Development of an active surveillance pathway

NHS Lothian is involved in the ‘Prostate Testing for Cancer Treatment’ (ProtecT) project which is a multi-site national study which invites men for PSA tests and then compares the effects of different treatments. As a consequence of involvement in the study, GP practices in and around Edinburgh have been educated about prostate cancer and the use of the PSA test. There is evidence to suggest that this is affecting the mix of patients who are diagnosed with prostate cancer. In Lothian, there is an 80:20 split between patients with early stage disease and those with advanced disease on diagnosis. In the west of Scotland, this ratio is approximately 50:50. The hypothesis, therefore, is that the greater use of the PSA test across the local area, and its better use may be leading to an increase in earlier diagnosis of prostate cancer.

As a result of this high level of early stage presentation, across NHS Lothian there are more men eligible for active surveillance (as opposed to more acute interventions such as operations) and the average age of diagnosis is younger than in the west coast of Scotland.

To ensure that this group of men receive the support they need, a Clinical Nurse Specialist was funded to set up a virtual and face-to-face clinic for men on active surveillance.

To date 564 patients have been supported via a mixture of, postal surveys, face-to-face clinics and telephone follow up.

The new active surveillance pathway has:

• Improved the experience of men on active surveillance (reduced anxiety, increased awareness of treatment plan).
• Created a more robust management system which is likely to have improved clinical outcomes.
• Allowed the analysis of the characteristics of this cohort of men.
• Improved the use of resources, as men on active surveillance are now managed by Specialist Nurses as opposed to Consultants

A patient experience survey has been completed and the results show that they patients are happy with the new pathway.

• 98% of patients felt they were given enough time
• 98% of patients felt they were listened to
• 98% felt they were treated with care and concern during their consultation.
• 87% of men surveyed are happy with being followed up this way and being reviewed by the CNS.