Rethinking the delivery of biologic cancer treatment in New Zealand

In New Zealand, approximately 25,000 people are diagnosed with cancer each year¹. Like many other health systems around the world, our system is struggling to meet the demand for cancer care.

Treatment delay can be long and tiring for patients. Health system capacity issues are also exacerbating medicines access inequities for high risk groups such as rural, Māori and Pacific communities, on top of existing barriers like proximity to health facilities.

This is why beyond treatment outcomes, modes of administration are an increasing focus for healthcare organisations like ours.

Subcutaneous injections can reduce waiting times, free up our hospitals, and improve patient access to cancer treatment.

Infusion or Injection?

For decades, most biologic cancer therapies were given intravenously (IV, via a cannula directly into a patients vein). In recent years, this has started to change and more medicines can also be administered subcutaneously - directly under the skin. Intravenous infusions can take from 30 minutes to several hours, while subcutaneous medicines can be administered within minutes.

Provide more flexible, patient- and whānau-centred care to New Zealanders

The shorter administration time of subcutaneous treatments mean patients spend less time receiving treatment, whether that be in hospital or clinic, translating to less time away from children or work, reduced childcare costs and reduced parking costs.

The flexibility of subcutaneous administration also means patients may be able to receive their treatment outside of the hospital setting and closer to home (i.e. clinic, healthcare facility, or in some cases at home). This model of care would mean a lower treatment burden for patients and their carers and whānau due to reduced travel time and the downstream costs (e.g. time off work, childcare, transport).

Patients prefer subcutaenous injection over intravenous treatment as it is less invasive. One clinical study found that 88.9% of patients with breast cancer preferred subcutaneous treatment over intravenous, and 60.4% of patients would hypothetically have preferred subcutaneous home administration². Many studies have produced similar findings for other subcutaneous medicines.

Free up health system capacity by saving time and resources

Nurses do not just administer treatments, they also play a crucial role in many other ways - making patients feel as comfortable as possible and helping them and their families to adapt. Often facing a heavy workload, nurses can benefit from advancements in drug administration technology, ideally helping them be as efficient as possible.

Subcutaneous treatments offer resource savings for hospitals, including reduced chair time, healthcare professional time (reconstitution, administration and monitoring for nurses and pharmacists) and less consumables. By introducing more subcutaneous medicines, hospitals can free up nurse and infusion capacity for other patients or medicines where there is no subcutaneous (or oral) administration option³.

Reduce medicine access inequities by enabling closer to home treatment

Closer to home treatment offers patients the ability to receive their medicine in a community setting closer to whānau support, while reducing time spent travelling to and at the hospital, and the associated costs. For many New Zealanders living in remote communities or urban communities that are situated some distance from a clinic / treatment facility, closer to home care could be life-changing. Shifting aspects of care to the community also has the potential to free up hospital capacity and reduce access inequities which currently exist. Subcutaneous medicines enable closer to home treatment as they can often be administered outside of a hospital and are typically quick and convenient to administer.

Are you a healthcare professional? Visitfor more information on Roche products, including Cost Share Programmes for our subcutaneous medicines.

REFERENCES:

1. Te Aho O Te Kahu / Cancer Control Agency. Cancer in Numbers in Aotearoa New Zealand. [Internet; cited July 2023] Available here. (https://teaho.govt.nz/cancer-numbers)

2. Pivot X, Gligorov J, Müller V, Curigliano G, Knoop A, Verma S, Jenkins V, Scotto N, Osborne S, Fallowfield L; PrefHer Study Group. Patients' preferences for subcutaneous trastuzumab versus conventional intravenous infusion for the adjuvant treatment of HER2-positive early breast cancer: final analysis of 488 patients in the international, randomized, two-cohort PrefHer study. Ann Oncol. 2014 Oct;25(10):1979-1987. doi: 10.1093/annonc/mdu364. Epub 2014 Jul 28. PMID: 25070545.

3. O'Shaughnessy J, Sousa S, Cruz J, et al. PHranceSCa study group. Preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive early breast cancer (PHranceSCa): A randomised, open-label phase II study. Eur J Cancer. 2021 Jul;152:223-232. doi: 10.1016/j.ejca.2021.03.047. Available here. (https://pubmed.ncbi.nlm.nih.gov/34147014/)