A qualitative study of the barriers and enablers to administration of supportive therapy closer to home for breast cancer patients

Exploring the advantages and barriers to administering breast cancer treatment closer to a patient’s home.

John Minshull, University College London Hospital

This project is funded through the BOPA-PRUK Research Award.

Denosumab 120 mg subcutaneous injection (Xgeva®) is an element of supportive care given to patients with or who have suffered from solid tumors to prevent skeletal realted events associated with bone metastases. This treatment has been recommended as a cost-effective intervention by the National Institute for Health and Care Excellence (NICE TA 265).

Where denosumab is administered, patients in North Central London (NCL) receive the injection from their local chemotherapy unit. For two groups of patients (those whose chemotherapy cycle falls outside the denosumab cycle and those no longer receiving chemotherapy) this is inconvenient as they attend the chemotherapy centre just for this injection.  It is also expensive to the Clinical Commissioning Group (CCG) that pays for the treatment (up to £513 + local market force factors (MFF) per administration).  The MFF is a local adjustment calculated for each hospital based on the relative cost of providing the same care package at that site.

The NCL Joint Formulary Committee, a group of senior NHS medical and pharmaceutical professionals, determined that denosumab injection does not need to be given in the chemotherapy unit as this is not a high risk drug in terms of handling, and doesn’t require complex interpretation of blood results before administration, therefore there is support in NCL to explore other delivery options for denosumab, including administration by the GP, administration in a community health centre and self-administration by the patient, to improve patient experience.

This research aims to understand the views and opinions of two stakeholders that would be affected by the decision to administer denosumab closer to the patient’s home: the patient and the GP. These viewpoints are essential to ensure the success of this medicines optimisation project.

This project started in July 2016 and is due to finish in March 2018.