A recent study conducted at UC Davis Comprehensive Cancer Center (UCDCCC) investigated the factors influencing infusion appointment durations for patients participating in oncology clinical trials. The retrospective quality improvement initiative, spanning from July 2019 to July 2022, aimed to identify variables significantly affecting appointment times and differentiate between intrinsic and extrinsic delays to optimize efficiency.
The analysis, which included data from 392 adult patients, examined variables such as patient age, the number of investigational products (IPs) administered, appointment time (morning vs. afternoon), study type and phase, pharmacokinetics (PK) at chair time, and the use of interactive response technology (IRT) kit assignment. Despite the comprehensive approach, the study found no significant correlations between the analyzed variables and infusion appointment duration (P = .085-.53) or arrival-to-chair time (P = .085-.93).
Study Design and Findings
The study, presented as a single-center, retrospective quality improvement initiative, leveraged EPIC (electronic health record software) reports to gather data on patients enrolled in oncology clinical trials involving infusion treatment. Researchers collected data on patient age, appointment time (AM/PM), study type, study phase, PK blood draw requirements, IP IRT kit assignment, and the number of IPs administered.
Key findings indicated that while the phase of the study showed some association with appointment duration (overall model P = .0555), only phase 3 studies were associated with a significant increase in appointment duration by 98.4 minutes (P = .0433). Interestingly, age was significantly associated with appointment duration (P = .0443), with each year increase in age reducing the appointment duration by 2.79 minutes. The number of IPs administered also showed some association with appointment duration (overall model P = .085), particularly when three IPs were administered, increasing the duration by 151.21 minutes (P = .0127).
Implications and Context
The results challenge initial assumptions about factors influencing infusion chair time. "The findings from our comprehensive analysis underscore the complexity of optimizing infusion chair time for patients with cancer enrolled in clinical trials," the researchers noted. Contrary to expectations, many intrinsic variables—including the type of study, PK requirements, and IRT kit assignment—showed no significant association with appointment duration or arrival-to-chair time.
Addressing Complexities in Oncology Trials
The study highlights the intricate nature of managing infusion center efficiency, particularly in the context of oncology clinical trials. While the timing of appointments (AM/PM) was anticipated to influence efficiency, the data did not support this hypothesis. Although PM appointments were, on average, shorter by 41 minutes, this difference was not statistically significant.
Limitations and Future Directions
The authors acknowledge several limitations, including the study's single-center design and the potential for human error in manual data input. They suggest that future research should aim for longer study durations, multicenter collaborations, and the implementation of automated time-tracking systems to improve data accuracy.
Conclusion
Despite not yielding definitive results, the study underscores the complexity of delays in oncology infusion chair times. The lack of significant correlations suggests intricate interactions among various factors, emphasizing the need for further research to uncover these complexities and optimize appointment efficiency for patients in clinical trials. The findings serve as a foundation for future quality improvement initiatives aimed at enhancing the experience and care of oncology trial patients.
