Continuity of cancer treatment preparation : what resources are available at the regional level?

Introduction
Healthcare centers (HC) are faced with unscheduled interruptions in their cancer treatment preparation activities, particularly due to equipment failures, contamination, or human resource (HR) difficulties. In such situations, mutual assistance between HC could be a solution. In order to ensure continuity of preparation activities, consideration is being given to establishing regional inter-center cooperation. The aim is to identify the human, material, and organizational resources that each HC could mobilize if necessary.

Method
A Google Forms^® survey was sent to all pharmacists in charge of a Centralized Chemotherapy Preparation Unit (CCPU) in private and public HC via the mailing list of the regional college of oncology pharmacists (RCOP). It contained 75 questions divided into seven sections : equipment, HR, production capacity, subcontracting, cessation of activity, continuity plan, and regulatory framework. Each HC had 15 days to respond.

Results
The response rate within the specified time frame was 18 out of 21 respondents. The isolator was the most used equipment (n = 26), followed by the laminar flow cabinet (n = 9) and automated preparation robots (n = 2). A total of 88 pharmacists/residents and 190 technicians are trained in this activity, which involves 20 pharmacists/residents and 69 technicians on a daily basis. The CCPUs are generally open 8 hours a day, 5 days a week. Per site, the average number of daily preparations is 80 and could reach 140 in the absence of HR or material constraints, representing a 75% increase in capacity. In the event of an interruption in activity, the main need expressed is access to external premises (n = 13), and 11 HC are willing to lend theirs. Outsourcing preparations, already carried out in 10 HC, is the most proposed form of assistance. The majority of HC could offer to produce fixed doses in series for other HC, by increasing the number of hours and technicians; the main limiting factor cited is the lack of staff.

Discussion - Conclusion
More than half of HCs say they are willing to help each other, with alternative solutions already partially in place but still needing to be structured. However, there appears to be a discrepancy between the resources that could theoretically be mobilized and the feelings of professionals in their daily practice. These results were discussed during the RCOP day and presented to the Regional Health Agency. Ultimately, the implementation of a regional cooperation strategy (standard assistance agreement) may require regulatory changes in order to provide a legal framework for mutual assistance between HC.

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