Optimisation of the organisation of a Chemotherapy Reconstitution Unit in a French Oversea Territory – Dose standardisation of paclitaxel

Introduction
French Polynesia (FP) has only one Chemotherapy Reconstitution Unit (CRU). As paclitaxel represents more than 13% of the total annual preparations of the CRU, it was decided to set up standard doses (SD) of paclitaxel to better distribute the activity of the CRU, to improve the efficiency of the daytime oncology unit and reduce waiting times for patients.

Methods
This single-centre study includes a cohort of 79 patients with breast cancer. Their maintenance therapy includes a weekly infusion of paclitaxel 80 mg/m². Prescription and preparation data were extracted from Asclepios^® software from October 2021 to March 2022. The SDs were established by considering the literature, and the analysis of the prescription and preparation data using an Excel^® spreadsheet.

Results
Over a 6 months period, 151 infusion bags of paclitaxel were prepared with prescribed doses between 117 mg and 160 mg. After defining the quartiles within this range, the average of the prescribed doses within each quartile was calculated. Considering the feasibility of preparation, four standard prepared doses were established to obtain a maximum variation rate of 5.6% between the lower and upper bound of the range covered: 126 mg [120-133], 138 mg [134-144], 150 mg [145-156] and 162 mg [157-162]. Of the patients, 23% have a body surface area greater than or equal to 2 m², thus it was decided to produce batches of 10 bags of 162 mg and 5 bags of each for the other doses. The allocation of the DS is carried out by the pharmacist according to the dose prescribed by the oncologist.
Currently, the preparation time for a bag of paclitaxel, from sterilisation to analytical control, is 20 minutes. The serial preparation of the DS makes it possible to reduce this time to 35 minutes for 5 bags, being 7 minutes per bag, representing a minimum time saving of 13 minutes per bag compared to current practice. Over a period of 6 months of activity, this would represent a time saving of nearly 33 hours for the staff of the CRU.

Conclusion
In the face of a strong increase in activity, the implementation of dose standardisation of paclitaxel makes it possible to optimise the organisation of the CRU and to improve the time used to make chemotherapy available for daytime oncology units. Other drugs are considered for dose standardisation in the future (oxaliplatin, irinotecan, etc.).

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