Ascertaining the causes of delays in delivery of out-patient systemic anti-cancer therapy (SACT) for metastatic soft tissue sarcoma (STS); baseline data & quality improvement project (QI)

Introduction: In 2018 Olaratumab and Doxorubicin was introduced as 1st line treatment for metastatic STS, this project aimed to assess the impact on SACT delivery and improve this with a clinical nurse specialist (CNS) led service. Methods: A protocol for a CNS clinic was developed under a Joint Working Agreement (JWA) with Lilly UK providing QI consultancy. Data sources included patient diaries & interviews, time in motion, the electronic chemotherapy prescribing and dispensing system. JMP statistical software was used for analysis. 1o end point was ‘total time of treatment’, measured from clinic check in to discharge. Results Patient diaries demonstrated an average of 8 hours 2 minutes were spent in hospital. Optimal time from authorisation to treatment end was calculated as 3.5 hours, however actual duration averaged 6.3 hours. Treatment delays of an average of 79 minutes from planned to actual start time and a delay of an average of 106 minutes from planned to actual end time. There was variance in delays across the 5 treatment areas, from 89 to 223 minutes. Clinical pharmacy authorisation consistently took 29 minutes on average. A reduction in the delay from authorisation to treatment end occurred from cycle 1 to subsequent cycles. Interviews detailed the negative impact of delays on patient experience of SACT administration. Conclusions: Patients faced delays, spending most treatment day waking hours at the hospital. Doxorubicin monotherapy is again standard treatment; these methods will be applied to the new SACT CNS clinic, plus patient satisfaction assessed using EORTC QLC-30 & OUTPATSAT7.