Challenging historical perspectives of the 24-h chemotherapy day: Flexible chemotherapy dose-timing guidelines

Aim: Variation in dose-timing within multiday chemotherapy regimens is largely unknown with convention being to administer subsequent days of treatment at 24-h intervals. However, in reality there are many occasions where doses are given either earlier or later to accommodate a variety of clinical and operational priorities. This project aimed to evaluate the degree of existing variation in chemotherapy dose-timing and to investigate whether deliberate variation could improve quality and efficiency outcomes such as reduction of after hours chemotherapy administration or reduced inpatient length of stay. Method: Chemotherapy charts and hospital admission datasets (n = 112) from sarcoma and hematology inpatient regimens were retrospectively audited to ascertain existing variation in dose-timing and overall length of stay. Clinical practice guidelines enabling a safe degree of dose-timing variation for individual chemotherapy regimens were developed, implemented over a 3-month period, and evaluated against safety, efficiency and economic outcomes. Results: Baseline dose-timing variation was common with administration occurring up to 8 h early and 7 h later than conventional 24-h dosing intervals. Following implementation of clinical practice guidelines, there was a 10% reduction in chemotherapy finishing after hours and a significant reduction in length of stay for two sarcoma regimens, projected to save 24 inpatient bed days (over $20,000) across more than forty inpatient episodes annually. Conclusion: Deviation from the standard 24-h chemotherapy day (deliberately or inadvertently) was a common yet unstandardized practice. Clinical practice guidelines enabling flexible dose-timing of chemotherapy provided an opportunity to improve chemotherapy administration safety measures, tailor chemotherapy delivery to ward and patient needs, and in some instances reduce non-value-added length of stay.