Aim:
With the rising number of prostate cancer patients requiring androgen deprivation therapy (ADT), especially with monthly gonadotropin-releasing hormone (GnRH) antagonist injections, our province was the first in Canada to implement an off-site injection program. The goal was to decentralize ADT from hospital clinics, reduce healthcare workload, and improve patient access, following Lean Management principles. This study evaluates program acceptance, challenges, and outcomes.

Methods:
Nurses from the Community Oncology Program of Saskatchewan (COPS), selected pharmacies, and home injection services were trained by nurses from two tertiary cancer centers and pharmaceutical representatives. Since 2012, pharmaceutical companies have hired nurses to deliver off-site injections. Patients with mobility or travel barriers were offered home administration. Oncologists identified candidates and coordinated care. Initially, patient consent was faxed to urban off-site programs and COPS in rural areas. Later, electronic health records and incident reporting were introduced. In 2014, 60 patients were randomly selected from 662 enrolled to evaluate the program using telehealth feedback, faxed nursing reports, and record reviews.

Results:
By 2014, 662 patients were enrolled. Rural patients appreciated care closer to home; staff reported smoother workflows. Some miscommunications led to missed visits or medication confusion. One site had increased injection reactions, prompting retraining. Scheduling and supply delays improved with better communication. Traveling patients continued treatment abroad. PSA monitoring improved with nursing reminders.

Conclusions:
The off-site ADT program is feasible and effective, enhancing access, reducing hospital burden, and supporting Lean Management goals for more efficient care.

Lorent Sijarina, MD, is a recent medical graduate from University of Prishtina, Kosovo, with broad interests in internal medicine, oncology, and public health. Passionate about research and evidence-based practice, he has engaged in international collaborations with diverse experts. Currently mentored by Professor Patricia Tai, a global leader in oncology, Lorent is further inspired to pursue clinical research and global health. He is committed to advancing medicine through scientific inquiry, innovation, and compassionate care. With a strong drive for interdisciplinary learning, he aims to grow as a physician-researcher dedicated to improving healthcare outcomes and promoting excellence in science.