ABSTRACT
Background: In February 2021 Roche announced a new subcutaneous (SC) product to the market;Phesgo. Phesgo was a combination pertuzumab and trastuzumab product which was funded by NHS England for all HER2 positive breast cancer indications. Day case unit capacity is a local and national issue, which has been further highlighted through the COVID19 pandemic with the reduction in treatment chairs due to social distancing and increase in cancer diagnosis and required treatments caused by the backlog from the pandemic. Aim: The aim of this project was to switch all intravenous (IV) pertuzumab and trastuzumab combination patients to SC Phesgo;to alleviate day case unit capacity and to improve the patient experience by June 2021. Methods: A report from CIS Healthcare was run within the electronic prescribing system to highlight all patients and regimes receiving and containing IV pertuzumab;a total of 148 patients network wide. A patient information letter was drafted explaining the change underway which was then emailed or posted out to all patients across the network receiving IV pertuzumab. Alternative regimens containing SC Phesgo were built into the electronic prescribing system;from week commencing 19.04.21 any patient receiving treatment at the tertiary centre (Weston Park Hospital(WPH)) who had received IV pertuzumab and trastuzumab previously would receive SC Phesgo. A patient evaluation questionnaire was distributed to all patients who participated in the switch to SC Phesgo at WPH, to gain qualitative feedback on the switch from the patient perspective. Results: All 148 identified patients receiving IV pertuzumab and trastuzumab were switched to SC Phesgo. Of the 148 patients 81 patients were receiving treatment at WPH, 49 patient evaluation questionnaires were completed;96% of patients were happy with the switch to SC Phesgo. By switching to SC Phesgo there was a weekly average of 48.1 h of chair time saved per week;a 56.9% reduction in chair time for this cohort of treatments and an overall reduction of 5.5% of chair time for the day case unit. In additional to the chair time saved, there was also on average 21.2 nurse hours saved per week;a reduction of 53.5% in nurse time for this cohort and an overall reduction of 4.6% of nurse time for the day case unit. Discussion/Conclusion: By administering SC Phesgo instead of the IV equivalents there have been significant reductions in patient, chair and nurse time. This reduction has help alleviate chair and nurse time capacity issues which were critical prior to the switch in April 2021 due to the COVID19 pandemic. There is an associated cost saving for commissioners despite the number of treatments remaining stable, in March 2021 the cost to the commissioners for all IV pertuzumab and trastuzumab given to breast cancer patients was £320,532.70;in May 2021 this figure (for SC Phesgo) had reduced to £145,956.00. In conclusion the switch the SC Phesgo has improved the patient experience, increased chair and nurse capacity on the day case unit.
ABSTRACT
Objective: The systemic anti-cancer therapy (SACT) work stream of the East of England Cancer alliance identified variation in SACT administration times as a potential area to counter the impact of Covid-19 capacity restrictions within chemotherapy day units. The aim is to assess the impact of reducing post infusion observation time of pertuzumab-trastuzumab on efficiency and safety. Methods: The recommendation from East of England Cancer Alliance was to adopt one hour observation post pertuzumab and one hour post trastuzumab for cycle 1, 30 min after each infusion for cycle 2 and 3 and a zero observation time thereafter for patients who have had no reaction. All patients administered IV pertuzumab-trastuzumab between October 2020 and May 2021 were identified. The number of patients experiencing hypersensitivity reactions with the original and reduced observation time was compared. The impact of reduced observation time on chair capacity was also calculated. Results: Of the 26 patients treated with the original observation time between October 2020 to January 2021, two patients reacted and received Hydrocortisone IV 100 mg and Chorphenamine IV 10 mg. Patients continued treatmnet at a slower rate. No patients discontinued treatment due to the reaction. Reactions included flushing, stomach pain, uncontrolled bladder and face swelling. Between February and May 2021,18 patients were treated with reduced observation times and 3 patients reacted. Reactions included hypertension, chills, vomiting and shivering. The total number of patients between the cohorts differs due to the conversion of some patients to Phesgo from April 2021. These patients were managed similarly to the previous cohort with added IV ondansetron and IV metoclopramide. No patient discontinued treatment following the reaction. Chair times savings were 5 h for cycle 1, 2 h for cycle 2 and 3, and 3 h from cycle 4 onwards. In total, 53 chair hours in the chemotherapy day unit were released between February to May 2021. Conclusion: The pressure on chemotherapy units has been exacerbated by staff absence, reduced capacity due to social distancing and use of PPE. Whilst the SPC for trastuzumab states patients should be observed for 6 h post first infusion and for 2 h post subsequent infusions, the implementation of reduced observation times post infusion of pertuzumab-trastuzumab did not impact on patient safety and encouragingly increased the capacity of the day unit by 53 h in four months.