Abstract:
Aim: With the rising number of prostate cancer patients needing androgen deprivation therapy (ADT), especially with new monthly gonadotropin-releasing hormone (GnRH) antagonist injections, our province became the first in Canada to implement an off-site injection program. The goal was to decentralize ADT administration from hospital clinics, reduce healthcare workload, and improve patient access (concept of “Lean Management”). This study evaluates program acceptance, challenges, and outcomes after its implementation.
Methods: Nurses in the Community Oncology Program of Saskatchewan (COPS), designated drug stores, and home injection programs, are trained by nurses from the two tertiary cancer clinics and pharmaceutical company representatives in Saskatchewan. Since 2012, the pharmaceutical companies hired nurses for off-site injection programs. Patients with mobility or travel barriers were offered home injection. Oncologists identified patients and coordinated care through the pharmaceutical company. Initially, patient consent required faxing to off-site programs in cities and COPS in rural areas. In later years, electronic health records and incident reporting were introduced. In 2014, 60 patients were randomly selected from the total 662 in injection programs to evaluate the initiative, based on feedback via telehealth, faxed nursing reports, and electronic health record reviews.
Results: By 2014, 662 patients were enrolled. Many rural patients valued receiving care closer to home, and staff experienced smoother workflows. Some miscommunications led to missed home visits or confusion about medication changes. An increased incident of injection reactions at one rural hospital prompted retraining. Delays in scheduling or drug supply were addressed through better team communication. Patients traveling abroad (“snowbirds”) maintained treatment continuity. Routine PSA monitoring improved as nurses reminded patients about follow-up tests.
Conclusions: The off-site ADT program has proven feasible and beneficial, enhancing patient access and relieving hospital clinics. Improved communication and health record integration are key for continued progress. Decentralizing care has increased efficiency and aligns with Lean Management principles, improving both service delivery and patient experience.
