WASHINGTON — Earlier this year, the VA announced expansion of the “Close to Me” cancer program, with the understanding that access to medical centers providing specialty cancer care can be difficult for many veterans.
The expansion will bring new cancer diagnosis, treatment, and surveillance services to an additional 9,000 veterans and 30 locations by the end of October 2025.
Under this program, VA clinicians travel to provide veterans with care at nearby community-based outpatient clinics, often in rural locations. Patients don’t have to travel to medical centers for cancer care, which can be challenging, especially for those who are seriously ill. The program also allows more veterans to access VA care instead of having to go outside the network.
“We want veterans to have easy access to the care they need, where they need it,” said VA Secretary Denis McDonough in a press release. “We also know that VA provides the best care possible for veterans. This expansion will provide veterans with a VA care option that delivers truly personalized, high-quality, integrated cancer care closer to where they live.”
To date, the service has resulted in savings of more than $1.9 million in medication costs by leveraging VA’s statutory access to reduced drug costs compared with costs if those same patients had been referred to the community, according to the department.
In a similar vein, a recent study pointed out that the time required for in-clinic drug administration can substantially affect breast cancer patients’ quality of life. Dana-Farber Cancer Institute-led researchers pointed out that subcutaneous (SC) drug administration, as compared to intravenous (IV), might reduce the time commitment.
The study published in JCO Oncology Practice sought to estimate the difference in time burden between IV and SC administration of trastuzumab and pertuzumab (HP).
To do that, the study team prospectively enrolled a subcohort of patients participating in the ADEPT trial, which investigated adjuvant HP plus endocrine therapy for stage I human epidermal growth factor receptor 2–positive breast cancer, to a single-arm crossover time and motion substudy.
In the substudy, patients received two cycles of IV HP followed by two cycles of SC HP, with researchers capturing time points in drug preparation and administration were captured within each cycle.
Defined as the primary endpoint was total patient time in the treatment chair. Other endpoints included total patient treatment experience time and total pharmacy workflow time. The sample size of 22 patients was estimated to provide 90.7% power with two-sided alpha .05 to detect a difference of 70 minutes in the primary end point by treatment arm (IV v SC).
Results indicated that the mean total patient time in the treatment chair was 61.8 minutes shorter with SC versus IV HP (22.5 v 84.3 minutes; P < .0001). At the same time, the mean total patient treatment experience time (incorporating time spent waiting for treatment initiation and time spent in the treatment chair) was 81.8 minutes shorter for SC administration (96 v 177.8 minutes; P < .0001).
In addition, the pharmacy workflow time was 78.2 minutes shorter for SC versus IV formulation (41 v 119.2 minutes; P < .0001).
“SC administration of HP shortened patient time burden by approximately 1 hour. SC drug administration can facilitate faster workflows for healthcare professionals and improve patients’ breast cancer treatment experience,” the authors wrote.
“H and P were both initially developed as intravenous (IV) infusions and are often still administered as such,’ the researchers explained. “However, more recently, subcutaneous (SC) trastuzumab and a fixed-dose SC combination of HP have been developed and shown to be safe and noninferior to the IV forms.7,8 Furthermore, more than 90% of patients in the PrefHer study and 85% in the PHranceSCa study preferred SC injection of trastuzumab and fixed-dose HP, respectively, as compared with IV infusion, citing reasons such as reduced clinic time and improved comfort during administration.
“Both time and comfort are important components of a breast cancer patient’s overall quality of life. In particular, time-consuming treatments can pose significant psychosocial, financial, and work-related toxicities for patients. A better understanding of the potential time savings of SC administration is important for optimizing quality of life in this patient population, as well as health system efficiency.”
An accompanying editorial from Arjun Gupta, MD and Rachel I. Vogel, both of the University of Minnesota; Michelle Treager, PhD, of the National Breast Cancer Coalition in Washington, DC, and Makala B. Pace, PharmD, of the University of Utah in Salt Lake City stated, “We applaud the authors for conducting and reporting this substudy. As more SC formulations become available, the oncology community should carefully consider attributes relevant to various stakeholders—patients, care partners, clinical staff, health systems, and payers—so patients can maximize the advantages of scientific progress and their quality of life.”
Waks AG, Chen EL, Graham N, Frey AM, et. Al. Subcutaneous vs Intravenous Trastuzumab/Pertuzumab: A Time and Motion Substudy of a Phase II Trial of Adjuvant Trastuzumab/Pertuzumab for Stage I HER2+ Breast Cancer (ADEPT trial). JCO Oncol Pract. 2024 Jul 19:OP2400021. doi: 10.1200/OP.24.00021. Epub ahead of print. PMID: 39028923
