Prescribing inconsistencies in prostate cancer treatment in the UK
Eighty-four percent of GPs and 76 percent of specialists (uro-oncologists or urologists) agree that there is a significant legal risk associated with off-label prescribing in prostate cancer when there is a licensed alternative available, according to new survey data released today. Despite this, 46 percent of specialists felt that primary care commonly changes the recommended Leutinising Hormone-Replacement Hormone agonist (LHRHa) when referring management of patients to the community.
The Need for a Data Driven Solution
The data show that nearly all (92 percent) specialists, GPs, oncology pharmacists and specialist urology nurses surveyed agree that patients should receive an LHRHa with supporting clinical evidence wherever possible. Zoladex (goserelin) is licensed for all stages of prostate cancer suitable for hormonal manipulation. Also, it is the only LHRHa with a proven survival benefit in adjuvant treatment in high risk localised disease and in adjuvant treatment of locally advanced prostate cancer when compared to surgery or radiotherapy alone.,, However, when asked to differentiate between goserelin and another LHRHa not licensed for all stages of prostate cancer suitable for hormone manipulation, 75 percent of GPs and 42 percent of specialists felt in their view that the clinical evidence was the same.
Commenting on the data, Dr Heather Payne, Consultant Clinical Oncologist in Urological Tumours, University College Hospital, London stated: "Prostate cancer is a complicated disease and can be treated in several different ways. Depending on the stage of the cancer, a clear understanding of the supporting clinical evidence for treatments should guide prescribing decisions. As healthcare professionals, we need to provide patients with the best evidence-based treatment and care at all times."
Secondary and Primary Care Divide
Although 76 percent of GPs and 94 percent of specialists agree that prescribing decisions in prostate cancer should be left to specialist care, only 46 percent of specialists always recommend an LHRHa by specific molecule name and dose. In addition, only 24 percent of GPs would actually consult the specialist for further advice when they receive a referral / recommendation that indicate an LHRHa class only, indicating a need for improved communication between primary and secondary care in the management of patients with prostate cancer.
Although, only 38 percent of GPs said they would be confident in identifying the different stages of prostate cancer more than half (59 percent) said they felt comfortable prescribing LHRHa's for patients with prostate cancer, even though not all LHRHa's are licensed for all stages of prostate cancer.,,,, Goserelin is the only LHRHa with the supporting clinical evidence and licensed indications for all stages of prostate cancer suitable for hormone manipulation.2 The data show more awareness of LHRHa clinical evidence and treatment licences is needed amongst healthcare professionals managing ongoing LHRHa treatment.
Continuity and consistency of prescribing in prostate cancer is important to maintain patient confidence and reduce patient anxiety with more than 73 percent of specialists, GPs, oncology pharmacists and specialist uro-oncology nurses agreed that changing the LHRHa in primary care from that referred / recommended in secondary care can be unsettling for patients. Although off-label prescribing is vital in some situations, the GMC requires that patients be informed when an unlicensed product is prescribed. Dr. Payne additionally commented: "Results show that even though healthcare professionals agree that changing the LHRHa treatment could be unsettling for patients, it may occur in practice without informing the patient. It is clear from the data that we need to improve communication between secondary and primary care to ensure patients receive the most appropriate treatment at the right time. In this way, we can avoid unnecessarily unsettling the patient's treatment routine."