Restricted accessResearch articleFirst published online 2026
Reducing waiting time of injectable anticancer drug preparations in day care oncology units: A summary of evidence,implemented strategies,and perspectives for hospital pharmacists
With the increasing incidence of cancer worldwide, injectable anticancer agents are being increasingly prescribed for outpatients in day care oncology units. These drugs are prepared in hospital pharmacy cytotoxic units. This paper explores delay factors and pharmacist-led solutions to reduce patients’ waiting time for antitumor treatment infusion in day care cancer hospitals.
Data Sources
A literature review was carried out using PubMed and other sources, including conference abstracts and relevant publications. The main search terms included “chemotherapy,” “waiting time,” “oncology,” “outpatient,” “pharmacy,” “pharmacist,” and “satisfaction,” combined with AND/OR operators. Available data were analyzed and complemented by our pharmaceutical and clinical expertise.
Data Summary
Based on published works, we examined the negative impacts of delays on patients’ well-being, the role of hospital pharmacists in decreasing these delays and provided our perspective.
Discussion
Cancer patients already face multiple emotional and physical challenges. Long waiting time can further heighten patients’ anxiety and stress. Delays in the delivery of anticancer infusions can be caused by various factors, including logistical problems, drug supply delays, and administrative issues. To minimize these delays, several initiatives can be implemented, such as efficient treatment planning, early prescription and preparation in advance, robotization to enhance productivity, proactive lean management, and improved communication between care teams.
Conclusions
It is important for hospital pharmacists to define a dispensing time for injectable anticancer treatments and monitor it as a quality indicator. Collaboration between pharmacists and physicians to establish this critical threshold will help optimize care and improve the patient's experience.
PatelVRRameshVTsaiAK, et al.Health care contact days experienced by decedents with advanced GI cancer. JCO Oncol Pract nov 2023; 19: 1031–1038.
2.
GuptaAEisenhauerEABoothCM. The time toxicity of cancer treatment. J Clin Oncol 20 mai 2022; 40: 1611–1615.
3.
GuptaAJensenEHVirnigBA, et al.Time-related burdens of cancer care. JCO Oncol Pract avr 2022; 18: 245–246.
4.
PlourdeCLVarnadoWTGleatonBJ, et al.Reducing infusion clinic wait times using quality improvement. JCO Oncol Pract août 2020; 16: e807–e813.
5.
TranVTBarnesCMontoriVM, et al.Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions. BMC Med 14 mai 2015; 13: 115.
6.
KallenMATerrellJALewis-PattersonP, et al.Improving wait time for chemotherapy in an outpatient clinic at a comprehensive cancer center. JOP janv 2012; 8: e1–e7.
7.
KallenMATerrellJALewis-PattersonP, et al.Improving wait time for chemotherapy in an outpatient clinic at a comprehensive cancer center. J Oncol Pract janv 2012; 8: e1–e7.
8.
AndersonRTCamachoFTBalkrishnanR. Willing to wait?: the influence of patient wait time on satisfaction with primary care. BMC Health Serv Res 28 févr 2007; 7: 31.
9.
GesellSBGregoryN. Identifying priority actions for improving patient satisfaction with outpatient cancer care. J Nurs Care Qual2004; 19: 226–233.
10.
HendershotEMurphyCDoyleS, et al.Outpatient chemotherapy administration: decreasing wait times for patients and families. J Pediatr Oncol Nurs2005; 22: 31–37.
11.
Hashemi-SadraeiNSasankanSCrozierN, et al.Improving outpatient infusion clinic wait times at a comprehensive cancer center. JCO Oncol Pract déc 2021; 17: e1935–e1942.
12.
LereboursFSaltelPBéthune-VoltersA, et al.Satisfaction of breast cancer patients treated by chemotherapy outpatient clinics: results of the TemporELLES survey. Bull Cancer avr 2015; 102: 316–323.
13.
KagalwallaSTsaiAKGeorgeM, et al.Consuming patients’ days: time spent on ambulatory appointments by people with cancer. Oncologist 3 mai 2024; 29: 400–406.
14.
LavalleeJ. Acuity-Based Models of Care: Improving Wait Times and Efficiency in an Outpatient Infusion Center. Master’s Theses and Capstones [Internet], 1 janv 2024. Disponible sur: https://scholars.unh.edu/thesis/1804
15.
SugalskiJMKubalTMulkerinDL, et al.National comprehensive cancer network infusion efficiency workgroup study: optimizing patient flow in infusion centers. J Oncol Pract mai 2019; 15: e458–e466.
16.
Debreuve-TheresetteAJoveninNStonaAC, et al.Patients’ satisfaction and waiting time in oncology day care centers in champagne-ardenne. Rev Epidemiol Sante Publique déc 2015; 63: 381–386.
17.
Hashemi-SadraeiNSasankanSCrozierN, et al.Improving outpatient infusion clinic wait times at a comprehensive cancer center. JCO Oncology Practice déc 2021; 17: e1935–e1942.
18.
DescalzoJMFrutosELCastroJ, et al.Improving waiting time for chemotherapy with ahead-of-time drug preparation. Stud Health Technol Inform 25 janv 2024; 310: 144–148.
SchmidPCortesJPusztaiL, et al.Pembrolizumab for early triple-negative breast cancer. N Engl J Med 27 févr 2020; 382: 810–821.
21.
Ariza-HerediaEJChemalyRF. Update on infection control practices in cancer hospitals. CA Cancer J Clin sept 2018; 68: 340–355.
22.
SohTIPTanYSHairomZ, et al.Improving wait times for elective chemotherapy through Pre-preparation: a quality-improvement project at the national university cancer institute of Singapore. JOP janv 2015; 11: e89–e94.
23.
MahrousMEl ShaerERezikL, et al.Decreasing prolonged waiting times for chemotherapy administration for patients with cancer. Global J Qual Saf Healthcare 31 mars 2020; 1: 44–48.
24.
BleusteinCRothschildDBValenA, et al.Wait times, patient satisfaction scores, and the perception of care. Am J Manag Care mai 2014; 20: 393–400.
25.
LacyNLPaulmanAReuterMD, et al.Why we don’t come: patient perceptions on no-shows. Ann Fam Med2004; 2: 541–545.
26.
PearceSKellyDStevensW. « more than just money » – widening the understanding of the costs involved in cancer care. J Adv Nurs févr 2001; 33: 371–379.
27.
MadeiraAMoutinhoVFuinhasJA. Does waiting times decrease or increase operational costs in short and long-term? Evidence from Portuguese public hospitals. Eur J Health Econ nov 2021; 22: 1195–1216.
28.
MathewsMRyanDBulmanD. What does satisfaction with wait times mean to cancer patients?BMC Cancer 28 déc 2015; 15: 1017.
29.
LisCGRodeghierMGuptaD. Distribution and determinants of patient satisfaction in oncology: a review of the literature. Patient Prefer Adherence 3 nov 2009; 3: 287–304.
30.
EdwardsLHermisKLeGetteCR, et al.Acuity-Based scheduling: outcomes in ambulatory oncology centers. Clin J Oncol Nurs 1 avr 2017; 21: 250–253.
31.
GourdjiIMcVeyLLoiselleC. Patients’ satisfaction and importance ratings of quality in an outpatient oncology center. J Nurs Care Qual2003; 18: 43–55.
32.
GroffSLCarlsonLETsangK, et al.Cancer patients’ satisfaction with care in traditional and innovative ambulatory oncology clinics. J Nurs Care Qual2008; 23: 251–257.
33.
AmbadyNLaplanteDNguyenT, et al.Surgeons’ tone of voice: a clue to malpractice history. Surgery juill 2002; 132: 5–9.
34.
WilliamsSWeinmanJDaleJ. Doctor-patient communication and patient satisfaction: a review. Fam Pract 1 oct 1998; 15: 480–492.
35.
Haskard ZolnierekKBDiMatteoMR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care août 2009; 47: 826.
36.
ManaryMPBouldingWStaelinR, et al.The patient experience and health outcomes. N Engl J Med 17 janv 2013; 368: 201–203.
37.
JhaAKOravEJZhengJ, et al.Patients’ perception of hospital care in the United States. N Engl J Med 30 oct 2008; 359: 1921–1931.
38.
StelfoxHTGandhiTKOravEJ, et al.The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med oct 2005; 118: 1126–1133.
LaurainnePJobinMHCordeauJF, et al.Optimisation du parcours patient en hôpital de jour en oncohématologie par simulation intégrée à une démarche kaizen*. Logistique Manag 2 janv 2017; 25: 34–42.
41.
SimonsPAMRamaekersBHoebersF, et al.Cost-Effectiveness of reduced waiting time for head and neck cancer patients due to a lean process redesign. Value Health juill 2015; 18: 587–596.
42.
JenWYChanZYLeeYM, et al.Reducing chemotherapy waiting times in the ambulatory setting of a tertiary cancer centre using a design thinking approach. Cancers (Basel) (Basel). 19 sept 2023; 15: 4625.
43.
RadheshyamARamaniVKMhaskeM, et al.Decreasing patient wait time by process level interventions in an oncology daycare unit: a quasi-experimental study. Health Sci Repdéc 2024; 7: e70224.
44.
LammMHEckelSDanielsR, et al.Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times. Am J Health Syst Pharm 1 juill 2015; 72: 1138–1146.
45.
PeyrillesELepage-SeydouxCSejeanK, et al.Mise en place d’un programme de suivi à distance des patients atteints de cancer et traités par chimiothérapie en hôpital de jour : un enjeu de taille pour les différents acteurs. Bulletin du Cancer avr 2018; 105: 357–367.
46.
GeHLiLZhangD, et al.Applications of digital medicine in oncology: prospects and challenges. Cancer Innov déc 2022; 1: 285–292.
47.
ParikhRBBasen-EnquistKMBradleyC, et al.Digital health applications in oncology: an opportunity to seize. J Natl Cancer Inst 31 mai 2022; 114: 1338–1339.
48.
Ramos LinaresSMerino AlonsoJRomán GonzálezN, et al.Reusing cytostatics in a centralised pharmacy preparation unit. Farm Hosp2011; 35: 70–74.
49.
Yuste-VilaDAlbert-MariAJiménez-ArenasV, et al.Management of returned anti-neoplastic treatments and their reuse in oncology patients. Farmacia Hospitalaria (English Edition) 1 janv 2009; 33: 217–223.
50.
BonanBMartelliNBerhouneM, et al.Fabact®: a decision-making tool for the anticipation of the preparation of anticancer drugs. J Eval Clin Pract2010; 16: 1129–1135.
51.
BlackmerJAmolineKAmancherJ, et al.Leveraging advanced preparation of oncology medications: decreasing turnaround-times in an outpatient infusion center. J Oncol Pharm Pract août 2021; 27: 1454–1460.
52.
AcramelABlondeel-GomesSDupréM, et al.Advanced prescription of injectable anticancer drugs: safety assessment in a European comprehensive cancer centre using the risk matrix approach. Br J Clin Pharmacol mai 2024; 90: 1333–1343.
53.
ParkesANusratMDi TomassoPM, et al.Successful implementation of a multidisciplinary chemotherapy efficiency initiative at a community hospital. J Oncol Pract juin 2019; 15: e576–e582.
54.
DesmarisRPBermudezEAnnereauM, et al.Organization of chemotherapeutic preparations in advance: do we save or waste money?J Oncol Pharm Pract oct 2021; 27: 1699–1703.
55.
DupreMEscalupLBlondeel-GomesS, et al.Errors in prescribing injectable anticancer drugs: benefits of a pharmaceutical long-term monitoring to improve patient safety in a European comprehensive cancer centre. Eur J Hosp Pharm2025; 32: 289–292. https://doi.org/10.1136/ejhpharm-2023-003680
56.
ChatelutEWhite-KoningMLMathijssenRH, et al.Dose banding as an alternative to body surface area-based dosing of chemotherapeutic agents. Br J Cancer 25 sept 2012; 107: 1100–1106.
57.
Itoua-GassayeKFriouMEscalupL, et al.Dose standardisation of intravenous anticancer drugs: risk analysis and implementation in a French cancer centre. J Oncol Pharm Pract 28 oct 2025: 10781552251386071.
58.
PouliquenALEscalupLJourdanN, et al.Dose standardisation of anticancer drugs. Int J Clin Pharm avr 2011; 33: 221–228.
59.
DespiauFZagalaYDelordJP, et al.Étude observationnelle du temps passé en hôpital de jour selon la voie d’administration (intraveineuse vs sous-cutanée) d’une thérapie ciblée. Bull Cancer 1 oct 2017; 104: 869–874.
60.
CappuzzoFZvirbuleZKorbenfeldE, et al.Primary results from IMscin002: a study to evaluate patient preferences and perceptions of health care professionals for atezolizumab subcutaneous versus intravenous for the treatment of NSCLC. JTO Clin Res Rep mai 2025; 6: 100815.
61.
ShinSKooJKimSW, et al.Evaluation of robotic systems on cytotoxic drug preparation: a systematic review and meta-analysis. Medicina (Kaunas) 22 févr 2023; 59: 431.
62.
CeruttiALedouxTVantardN, et al.Comparing different robots available in the European market for the preparation of injectable chemotherapy and recommendations to users. J Oncol Pharm Pract oct 2023; 29: 1599–1612.
63.
CapilliMEnricoFFedericiM, et al.Increasing pharmacy productivity and reducing medication turnaround times in an Italian comprehensive cancer center by implementing robotic chemotherapy drugs compounding. J Oncol Pharm Pract mars 2022; 28: 353–361.
64.
VoNDesmarisRBrandely-PiatML, et al.Robotic production of injectable anticancer drugs in hospital pharmacies. Bull Cancer juin 2023; 110: 665–675.
65.
RiestraACLópez-CabezasCJobardM, et al.Robotic chemotherapy compounding: a multicenter productivity approach. J Oncol Pharm Pract mars 2022; 28: 362–372.
66.
NurgatZFarisDMominahM, et al.A three-year study of a first-generation chemotherapy-compounding robot. Am J Health Syst Pharm 15 juin 2015; 72: 1036–1045.
67.
ChenWHShenLJGuanRJ, et al.Assessment of an automatic robotic arm for dispensing of chemotherapy in a 2500-bed medical center. J Formos Med Assoc avr 2013; 112: 193–200.
68.
MasiniCNanniOAntaridiS, et al.Automated preparation of chemotherapy: quality improvement and economic sustainability. Am J Health Syst Pharm 1 avr 2014; 71: 579–585.
69.
DesmarisRPRocheMMithaA, et al.Automated preparation of cytotoxic drugs: the evidence for an interface between the robot and computerized provider order entry?Eur J Hosp Pharm 1 mars 2023; 30: e12–e12.
70.
PourroyBTournamilleJFBardinC, et al.Providing oncology pharmacy services during the coronavirus pandemic: French society for oncology pharmacy (société francaise de pharmacie oncologique [SFPO]) guidelines. JCO Oncol Pract nov 2020; 16: e1282–e1290.
71.
Lucchi-AngellierEMinoJCBurnodA, et al.S’adapter face à la pandémie SARS-CoV2 : l’expérience de l’Institut curie. Bull Cancer sept 2021; 108: 787–797.
72.
BornerMScheithauerWTwelvesC, et al.Answering patients’ needs: oral alternatives to intravenous therapy. Oncologist2001; 6: 12–16.
73.
BrunMQuitteBEscalupL, et al.3PC-018 Time to availability of injectable anticancer drugs for outpatients: reassessment in a French comprehensive cancer centre. Eur J Hosp Pharm 1 mars 2023; 30: A18–A19.
74.
LeeSGroßSEPfaffH, et al.Waiting time, communication quality, and patient satisfaction: an analysis of moderating influences on the relationship between perceived waiting time and the satisfaction of breast cancer patients during their inpatient stay. Patient Educ Couns avr 2020; 103: 819–825.
