Background:
Patients in regional areas are vulnerable to interruptions in androgen deprivation therapy (ADT) due to general practitioner shortages, long travel distances, limited access to follow-up care, and movement across healthcare services. These challenges can result in inconsistent treatment adherence and increase the risk of poorer health outcomes.
Rationale:
To evaluate adherence to prescribed treatment protocols for parenteral ADT in men with prostate cancer receiving treatment within Designated Cancer Treatment Units (DCTUs) in regional hospitals.
Methods:
This observational retrospective cohort study reviewed episodes of parenteral ADT administered from January 2019 to September 2023. Each treatment was defined as a single episode of care. Adherence was assessed by correct medication, dose, frequency and route of administration, as per protocol.
Impact on practice:
Of 51 patients screened, 22 received ADT, with 50% (n=11) treated in a hospital DCTU. Across 86 episodes of care, leuprorelin was the most frequently administered (n=45), followed by degarelix (n=25) and goserelin (n=16). Adherence was highest with goserelin (94%, n=15), followed by leuprorelin (82%, n=37) and degarelix (76%, n=19). Annual adherence improved from 45% in 2019 (n=5) and 60% in 2020 (n=6) to 100% in 2021 (n=8) and 94% in 2022 (n=32).
Discussion:
Twelve-weekly administration schedules for leuprorelin and goserelin supported improved adherence by reducing complexity. The notable improvement from 2021 coincides with the introduction of a full-time Regional Cancer Pharmacist and Prostate Cancer Nurse, highlighting their pivotal roles in supporting consistent, safe ADT delivery. Pharmacist-led telephone clinics may provide a sustainable model for improving treatment adherence and follow-up across regional areas, regardless of administration site. This project may also serve as a model for other therapies and disease states, ensuring patients receive regular follow-up regardless of where treatment is supplied. The implementation of an oncology management system in regional hospitals may further enhance future practice in this area.