National Evaluation of Capacity in Intravenous Systemic Anti-Cancer Therapy (IV SACT) Preparatory Services

For some time concerns have been expressed across the UK regarding pharmacy aseptic SACT services and their ability to meet the ever-increasing demand for intravenous systemic anticancer therapy (IV SACT).

A combination of factors is believed to be creating a “perfect storm”:

  • Commercial compounders unable to meet demand for products
  • Increasing demand for IV SACT as hospitals fully recover from the COVID pandemic
  • Reductions in local aseptic unit capacity as units close either due to facilities being no longer fit for purpose, or recruitment difficulties making it impossible to sustain a viable and safe service
  • Recruitment and retention issues in pharmacy aseptic services affecting all grades of staff

This survey was undertaken by the Research Subcommittee of the British Oncology Pharmacy Association (BOPA) and supported by the Royal Marsden service evaluation committee. It was conducted in June-July 2022 and aimed to collect data from across the UK to demonstrate the extent of the problem, and for this information to support service leaders in taking steps to avert a situation where patient outcomes start to become affected by supply issues in pharmacy

In total, 69 completed responses were received capturing responses from 50 SACT providers in England, 4 in Scotland 12 in Wales and 3 in Northern Ireland. Most responses were from NHS providers, however 2 responses were received from independent sector SACT providers (3%).  

The key issues identified are:

1. The failure of commercial compounders to meet demand, and the subsequent delays and changes to orders meaning that patients are having treatments delayed or rescheduled creating additional workload for all staff involved in the treatment pathway.

2. High vacancy rates in both aseptic and clinical services mean that services are working at, or above capacity. Often these posts are hard to fill, with posts advertised several times before they are recruited into. 

3. When services are under strain, errors are more likely to occur. For staff involved in these errors there is a resulting loss of confidence and for some, a desire not to work in such a high-risk environment, further adding to existing workforce pressures.

4. When planning services, pharmacy capacity is not being taken into consideration by all providers, with an assumption that “pharmacy can cope”. It may well be the case in the future that the rate-limiting factor in the provision of IV SACT is pharmacy’s ability to provide the drugs.

The report makes a number of recommendations summarised below 

1. Recognition, outside of pharmacy, that this is a serious issue, with huge potential to affect the ability of hospital pharmacy teams to supply IV SACT.

2. The relationships with commercial compounders and larger licensed NHS units is key. Hospitals must work in partnership with these entities to ensure that all parties do everything they can to utilise optimally the limited aseptic compounding capacity available. All hospitals must fully adopt dose banding and standardisation in order that these products can be made in large volumes and truly become “off the shelf” products.

3. A clear plan must be developed to address both the short-term and long-term issues around IV SACT supply. Action is needed to address the workforce issues that are affecting all compounders of IV SACT.

4. A review of the regulatory environment in which hospital pharmacy aseptic units operate, to enable aseptic units with capacity to support other hospitals within their integrated care system (ICS) areas needs to be undertaken. There will always be a small number of products that have to be prepared locally on a patient-specific basis, and currently no mechanism exists for these products to be made, without relying upon commercial compounders.

5. Optimising the aseptic resources that we do have. Aseptic units should only be preparing those products that they have to prepare. Clear guidance is needed defining what should and should not be prepared within a hospital aseptic unit (e.g. standardising the preparation of some monoclonal antibodies in clinical areas) in order to make optimal use of the limited resources we have available.

6. Pharmacy teams must be part of all capacity planning discussions regarding IV SACT services. This may ultimately mean that alternative treatment options are followed in order that hospitals can provide all treatments to patients on curative treatment pathways.

Contact Details.

Professor Rob Duncombe.

Emma Foreman.

Jurga Biliune.

The full report can be read here