non‐secreting tumour. Conclusion Initial results suggest the algorithm‐based protocol is a viable, effective, and oncologically safe method for the controlled discharge of men from secondary to primary care. Longer‐term follow‐up, patient satisfaction and cost‐effectiveness data are required to assess the true impact of the initiative.