Supported self management for prostate cancer patients

Meet the team

The Hillingdon Hospitals NHS Trust serves the London Borough of Hillingdon as well as the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire and has a total catchment population of 350,000 people. Cancer services at the Trust have evolved over time and over the last few years there has been a shift to providing holistic survivorship services that meet the physical and emotional needs of patients.

The big idea

To implement a new remote tracking system for stable prostate cancer patients with the provision of self-management support in line with the Risk Stratified Pathway. Patients are managed with the PSA Tracker which is a database containing the information on Hillingdon’s prostate cancer patients.

Making it happen

The project has introduced a new remote tracking system for stable prostate cancer patients, increased the number of nurse led clinics (face to face or telephone), introduced health and well being days and facilitated a robust system for patients referral, i.e LUTS or ED clinics. It has also ensured that patients have Holistic Needs Assessments.

The team have ensured that community services are kept up to date and that there is a process is in place so patients have easy access back to the system and clinics if needed. Patients are given full contact details of the services available to them and understand how they could be accessed.

Finding out what works

435 patients have been supported by the new pathway and 144 registered on the PSA Tracker. The nurse led clinics (face to face and telephone clinics) increased to two clinics a week from one.

Since the introduction of the post, every new patient has had a chance to meet the CNS as their key worker.

Lessons learnt

There is a cost for the PSA tracker software and upgrades and Trusts need to ensure there is budget available


  • More follow up of patients (with stable PSA) have been moved to nurse led clinics/PSA Tracker which has freed up more clinic slots for patients.
  • Over 90% of patients who have been transferred to the new remote monitoring system (PSA Tracker) and the nurse led clinics (face to face/telephone) reported a high satisfaction level
  • More patients have been directly referred to LUTS/ED clinics with an immediate positive outcome, and more men are receiving referral to other survivorship services. - Of the 29 men assessed who had been referred to LUTS clinics 19 showed improvement and of the 12 referred to ED clinics 10 patients showed improvement.
  • Nurse led telephone clinics cost £25.77 per session compared to the £67.43 clinician clinic, which is restricted to only two follow up consultations. The introduction of this service has enabled more men to be followed up in nurse led clinics with access to clinician clinics if required. Full costs savings of the introduction of this service and CNS clinics are being assessed.
  • Health and Well being days received a positive evaluation from the men who attended

Next steps

The project has allowed the Trust to trial and run the PSA Tracker and measure its practicality as well as identifying trouble shooting aspects. It has proved it is a useful tool and it is being considered for use for other cancer sites.

The team will continue to run health and well being days and review patients through the nurse led clinics (face to face and telephone).

Find out more

This project has been funded through our Health and Social Care Professionals Programme, thanks to support from The Movember Foundation.

If you would like to learn more about this project, please contact us.