According to a national assessment, over 90% of intravenous (IV) systemic anticancer therapy (SACT) services from pharmacies in the UK have had to delay patient treatment because the required drug was not available at the scheduled time of administration.
Of these, more than a quarter (27%) said the shortages occurred on a weekly basis, and the report concluded that “urgent action” is needed to address ongoing issues of delays in treatment and pharmacy staffing IV SACT services.
The national IV SACT survey, which was conducted on behalf of the Royal Marsden NHS Foundation Trust and the British Oncology Pharmacy Association (BOPA), gathered experiences from across the UK with IV SACT delivery for the period January 2022 to June 2022.
A total of 69 completed responses were received, including 50 from SACT providers in England, 4 in Scotland, 12 in Wales and 3 in Northern Ireland. In the survey, respondents were asked about staffing levels, the quality of services, the capacity of the day units and trends in workload (see box).
Overall, 91% of respondents reported that their pharmacy service had been responsible for “same day” treatment delays, defined as any occasion when a patient’s IV SACT was not available at the scheduled time of administration.
When asked how often the pharmacy was responsible for same-day delays, 45% said it happened monthly, while 27% said it happened weekly and 16% reported daily delays.
The most common cause of pharmacy-related delays in the delivery of IV SACT was a delay in the delivery of SACT by commercial compounding companies (69%), followed by delayed compounding within the pharmacy’s aseptic pharmacy (62%), delays in screening for prescription (55%) and delays in checking or releasing SACT (any source) (45%).
The survey examined cases where a patient’s treatment had to be moved to another day because the pharmacy was unable to provide their IV SACT.
Of the respondents, 76% indicate that this has happened at least once in the past six months, with 43% indicating that this has happened at least monthly and 24% at least weekly.
The main causes of these specific delays were known staffing problems (33%), aseptic capacity of the unit (35%) or failure of the commercial link/NHS unit to deliver the drugs (67%).
“Pharmacy IV SACT services are under great pressure and approaching crisis point,” the report concluded.
“Currently, this manifests itself in poor patient experience, difficulties with recruitment and retention, and delays in treatment.”
Rob Duncombe, Chief Pharmacist at the Royal Marsden NHS Foundation Trust, said: “In recent months I have been struck by the number of times patients have had their treatment delayed due to problems in pharmacy. The results of this study show that this is a national problem.”
Duncombe said the causes of the delays were “mutifactorial” and it would take a “significant amount of effort” both locally and nationally to resolve.
“Ultimately there is a cancer patient waiting for us to deliver their treatment and we all need to redouble our efforts to ensure they have the very best experience at an incredibly difficult time in their lives.”
The report recommended that “urgent action” was needed to address the issues identified in the report, including a review of the regulatory environment in which aseptic units operate, to enable units of capacity to other hospitals within their integrated care system, and action to ensure pharmacy teams are part of all capacity planning discussions related to IV SACT services.
NHS England has been approached for comment but failed to provide in time for publication.
Box: Other findings
- In the technical services, the most difficult posts to fill were in band 3 and band 4, while the highest percentage of vacant posts was in band 7;
- In clinical services, the most difficult vacancies to fill were in band 7 and band 8, while the highest percentage of vacancies was in band 4.
Day unit capacity:
- 40% of respondents said their institutions experienced delays in starting patients on IV SACT;
- Of those who reported delays, 23% said the delay was less than 1 week, 45% said one to two weeks, and 18% said two to four weeks;
- 45% of respondents said the pharmacy team was involved in capacity planning discussions in their facility.
- 85% of respondents reported that workload had increased compared to pre-COVID-19 levels;
- 96% expected it to continue to rise over the next five years.
- The participants were asked to rate how concerned they were about IV SACT services and their ability to continue to provide IV SACT to patients over the next two years on a scale of 1-10 (1 = no concern, 10 = very concerned);
- The median score was 8.