The EAGLE study: improving the wellbeing of men by evaluating and addressing the gastrointestinal late effects of radical treatment for prostate cancer.

Background Prostate cancer survival is improving, in the UK it has tripled in the last 40 years. Radiotherapy is an effective treatment with the aim of cure, however, many patients experience a change in bowel habit, such as urgency and incontinence, developing months to years after completion of treatment. Evidence suggests that management of these symptoms by a gastroenterologist can be effective when following a detailed investigative and treatment algorithm and an equivalent level of care can be given by a trained nurse. The EAGLE study focuses on the early identification and management of radiotherapy-induced bowel symptoms, with the aim of improving the quality of life of prostate cancer survivors and their partners and/or families. Methods Successful evidence-based healthcare interventions are often challenging to embed into local clinical practice. In this effectiveness implementation hybrid study, a multi-component intervention consisting of: a simple screening tool to identify men with late effects of radiotherapy in oncology follow-up clinics; rapid referral to a specialised gastroenterology service; and enhanced algorithm-led assessment leading to targeted advice and treatment, was implemented in three UK centres. Mixed method approaches to data collection and analyses are used to assess the effectiveness of the intervention and the implementation strategy at baseline, six month and twelve month intervals. Implementation outcome variables such as, acceptability to patients and healthcare professionals, large scale adoption and sustainability are addressed via longitudinal semi-structured interviews, alongside the introduction of possible solutions to facilitate local implementation. A control group of prostate cancer survivors with radiotherapy-induced bowel symptoms from another local health board are followed up for twelve months to assess the cost effectiveness of the intervention. Results The screening tool used in oncology to identify men suffering from the late effects of radiotherapy has been validated against the Gastrointestinal Symptoms Rating Scale (GSRS). Qualitative interview data from patients suggests that the screening tool is quick and easy to understand, addresses symptoms that are of most concern to patients, and facilitates open discussion of their bowel symptoms with healthcare professionals. Final results will measure the effect of the new service in terms of acceptability to staff and patients, quality of life improvements, symptom control and cost effectiveness. Qualitative interview data from healthcare professionals across the three UK sites will address how each team is working towards sustainability of the service. Conclusion This study evaluates the effectiveness of an enhanced assessment and treatment service, spanning oncology and gastroenterology departments, in improving the outcome of prostate cancer survivors post-radiotherapy. The factors needed for successful implementation into local practice, which are essential for new initiatives in healthcare settings, will act as examples of best practice for a network of centres of excellence in this field.