Subcutaneous Treatment Alternative for Breast Cancer and Lymphoma Patients amid the Impending Threat of COVID-19

The COVID-19 outbreak is a current threat to the population worldwide, with domestic cases in Thailand rising up to 2,826 infections and 49 fatalities as of April 22th 2020.1 While most cases result in mild symptoms, infections for those in the high-risk groups can escalate critically and even lead to deaths. Amongst those at risk are cancer patients with compromised immune systems, who are under extreme risks for complications from the novel coronavirus. In addition to health threats for patients, the spread of virus also plays a large role in overwhelming the healthcare system when it comes to the rapid depletion of medical supplies, limitations in hospital beds capacity and most importantly exhausting the human resource of healthcare professionals (HCPs) who are continually called to work at the frontline of the pandemic.

The introduction of the SC therapy had expanded the options for patients who are required to endure chemotherapy treatments. Currently, there are options available for lymphoma and breast cancer, which aims to increase convenience of treatment through reduced treatment time. Based on 18 cycles, the SC treatment for breast cancer has a time reduction rate of 53.7% where the total service time can reduce from 23 hours to a little less than 7 hours including reduction of both the preparation time for HCPs and administration time for patients2. Similarly, the SC treatment for lymphoma can save up to a total of 32% in time reduction.3

Dr. Naiyarat Prasongsook, Medical Oncology Unit, Phramongkutklao Hospital stated “while IV Therapy is the most common form of treatment in chemotherapy; it does require the patient to stay at the hospital for a substantial period of time as the treatment comprises of many cycles and each cycle can take up to hours. In light of the recent COVID-19 outbreak, it is imperative that patients can gain access to a more convenient and less time consuming alternatives to reduce the risk of exposure to the coronavirus, simply by minimizing their time at the hospital. Alternately, there is the option of subcutaneous (SC) injection, which is administered into the fat layer between the skin and muscle and can reduce considerable treatment time of each cycle when compared to the traditional IV method. As far as the efficiency of both treatment methods, it is clinically proven that the SC treatment is comparable to its IV alternative and switching administration method will not compromise the efficacy or safety”. 

While physical distancing is advised, some cancer patients are inevitably required to receive treatments at hospitals where they are more prone to the exposure and threat of the COVID-19 virus. The most common form of cancer treatment is chemotherapy which is administered on a cycle basis, implying that the patient will need to make multiple visits to the hospital throughout the course of their treatment. Traditionally most hospitals are utilizing Intravenous therapy (IV) which is a method that delivers fluids directly into the vein where the duration and frequency of cycles vary from patient to patient depending on the type and extent of the cancer as well as other relevant factors.

Dr. Archrob Khuhapinant, MD, PhD, Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital states “with the current coronavirus threat, patients are confronted with the dilemma of balancing cancer care with the ongoing risk of exposure to the virus. Simply put, the longer they stay at the hospital, the higher the risk of getting infection. The number of health care providers is also reduced due to precaution measure to prevent infection. Not only does the SC treatment save time for the patients and their relatives, but it can also save the budget from IV set, admixture cost as well as hospital resources and personnel. As a result, this option will also provide more time for the HCPs to treat other cases, which will benefit the system especially during difficult times where resources are scarce”.

To further enhance the benefits and quality of life for patients, there are studies being conducted to test home administration of subcutaneous cancer treatment by healthcare professionals, signaling a more convenient and flexible future for cancer care. Specifically, the study trial conducted in Belgium and Israel examines the use of the subcutaneous method of breast cancer in a home-based setting which resulted in enhanced satisfaction, with both patients and HCPs citing the at-home administration as beneficial.4 The success of the study coupled with continual advancements in medical innovation creates a promising prospect for patients in Thailand and can help expand the accessibility of cancer care in the foreseeable future.   

The availability of SC treatment alternatives for breast cancer and lymphoma patients presents a vital solution for the healthcare system in the current dire situation. During this pandemic, efficiency in treatment time is the key in facilitating the flow of operation and relieving some of the overwhelming strain on healthcare professionals as well as minimizing risks for cancer patients.

Referance

1. “COVID-19 Live Update” Ministry of Public Health, 22 Apr. 2020, covid19.moph.go.th/#/portal

2. Cancer Medicine 2016; 5(3):389–397.

3. Erwin DC, et al. Time & Motion study in Eight Counties, 2016.[1] Bennett, Christina. At-Home Subcutaneous Injection of Trastuzumab Meets Safety Endpoint.

4. Bennett, Christina. At-Home Subcutaneous Injection of Trastuzumab Meets Safety Endpoint.