Clinical pathway improves implementation of evidence-based strategies for the management of androgen deprivation therapy-induced side effects in men with prostate cancer

Objectives: To assess the effects of a prostate cancer (PCa) clinical pathway on the implementation of evidence-based strategies for the management of androgen deprivation therapy (ADT)-induced side effects.

Patients and methods: A clinical pathway was introduced at hospital level in 2015. The pathway consists of evidence-based strategies for the management of ADT-induced side effects. All patients with PCa receiving ADT for >6 months were eligible to enter the clinical pathway. Data on recommended evidence-based strategies were retrospectively extracted from the electronic health records of all eligible patients in the year before (2014) and the year of implementation of the pathway (2015). Descriptive statistics were used for patient characteristics. The chi-squared test (or Fisher's exact test) and Mann-Whitney U-test were used to compare results in the control group with those in the intervention group.

Results: In total, 126 patients were included in the control group and 132 patients in the intervention group. Baseline patient characteristics were well balanced. After implementation of the pathway, metabolic, bone and cardiac risk assessment screenings were more frequently applied in the intervention group (metabolic 46% vs 4%; bone 58% vs 10%; cardiac 61% vs 16%; P < 0.001). Advice on strategies preventing ADT-induced side effects was more frequently provided in the intervention group (exercise 62% vs 11%; nutrition 58% vs 10%; psycho-education 54% vs 13%; P < 0.001).

Conclusion: A clinical pathway for patients with PCa improved the implementation of evidence-based strategies for the management of ADT-induced side effects. A clinical pathway could serve as a method to bridge the gap between evidence-based guidelines and daily clinical practice.