School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan.
Department of Pharmacy System, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
BMJ Open. 2023 Mar 16;13(3):e059288. doi: 10.1136/bmjopen-2021-059288.
This study aimed to compare the time required and concerns raised by various perspectives of participants regarding administering subcutaneous and intravenous trastuzumab for patients with breast cancer (BC).
This observational time-motion study design with mixed-methods research (cross-sectional surveys and semistructured interviews) was conducted. The time spent on preparing or administering trastuzumab by different healthcare professionals (HCPs) was recorded. The data were analysed by descriptive/inferential statistical analyses, followed by thematic analyses.
Outpatient and inpatient administration units of a single medical centre in Taiwan.
The study included patients with early-stage BC who received subcutaneous or intravenous trastuzumab (n=93), and HCPs including two attending physicians, a nurse practitioner, two pharmacists and two nurses.
Based on the perspectives of patients and HCPs, the subcutaneous form of trastuzumab was more efficient, less expensive and produced less discomfort in outpatient units than inpatient units. More participants preferred the subcutaneous form over the intravenous form in both outpatient and inpatient units. Pharmacists and nurse practitioners spent threefold more time on patients when preparing and administering the intravenous form in both outpatient and inpatient units. The concerns raised by patients and HCPs varied in certain aspects, including the injection skills, speed, mental distress (eg, needle phobia) and pain associated with the subcutaneous form. Almost all patients preferred receiving the subcutaneous form in outpatient units after the initial COVID-19 outbreak.
Patients with early-stage BC preferred receiving subcutaneous trastuzumab in outpatient units rather than inpatient units or the intravenous form before and after the COVID-19 outbreak. Such findings may serve as real-world evidence to facilitate better quality of care regarding administration of subcutaneous or intravenous trastuzumab in medical settings, and its feasible resolutions to balance the quality, concerns and efficiency of anticancer administration during the COVID-19 pandemic.
本研究旨在比较不同参与者对乳腺癌（BC）患者皮下和静脉注射曲妥珠单抗所需时间和关注问题。
本观察性时间运动研究设计采用混合方法研究（横断面调查和半结构化访谈）。记录不同医护人员（HCP）准备或给予曲妥珠单抗的时间。采用描述性/推断性统计分析对数据进行分析，随后进行主题分析。
台湾一家医疗中心的门诊和住院部。
本研究纳入了接受皮下或静脉曲妥珠单抗治疗的早期 BC 患者（n=93），以及包括两名主治医生、一名护士从业者、两名药剂师和两名护士在内的 HCP。
基于患者和 HCP 的观点，与住院部相比，门诊部皮下形式的曲妥珠单抗在效率、成本效益和患者舒适度方面更具优势。在门诊和住院部，更多参与者更喜欢皮下形式而非静脉形式。在门诊和住院部，药剂师和护士从业者在准备和给予静脉形式时，为每位患者花费的时间是准备和给予皮下形式的三倍。患者和 HCP 在某些方面提出了不同的关注问题，包括注射技巧、速度、精神困扰（如，恐针症）和与皮下形式相关的疼痛。在 COVID-19 疫情爆发后，几乎所有患者都更喜欢在门诊部接受皮下曲妥珠单抗。
在 COVID-19 疫情爆发前后，早期 BC 患者更喜欢在门诊部接受皮下曲妥珠单抗，而不是在住院部或静脉形式。这些发现可能为医疗环境中曲妥珠单抗皮下或静脉注射管理提供真实世界的证据，以促进更好的护理质量，并为 COVID-19 大流行期间平衡抗癌药物管理的质量、关注问题和效率提供可行的解决方案。
