Case Number 4612
Request Date 04/02/2016
Completion Date 04/04/2016

 

Details of the Request

We would like to request the following information regarding the administration of gonadorelin (GnRH) analogues (also known as LHRH analogues) for the treatment of prostate cancer within: Ashford and St Peter's Hospitals NHS Foundation Trust

  1. Within your organisation, which healthcare professional (role) clinically recommends the LHRH that is prescribed?
  2. Which healthcare professional (role) within your organisation usually administers the first injection?
  3. Where is the first injection usually given (hospital or primary care)?
  4. Which healthcare professional (role) within your organisation usually administers subsequent injections?
  5. Where are subsequent injections usually given (hospital or primary care)?
  6. For subsequent injections, does the patient still remain under the care of the hospital (eg attends hospital clinics although injections are given in primary care), and if so, for how long?
  7. If injections are administered in primary care, what recommendation/advice comes from the hospital?

 

Details of the Response

1 Within your organisation, which healthcare professional (role) clinically recommends the LHRH that is prescribed?

LHRH to be prescribed will be done so by a doctor able to prescribe but usually consultant, SpR (including oncology doctors). Recommendation of brand of LHRH to prescribe by GP can be made either by a doctor or nurse in Urology as all have same properties, actions, but may vary in price. This may influence GP choice. It will either be Prostap or Zoladex and can be given subcutaneously with either a 1 monthly or 3 monthly preparation.

 

2 Which healthcare professional (role) within your organisation usually administers the first injection?

The first injection may be given by either a nurse or a doctor in the hospital if the patient is an inpatient on the ward. Often if a patient has been admitted and diagnosed with prostate cancer, particularly at an advanced stage, we will give them an LHRH called Degarelix. This is very beneficial under these circumstances but can be continued by the GP with cheaper versions such as Prostap or Zoladex, whichever their choice, once the patient has gone home.

If patients come into clinic with an obvious advanced prostate cancer then we can also start this injection at this stage with future follow ups with GP as stated above. There is otherwise no need for the injection to be commenced by the hospital and GP’s can give this at the surgery and do.

 

3 Where is the first injection usually given (hospital or primary care)?

See above for answer to Q3. GP’s (practice nurses) will give the first injection under usual circumstances. This is especially important if starting Zoladex or Prostap as the patients will need a course of tablets (Bicalutamide) to take at least a week before administration of the injection and a week’s worth afterwards. The tablets are then stopped and just injections thereafter.

 

4 Which healthcare professional (role) within your organisation usually administers subsequent injections?

Subsequent injections need to be administered by the community – GP

 

5 Where are subsequent injections usually given (hospital or primary care)?

Subsequent injections should be given in primary setting

 

6 For subsequent injections, does the patient still remain under the care of the hospital (eg attends hospital clinics although injections are given in primary care), and if so, for how long?

If patients are receiving LHRH injections, they will remain under hospital care as outpatients in order to monitor effect of LHRH on prostate cancer progression – for how long will depend on many variables e.g. For as long as under treatment whether watchful waiting, awaiting radiotherapy or as long as they are under surveillance.

 

7 If injections are administered in primary care, what recommendation/advice comes from the hospital?

If patients are placed on LHRH in hospital or told that their GP will start the injections then they will be informed of the potential side effects with written information available also. GP’s should be aware of these side effects also which they should be able to convey to patients. LHRH comes with written information also for patients to read and as patients are followed up regularly at the hospital whilst on LHRH, any issues in relation to side effects are discussed there.