Overview of the care pathway

We can divide the colorectal cancer care pathway into 3 phases:

1. Baseline / choice of treatment
2. Acute treatment phase
3. Long-term follow-up post-treatment (annual survey for 10 years)

The backbone of the care pathway is summarized in the figure below, for this flow we relied mainly on the ICHOM standard set of Patient-Centered Outcome Measures for prostate cancer.

Baseline / choice of treatment

The prostate cancer care pathway has different types of flows depending on the treatment. Following treatments are supported:

1. Prostatectomy
2. Radiotherapy
3. Active Surveillance
4. Watchful Waiting
5. Androgen Deprivation Therapy
6. Brachytherapy
7. External Beam Radiation Therapy
8. Focal Therapy
9. Brachytherapy + Hormone therapy
10. Radiotherapy + hormone therapy
11. Chemotherapy
12. Hormone Therapy

At the start of the care pathway, a healthcare professional must indicate which treatment will be followed. Once the patient approved their informed consent, the patient will be notified to fill out a number of questionnaires.

6 week follow-up

Depending on the chosen therapy, a message will be sent to the patient 6 weeks after the start of treatment to complete an abbreviated version of the EPIC-26. Subsequent treatments will receive this follow-up message:

1. Hormone therapy
2. Brachytherapy
3. Radiotherapy
4. Focal therapy
5. Radical prostatectomy
6. Brachytherapy + Hormone therapy
7. Radiotherapy + hormone therapy

3 month follow-up

Depending on the chosen therapy, a message will be sent to the patient 3 months after the start of treatment to complete an abbreviated version of the EPIC-26. Subsequent treatments will receive this follow-up message:

1. Hormone therapy
2. Brachytherapy
3. Radiotherapy
4. Focal therapy
5. Radical prostatectomy
6. Brachytherapy + Hormone therapy
7. Radiotherapy + hormone therapy

6 month follow-up

After 6 months, each patient will receive a set of follow-up PROMs/PREMs. This is regardless of the choice of treatment. Patient will complete following questionnaires:

1. EPIC-26
2. Utilization of Sexual Medications
3. EQ-5D-5L

Yearly follow-up

After treatment starts, the patient will receive annual follow-up PROMs/PREMs. This is regardless of the choice of treatment. Patient will complete following questionnaires:

1. EPIC-26
2. Utilization of Sexual Medications
3. EQ-5D-5L

Add steps

In the care pathway, it is also possible to dynamically add steps to the patient journey. These are steps that are not needed in each patient journey and depends on the specific patient situation. That's why healthcare professionals can manually trigger those ad hoc events. There are three add steps available in the care pathway:

1. Report metastasis
2. Patient died
3. Change of treatment

Integrations

From your EMR to scheduling or billing, Awell easily connects with your systems so you can create powerful care pathways that tie disjointed systems together.

Dashboards

The following patient-reported-outcomes are visualized in the care pathway:

• Expanded Prostate Cancer Index Composite-26 (EPIC-26): Heatmap
• Expanded Prostate Cancer Index Composite-26 (EPIC-26): Total Score
• EQ-5D-5L: Heatmap
• EQ-5D-5L: Total Score
• International Prostate Symptom Score (IPSS)

Information brochures & video's

In the care pathway a number of information brochures and video's are included:

• Physiology & anatomy of the prostate
• Prostate Specific Antigen (PSA)
• TNM classification - staging prostate cancer
• Nutrition advice in cancer
• Radiotherapy: treatment of prostate cancer
• Side effects of radiotherapy
• Radiotherapy: general information brochure

Benefits

The prostate cancer care pathway offers numerous benefits that will increase efficiency on the one hand and improve the quality of care for both patient and provider on the other.

• Automatic data collection based on the ICHOM Standard Set
• Automatic scoring calculations
• Integrated with your systems (Electronic Medical Record, scheduling, medical billing, online pharmacy & fulfilment, e-prescribing, insurance eligibility....)
• Decreased administrative burden for the care team
• Automatic alerts to the care team if patients reports alarming Patient-reported-outcomes
• Patient can access information brochures about treatment, symptoms, etc

In addition, we see that by digital monitoring the patient we also lowered the bar to express concerns about their sexual activity. This results in the earlier introduction of the utilization of sexual medication.