{
  "abstract": "Aim The NHS allocates substantial funding to medication, with chemotherapy accounting for an estimated £1.4 billion annually. Drug costs make up about 80% of this spending. 1 Despite this investment, treatment delays and inefficiencies contribute to considerable chemotherapy waste, though exact national figures for chemotherapy wastage are unavailable. This audit aimed to (1) identify the factors causing delays and (2) quantify the financial impact of wasted intravenous/intramuscular systemic anticancer therapy (IV/IM SACT) over six months in a paediatric oncology service.Method A prospective audit was conducted at a tertiary paediatric oncology centre from February to August 2024. Data were collected using a standardised template to record details of wasted chemotherapy, including drug name, batch number, expiry date, dosage, reason for waste, and anonymised patient identifiers. All ward staff involved in chemotherapy handling were informed and contributed to data collection. Direct drug costs were calculated using BNF list prices. 2 Cost calculations focused solely on IV/IM SACT, excluded sponsor-supplied Investigational Medicinal Products (IMPs), and indirect costs (eg dispensing fees, diluent, consumables). Aseptic unit remakes were not quantified. Microsoft Excel and GraphPad Prism were used for descriptive statistics and cost aggregation.Results Over six months, 146 episodes of chemotherapy waste were recorded, including intrathecal agents (25 wasted doses, equivalent to three days of full intrathecal operational capacity). IV/IM SACT involving 206 vials and costing £65,452.20. Dinutuximab, at £7,600 per vial, accounted for the greatest financial loss. It was wasted primarily due to infections or adverse reactions necessitating treatment cessation. Clinical toxicity drove about 50% of waste. Modifiable factors accounted for £16,359.81 of £34,770.58 total waste once the dinutuximab outlier (£30,440) was excluded, representing approximately 47% of the remaining waste. Even when including dinutuximab, modifiable factors still comprised about 25% of overall waste. The most common modifiable factors for wastage were haematological toxicities and other organ toxicities, with most laboratory and clinical results becoming available after chemotherapy preparation. Some hospitals with integrated electronic laboratory systems, results may be available before chemotherapy is prepared, whereas other hospitals relying on manual reporting typically receive results after preparation. Logistical and administrative issues, such as lack of bed availability, compromised product quality, and communication failures, also contributed significantly.Conclusion This audit establishes a baseline for chemotherapy wastage in paediatric oncology. It also identifies potential modifiable factors contributing to loss such as delayed lab reporting and fragmented communication. Streamlining pre-treatment assessment workflows, particularly improving communication of laboratory results and interdisciplinary coordination, could reduce costs associated with unused chemotherapy. Future initiatives should focus on implementing unified, specialised chemotherapy prescribing electronic systems across hospitals to facilitate rapid integration of laboratory results and alert staff as soon as results are available. 3 4 This approach ensures prompt review and action, replacing manual checks and avoiding delays. Enhanced communication and workflow could improve operational efficiency and maintain high standards of patient care.References NHS England. Chemo drug optimisation to improve patient experience of cancer treatment [Internet]. 2016. Available from: https://www.england.nhs.uk/2016/05/chemo-drug-optimisation/ Joint Formulary Committee. British National Formulary Online. 2024. Available from: https://bnf.nice.org.uk/ Bellomo R, Chan M, Guy C, et al. Laboratory alerts to guide early intensive care team review in surgical patients: A feasibility, safety, and efficacy pilot randomized controlled trial. Resuscitation 2018;133:167–172.Slovis BH, Nahass TA, Salmasian H, et al. Asynchronous automated electronic laboratory result notifications: A systematic review Journal of the American Medical Informatics Association 2017;24(6):1173–1183.",
  "authors": [
    {
      "affiliations": [
        "University Hospital Southampton, UK"
      ],
      "name": "Yin Ying Mak"
    },
    {
      "affiliations": [
        "University Hospital Southampton, UK"
      ],
      "name": "Amy Coster"
    }
  ],
  "title": "P08 Chemotherapy waste in paediatric oncology: causes and costs",
  "uid": "074ca957-d9dc-5ab6-a032-035cfd7f9417"
}