Tjalma Waa, Huizing M T, Papadimitriou K
Multidisciplinary Breast Clinic, Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Antwerp.
Facts Views Vis Obgyn. 2017 Mar;9(1):51-55.
Trastuzumab has become standard of care in the treatment of early and metastatic HER2-positive breast cancer. Initially trastuzumab could only be administered intravenously (IV), however since a few years there is also a subcutaneous (SC) formulation. The efficacy and the safety profile of both formulations is the comparable. The administration logistics however have an impact on the patients, the health care professionals (HCPs), the hospital and the government. The preference for the patients (89%) and the HCPs (77%) is in favour of the SC formulation. The patient chair time per cycle, as defined by the time between entry and exit of infusion chair, is between 53 and 122 minutes shorter for SC administration. Also, the time actively dedicated by the HCP on preparation and administration SC, is between 17 and 50 minutes shorter per cycle. These time savings may increase the capacity of an oncological day clinic and reduce waiting lists. An additional benefit is that the use of SC formulation reduces the consumables and the waste. When the SC form was given at home instead of in the hospital the safety profile remained the same, but the satisfaction rate improved further for both the patients and the HCPs. The next and final step will be potentially to invest in teaching the patients to self-administer the medication. The home administration and the education of the patients and the HCPs will have a cost price and it will be interesting to see how the hospital financial authorities and the government will deal with this situation in the time of budgetary restrictions.
曲妥珠单抗已成为早期和转移性HER2阳性乳腺癌治疗的标准疗法。最初，曲妥珠单抗只能静脉注射（IV），然而近年来也有皮下（SC）制剂。两种制剂的疗效和安全性相当。然而，给药方式对患者、医护人员（HCP）、医院和政府都有影响。患者（89%）和医护人员（77%）更倾向于皮下制剂。每个周期的患者在输液椅上的时间，即从进入输液椅到离开输液椅的时间，皮下给药缩短了53至122分钟。此外，医护人员用于准备和给予皮下制剂的时间，每个周期缩短了17至50分钟。这些时间的节省可能会提高肿瘤日间诊所的容量并减少候诊名单。另一个好处是，皮下制剂的使用减少了耗材和浪费。当皮下制剂在家中而非医院给药时，安全性保持不变，但患者和医护人员的满意度进一步提高。下一步也是最后一步可能是投资培训患者自行给药。患者在家给药以及对患者和医护人员的教育将产生成本，有趣的是看看在预算受限的情况下，医院财务部门和政府将如何应对这种情况。
