Non-administered chemotherapy preparations (NCPs) and COVID-19: what are the impacts?

E. DI FALCO , J. BOURBON, C. LEMARIGNIER, O. KAATZ-ESCHBACH, JD. KAISER Service Pharmacie-Stérilisation, Hôpitaux Civils de Colmar, 39 avenue de la Liberté, 68024 COLMAR

Introduction
In the current context of COVID-19 pandemic, number of patients need care at hospitals but dare not come in. The aim of this study was to rate COVID-19 impacts on the quantitative and economic evolution of non-administered chemotherapy preparations (NCPs), and to analyse the different reasons of non-administration.

Methods
Production of sterile chemotherapy products from March to June 2019 and 2020 is extracted from the CHIMIO ® software. At the same time, every NCP is prospectively collected in an EXCEL ® file since 2014, mentioning: the drug, the dose, the cost of the preparation, the reason for non-administration and if relevant, the reassignment of the preparation. Since 2019, some fixed-dose chemotherapies are produced by anticipation (ex: nivolumab, pembrolizumab): in case of non-administration, we do not take them into account in our calculations because they are systematically reallocated. The medical records and CHIMIO ® software enable to analyse the reasons for non-administration.

Results
In 2019, over the 4-month period, 7.909 chemotherapies were prepared. In 2020, 8.659 chemotherapies were prepared (+9,5%). As the pandemic continues, the chemotherapy day unit as the hospital make changes in real times to fit COVID-19, to prevent the spread of SARS-CoV-2 and to ensure proactively the best possible care. For example, patients are contacted via telephone the day before their scheduled appointment to check that they have not developed any symptoms. Compared to global activity, NCPs rate decreased by 0.10%, from 1.31% (104/7909) in 2019 to 1.21% (105/8659) in 2020. There is a decreasing trend, but it does not reach statistical significance (p=0.61). If we consider the preparations that may have been reallocated, 7/105 in 2020 and 2/104 in 2019, NCPs rate decreased by 0,19% to reach 1,10% in 2020 (p=0,29). The cost of the NCPs decreased from 31999.55€ in 2019 to 8659.55€ in 2020. Compared to the global costs of prepared chemotherapies, there is no significant decrease (p=0.44). The main reasons for non-administration were similar over the period: clinical or biological disorders (43 %), prescription changes after “OK Chimio” (37%).

Discussion-Conclusion
In the context of COVID-19 pandemic, questions have been raised and therapeutic strategies have been proposed on an international level (e.g.: reduce the frequency of hospital admissions, home care). But some patients will have to be admitted to hospital for systemic treatments and measures have been implemented: in particular, caregivers are advised to organise phone calls to patients with cancer planned to be admitted the following day. This new practice reduced the rate of NCPs preparations by 0.10% and will be followed long-term. In terms of cost, a decreasing trend is observed, possibly due to the decrease in immunotherapy prescriptions during the pandemic.

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