Parliamentary team for oncology: differentiated forms of drug administration

Prof. Maciej Krzakowski, national consultant in clinical oncology and president of the Polish Society of Clinical Oncology, stressed that the increase in the number of cancer cases and the shortage of doctors and nurses in basic oncology specialties necessitates a reorganization of the delivery system. He spoke of the need to reduce the number of hospitalizations and outpatient services. Subcutaneous and oral medications make it possible to replace inpatient treatment with outpatient or home-based therapy. - This is a huge relief for the system," he pointed out. - The number of patients is growing, thanks to the development of medicine they are living longer and longer, so the patient's time in the system is also increasing. Patients even with advanced breast cancer are often treated for 10 years. Cancer is becoming a chronic disease. Therefore, solutions are needed to help us meet these challenges," added Prof. Barbara Radecka, head of the Oncology Clinic at the Opole Oncology Center.

The same is true for lung cancer patients, who are living longer thanks to modern innovative therapies.

Clinicians on benefits of subcutaneous therapies

Prof. Iwona Hus, head of the Department of Hematology at the National Medical Institute of the Ministry of Internal Medicine, speaking of the benefits of subcutaneous therapies, mentioned the lower risk of systemic side effects, reduced staff commitment, and the possibility of admitting more patients in day stays, among others.

Dr. Maciej Bryl, director of the Wielkopolska Pulmonology and Thoracic Surgery Center, added that the number of patient visits at his facility has increased several times in two years. - The subcutaneous forms shorten the patient's stay and thus more patients can be admitted, he stressed.

Prof. Barbara Radecka also emphasized the benefits of the subcutaneous form of drug administration. - This creates more opportunities to diversify the places where the procedure is performed. These can be nurses' offices, home hospices, or the patient's home, she enumerated.

She talked about the results of the prospective FlexCare study, which was conducted at the Opole Cancer Center in 2022. It proved that it is safe and possible to administer cancer drugs available in drug programs at the patient's home. Prof. Barbara Radecka pointed out that RA patients have the option of administering biologic drugs to themselves at home.

She pointed out that the preparation of intravenous drugs involves a pharmacist, who is not needed to prepare subcutaneous drugs.

However, she noted that the low valuation of the subcutaneous drug administration procedure may be a barrier to access to this form of administration, but from the clinician's point of view it is very important to be able to reach for different solutions.

Counted savings

Katarzyna Klimkowska, representing the health ministry, admitted that the optimal solution is to provide all forms of a given therapy. The limitation, however, is cost. - Dilemmas arise as to whether to finance a new therapy or an existing one in a more convenient form, she said.

As patient organizations have pointed out, by making a more patient-friendly form of drug administration available, especially if there is an intravenous equivalent, it does not increase the patient population. Subcutaneous therapy in such situations is used interchangeably with intravenous therapy, which is already available and reimbursed.

Irena Rej president of the Economic Chamber of Pharmacy Poland stressed that today the Ministry of Health has a whole range of different tools, RSS, corrective factors, etc., to secure the payer's budget. She pointed out that subcutaneous forms are a natural result of advances in medicine.

As Prof. Barbara Radecka rightly pointed out, reimbursement decisions are issued for a specific period of time and the drop in price to the 15-20% indicated by the Treatment Department is a process calculated over years.

According to the meeting participants, making drugs available to patients in a more favorable form of administration while maintaining the same clinical effect is not only a benefit to the patient, but most importantly a savings for the health system.

Dr. Michal Seweryn, a specialist in epidemiology and public health, proved that the use of a subcutaneous form of drug administration will become a necessity. He recalled that epidemiological forecasts show an increasing incidence of cancer. - Since 2019, there has been an increase of almost 60% in the number of DILO cards issued. Meanwhile, the number of hospitals implementing drug programs is not increasing. In the autumn enrollment in 2023, there were 39 applicants for the oncology specialty out of 200 places, he calculated.

Citing a British study, he pointed out that subcutaneously administered drugs can save 45 minutes of staff involvement in patient care. The British calculated that fewer occupied beds, reduced staff time, lower administration costs, shorter patient stays in the hospital, and lower risk of infection generated £7 billion in savings between 2021 and 2023.

Dr. Michal Seweryn also spoke about the benefits for patients. On average, a Polish patient has to commute 40 km to an oncology center. These disorganize his professional and private life. Meanwhile, subcutaneous forms in oncology and hematooncology programs in 2023 were used by only 8% of patients.

Tailoring treatment to patients' expectations

Representatives of patient organizations spoke about the need to personalize therapy and tailor treatment to patients' expectations.

- I know that subcutaneous drugs are not coming in as fast as you would like," admitted Michal Dzięgielewski, director of the Treatment Department at the Ministry of Health.

Meanwhile, as patient representatives pointed out, the work interruptions and loss of productivity associated with hospital administration of drugs is a measurable social cost. - Instead of spending a whole day in the hospital, patients prefer to give themselves the drug at home, emphasized Katarzyna Lisowska, leader of the Hematooncology Association. A patient who gets the drug intravenously requires hours of infusions, which must be controlled by a medical and nursing team, as complications can arise. Subcutaneously, the drug is administered in minutes and is very well tolerated.

Anna Kupiecka, president of the OnkoCafe Foundation - Together Better, pointed out that for patients who have their veins destroyed by infusions, the subcutaneous form of administration is the only possible one.

Patients also indicated that subcutaneous administration of the drug helps reduce infections acquired by patients during hospital visits.