Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium.
Department of Urology, Ghent University Hospital, Ghent, Belgium.
BJU Int. 2018 Apr;121(4):610-618. doi: 10.1111/bju.14086. Epub 2018 Jan 10.
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.
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.
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).
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.
评估前列腺癌（PCa）临床路径对实施雄激素剥夺治疗（ADT）相关副作用管理循证策略的影响。
2015 年在医院层面引入了临床路径。该路径包括 ADT 相关副作用管理的循证策略。所有接受 ADT 治疗>6 个月的 PCa 患者均有资格进入临床路径。从符合条件的所有患者的电子健康记录中回顾性提取接受 ADT 治疗>6 个月的患者在路径实施前一年（2014 年）和实施当年（2015 年）推荐的循证策略数据。采用描述性统计方法对患者特征进行分析。采用卡方检验（或 Fisher 确切检验）和曼-惠特尼 U 检验比较对照组和干预组的结果。
共纳入对照组 126 例和干预组 132 例患者。基线患者特征均衡。实施路径后，干预组更频繁地进行代谢、骨骼和心脏风险评估筛查（代谢 46% vs 4%；骨骼 58% vs 10%；心脏 61% vs 16%；P<0.001）。干预组更频繁地提供预防 ADT 相关副作用的策略建议（运动 62% vs 11%；营养 58% vs 10%；心理教育 54% vs 13%；P<0.001）。
PCa 患者的临床路径改善了 ADT 相关副作用管理循证策略的实施。临床路径可以作为一种方法，弥合循证指南与日常临床实践之间的差距。
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