Current practices, challenges, and future directions in subcutaneous oncology monoclonal antibody delivery: A qualitative study

BackgroundSubcutaneous oncology monoclonal antibodies (SCOmAbs) offer significant benefits compared to intravenous formulations, including reduced administration time and potential for self-administration. However, little has been published on real-world preparation and administration practices with these novel formulations. MethodsThis was a qualitative, exploratory study of 30 participants (10 patients receiving SCOmAbs, 10 nurses, and 10 pharmacists/pharmacy technicians) across various U.S. healthcare facilities. One-on-one, in-depth interviews examined current practices, pain points, device integration potential, projected impact of increased SCOmAb adoption, and perspectives on home administration. ResultsFindings revealed considerable variability in SCOmAb preparation and administration practices. While preparation methods generally aligned with typical parenteral workflows, notable deviations included bedside preparation by nurses (7/30), use of syringe pump modules (3/19), and one case of patient self-administration at home. Most participants utilized closed-system transfer devices (12/22) despite inconsistent hazardous drug treatment between facilities. Administration challenges included ergonomic difficulties for nurses during manual push (5/9 reporting physical discomfort) and variable injection techniques to accommodate patient comfort. Nurses reported significant workflow impact from being "tethered" to patients during administration, which could require staffing adjustments as SCOmAb frequency increases. Most patients (6/9) expressed interest in home administration for potential time savings and flexibility, though concerns about training, support, and safety were common. ConclusionsAs SCOmAb utilization expands, facilities may face barriers associated with increased demand that could necessitate innovative solutions. To leverage the full potential of SCOmAb products, developers should consider how next generation product presentations might minimize identified pain points, streamline administration, and facilitate safe transition to home self-administration. Delivery device integration, whether through prefilled syringes, portable infusion pumps, or other delivery systems, may address current challenges but requires careful consideration of facility infrastructure, product complexity and usability, workflow impact, and patient training requirements.