Title : A pioneering, first-of-its-kind Canadian off-site program designed to reduce the burden on hospital staff and optimize the use of space
Abstract:
Aim: Degarelix, a GnRH antagonist for ADT, showed remarkable results in clinical trials. We launched Canada’s first off-site injection program to decentralize services from overloaded acute care settings. This is the first reported Canadian community experience with degarelix.
Methods: Pharmacy records identified patients on degarelix, and additional data were retrieved from paper and electronic charts. A prospective database was built to track follow-ups. Primary outcome: absolute PSA decline.
Results: From Jan 2011 to Apr 2015, 176 men were advised to use degarelix; 169 proceeded. Breakdown according to treatment purpose, first line response rate and second line response rates are: adjuvant (27 patients, response rates not applicable), biochemical failure (49 patients, 80%, 40%) metastatic (74 patients, 76%, 28%). When used as the sole primary treatment in 19 patients, overall response was 38%. Maximal androgen blockade decreased PSA on the addition of bicalutamide in 81.4% (22/27) men. Side effects included local pain (13), fever/chills (8), rashes (5), hot flashes (5), swelling (3), and pulmonary embolism (1). Compliance: 18% stopped due to pain/swelling, but only 4.5% quit when given supportive medications. The impacts of this off-site program were reduced clinic crowding and allowed home visits for mobility-limited patients. Nurses could reallocate time to other duties. Patients better adhered when informed about degarelix’s superiority over GnRH agonists.
Conclusions: Off-site injection proved feasible and well-received, relieving overburdened cancer centers and providing better care options for patients.
