The Medical Oncology Advisory Board Meeting – Summary Report

The BD Medical Oncology Advisory Board has been created with the long-term aim of understanding medical oncology workflows, decision-making processes in cancer treatment, and the different oncology practices across Europe. The Board also aims to develop and create:

Awareness and education on best practices in medical oncology preparation and administration
Identification of the workflow best practices from the aseptic pharmacy to the oncology ward, that would help provide optimal patient care
A series of tools to drive implementation of best practices from safe preparation to optimised delivery

Another important objective of the board is to identify opportunities for BD to be a valuable partner for medical oncology healthcare professionals and to improve patient outcomes.

The first advisory board meeting

At its first meeting held on the 21 and 22 May 2021, the Medical Oncology Advisory Board gathered to understand the challenges in the current practice of parenteral therapy in oncology across Europe. The discussion aimed to understand the safe preparation and delivery of parenteral therapies in oncology as well as to outline possible future developments of these therapies.

The Advisory Board

The advisory board consists of nurses, pharmacists and oncologists from seven European countries:

Prof. Karin Jordan, University of Heidelberg, Germany
Prof. Irene Kraemer, Johannes Gutenberg-University, Mainz, Germany
Prof. Thomas Decaens, CHU Grenoble, France
Prof. Bruno Vincenzi, Campus Bio-Medico di Roma, Italy
Mrs. Grażyna Suchodolska, Medical University Gdansk, Poland
Dr. Jose Manuel Martinez Sesmero, Complejo Hospitalario de Toledo, Spain
Mrs. Åsa Ekbom-Claesson, Danderyds Sjukhus, Stockholm, Sweden
Dr. Susanne Cruickshank, The Royal Marsden NHS Foundation Trust, London, UK

Summary of the meeting

Discussions on oncology workflows, including pre-treatment, preparation and administration, formed a substantial part of the meeting. In pre-treatment workflows, the board members emphasised the need to focus on patient safety. The members highlighted that the aspects of the parenteral treatment of greatest concern include efficacy, safety, quality of life and the functional status of the patient. They were also of the opinion that support for nurse-led education on potential toxicities and effective communication between treatment centres would be beneficial for establishing the patient plan.

In the preparation phase, the board members recommended the use of closed-system transfer devices (CSTDs) for the preparation of oncology drugs. They felt that with an increasing trend towards automation, there is a need to investigate how to integrate CSTDs into the new automated processes. In addition, the board members highlighted an increased awareness in the nursing community about the need for CSTDs, with the budget holders often being unaware of their benefits for nursing staff. Training and simulations are important to overcome challenges with implementation, including issues with repetitive strain injury.

To avoid surface contamination, the board members advised routine monitoring using wipe sampling and hazardous drug monitoring devices, as a part of a surface contamination assessment program. The members felt that there is a need to implement such monitoring in hospital wards, although acceptable levels of exposure for healthcare workers still need to be established. Occupational health managers and risk managers should be involved as responsible persons.

In oncology administration, the board members discussed the challenges in therapy administration due to delays in receiving results from laboratories, the volume of treatment and the complexity of treatment regimes, in addition to cannulation difficulties, and occlusions. The members recommended the use of a vascular access team for catheter placement and that clinical pharmacists be present in the ward.

According to the board members, the choice of vascular access devices is governed by many factors including patient vasculature, lifestyle, phobia of needles/surgery, vesicant, duration, concomitant therapy, osmolarity, pH, long immunosuppression and guidance or influence of hospital procedures. BD is developing a tool based on a device assessment decision tree that starts from the drug and includes patient conditions and preferences, which could help ensure the selection of the right device right at the beginning of the therapy.

A BD oncology workflow tool model was also discussed. The board members believe that BD Oncology Simulation Tool is a valid support because it uses local hospital data to compare and benchmark with literature and also recognises areas of improvement.

The future

According to the board members, oncology therapies are expected to undergo a major transformation in the coming years due to the introduction of gene therapy and engineered CAR–T cells. However, these techniques will only complement and not replace conventional chemotherapy. The members believe that oral therapies are a solution for procedural risks if challenges with solubilisation and uptake are resolved. They also think that this will increase hospital workload, as cycles of standard chemotherapy can be followed by cycles of immunotherapy.