2ⁿᵈ Edition of the Cancer R&D World Conference 2026

Abstract

Background

The Saskatchewan Cancer Agency serves a population of 1 million in Saskatchewan, western Canada. Many prostate cancer patients require androgen deprivation therapy (ADT), administered via injections by nurses. However, the burden on nursing staff, booking teams, and hospital space was substantial.

Monthly degarelix, a gonadotropin-releasing hormone (GnRH) antagonist used in ADT, has demonstrated superior outcomes in clinical trials compared to other hormonal therapies.

Aim/Objective

We piloted Canada's first off-site ADT injection program to decentralize services and ease congestion in acute care settings. This is the first reported Canadian community experience with ADT.

Methods

From January 2011 to April 2015, 176 consecutive patients were recommended degarelix (initial dose: 240 mg; maintenance: 80 mg). Seven refused due to drug interactions, co-morbidities, or inconvenience. The remaining 169 men were categorized as follows:

• Adjuvant therapy (ADJ): 27
• Biochemical failure (BCF) after previous curative treatment: 49
• Distant metastases (MET): 74

For those receiving radiotherapy, high doses were used (≥74 Gy/37 fractions for external beam or high-dose-rate brachytherapy of equivalent doses).

Patients on degarelix were identified via electronic pharmacy records, followed by paper chart reviews and additional electronic data extraction. A continuously updated Excel database was maintained. The primary outcomes included patient and staff feedback as well as treatment statistics.

Results

The program led to less crowded waiting rooms every Tuesday afternoon in two central clinics. Nurses used freed-up time for other duties. Patients with mobility issues received home injections by drug company nurses (instead of privately funded nurses).

Nurses in one rural site, where multiple complaints of local reactions occurred, were retrained by drug company representatives. Oncologists received nursing reports detailing patient compliance, progress, and side effects, including local pain (13), fever/chills (8), rashes (5), hot flashes (5), local swelling (3), and pulmonary embolism (1, possibly treatment-related).

Overall, 24/133 (18%) men requested to discontinue due to local pain/swelling. However, with supportive medications such as Benadryl, acetaminophen, topical lidocaine, Emla numbing cream, and/or oral dexamethasone, only 1/22 (4.5%) stopped treatment (P=0.2, chi-square test with Yates’ correction). Patients with mild reactions continued therapy after explanations highlighting degarelix’s superiority over GnRH agonists, underscoring the role of effective communication in improving compliance.

At the last follow-up (median 37.7 months, range: 0.5-123.0 months), the status of 169 patients was:

• Died of disease: 52 (31%)
• Alive with disease: 64 (38%)
• No evidence of disease: 43 (25%)

Conclusion

The off-site injection program was positively received by nurses, clinic administrators, and patients. Effective communication among patients, nurses, and doctors improved compliance, tracking, and patient care. Only 1 out of 22 men discontinued treatment when supportive medications were provided.

This initiative enabled collaboration between the cancer clinic and the drug company, enhancing service delivery. During this period, high-dose external beam radiotherapy (≥74 Gy/37 fractions) or high-dose-rate brachytherapy remained the standard of care, ensuring relevance to current treatment settings. The program may serve as a practice-changing model for alleviating the strain on overburdened cancer centers while significantly enhancing collaboration between industry and healthcare staff.