Mapping of sterile anticancer drug preparations in hospital pharmacies in Nouvelle-Aquitaine: current status, territorial disparities and opportunities for cooperation

Introduction
In Nouvelle-Aquitaine, despite observed territorial disparities, no structured mapping of the supply of systemic anticancer therapy (SACT) preparations in hospital pharmacies (HP) has been carried out to date. The new “Good Preparation Practices” (GPP, 2023) provide an opportunity to rethink cooperation between healthcare facilities (HF). With increasing demand and staffing shortages, regional coordination is becoming essential. The aim of this mapping is to provide an overview of s the current capacity for SACT preparations in cytotoxic reconstitution units (CRU), identify territorial disparities, and support HF facing difficulties or transitioning toward subcontracting.

Materials & methods
A descriptive analysis was conducted based on data collected in 2020–2021 from HP in the region. The survey focused on the production volumes of three drug classes (cytotoxic drugs, immunotherapies, and innovative therapies), number of patients treated, contingency agreements, existing subcontracting arrangements, and intentions to cease production. Results were analyzed by department, type of facility (public or private), and care services.

Results
Among the 52 HF using systemic anticancer therapies (SACT) in Nouvelle-Aquitaine, 85% (n=44) were self-compounding centers. Production was concentrated in the most populated departments (Gironde, Charente-Maritime, Pyrénées-Atlantiques), and remained low in rural areas (Dordogne, Creuse, Lot-et-Garonne). Nine CRU produced over 20,000 preparations annually, while 40% (n=20) produced fewer than 10,000, and some fewer than 5,000 — the threshold below which the SFPO recommends subcontracting. University hospitals accounted for 30% of the annual regional output (n=188,057). Only 30% of HP had a contingency agreement, and none of the university hospitals did. Between 2020 and 2021, production increased by 5.3%, from 592,712 to 625,603 bags. Nine CRU acted as ordering parties, and nine others were considering discontinuing their activity. These findings revealed marked disparities in production capacity and access to CRU, as well as a need for harmonization and resource sharing.

Discussion/Conclusion
This mapping provides an operational tool to support HP in developing structured regional cooperation. It highlights opportunities to optimize production capacity, and improve quality and safety of preparations. It could also serve as a model for other regions, promoting resource sharing and care efficiency.

Keywords MeSH: Drug Compounding, Cancer Treatment, Geographic Mapping