Implementation of a lifestyle-based clinical pathway in daily clinical practice in men undergoing androgen deprivation therapy for prostate cancer

Aim: To assess the effect of a lifestyle-based prostate cancer pathway, incorporated in daily practice, to increase the implementation of evidence-based strategies to manage ADT-induced side effects. Methods: PCa patients receiving ADT for >6 months were referred to the pathway (ie as standard practice), through a central coordinator. The pathway consisted of a medical screening (ie bone and cardiometabolic screening) and a rehabilitation program with a supervised exercise program (3 months) and referrals to a dietician and a psychologist. Anthropometric parameters and physical performance were measured at baseline and after 3 months. Primary endpoint was physical performance evaluated with the 400-m walk test. Planned referral target was set at 200 to accomplish a sample size of 120 patients following the exercise program. A meaningful clinically important difference of the 400-m testwas defined as 17 s improvement and P < .05 was considered statistically significant. Results: Between January 2015 and June 2018, 200 patients were referred to the pathway, of which 177 were enrolled (median age 69, IQR 63-74). The majority (84%) had a good functional status (Karnofsky Performance ≥90) at baseline. The indication for ADT was curative in combination with local therapy for locally advanced PCa in 67% and palliative for (non)metastatic PCa in 33% of patients. In total, 124 followed the complete pathway. Medical screening indicated a lower bone mineral density in 51% of the patients and 25% had metabolic syndrome. After initial referral, 43% choose to receive diet advice and 64% psycho-education. A clinically meaningful performance improvement was observed in patients following the exercise program (282 to 253 s; P < .001). Compliance rate of the exercise program was high (83%). A total of 10% dropped-out due to medical reasons. After the 3-month exercise program, 81% voluntary continued. Conclusion: Physical performance improved after following a lifestylebased clinical pathway for prostate cancer patients in daily practice.