Substantial Variation in Chemotherapy Infusion Practices Seen at Large Cancer Centers

A high degree of variation in chemotherapy infusion practices were found across National Comprehensive Cancer Network (NCCN) member institutions, according to the results of a survey study published in the Journal of Oncology Practice.

As the demand for cancer infusion center services continues to increase, the development of best practices to optimize the operating efficiency and effectiveness of infusion centers becomes increasingly important. Toward that end, the NCCN conducted a series of surveys of its member institutions to assess current practices related to average patient wait time, chemotherapy premixing practices, infusion chair use, and premedication protocols.

Three consecutive, online surveys assessing infusion center practices were distributed to NCCN member institutions in 2016 and 2017. Survey 1 covered drug premixing, patient wait time in the infusion center, and scheduled infusion chair times; Survey 2 focused on the times for defined components of infusion chair time; and Survey 3 focused further on the premedications/hydration component of infusion chair time.

A key finding from this study was a high degree of variation across infusion centers at NCCN member institutions regarding patient wait time (25 to 102 minutes), as well as planned chair time for the administration of doxorubicin/cyclophosphamide (AC; 85 to 240 minutes), FOLFIRINOX (folinic acid, fluorouracil, irinotecan, oxaliplatin; 270 to 420 minutes), rituximab (120 to 350 minutes), paclitaxel/carboplatin (255 to 280 minutes), and zoledronic acid (30 to 150 minutes). In addition, only 19% of responding institutions reported premixing AC, paclitaxel, and rituximab prior to arrival of the patient for those patients meeting specific criteria.

Furthermore, while some institutions allotted substantial time for additional nursing activities (ie, reviewing orders, establishing intravenous access, patient assessment, line flushing, continuous infusion hookup, and patient education) as part of overall planned chair time, others scheduled only minimal chair time for these activities. There was also a high degree of variation in how premedications were administered, as well as in the amount of planned chair time between administration of an antiemetic and initiation of chemotherapy.  

Following consideration of the survey results, the NCCN Infusion Efficiency Workgroup recommended that cancer infusion centers:

·      Compare infusions times to those included in package inserts from the US Food and Drug Administration (FDA) as well as other sources

·      Compare actual with desired scheduling practices

·      Consider premixing chemotherapy drugs when appropriate

·      Reassess whether posthydration and postobservation are necessary in specific situations

·      Review time planned for nursing activities

·      Decrease or eliminate patient wait time

·      Consider whether alternate premedication routes are possible in particular situations

·      Evaluate practices regarding waiting periods following administration of antiemetic medications prior to administration of chemotherapy.

Reference

Sugalski JM, Kubal T, Mulkerin DL, et al. National Comprehensive Cancer Network Infusion Efficiency Workgroup Study: optimizing patient flow in infusion centers [published online April 9, 2019]. J Oncol Pract. doi: 10.1200/JOP.18.00563