Professor Lesley Fallowfield and Dr Valerie Jenkins, Director and Deputy Director of Sussex Health Outcomes Research and Education in Cancer (SHORE-C) at BSMS, run jointly by the universities of Brighton and Sussex, worked with cancer experts from around the world on the PrefHer trial.
Nine out of 10 (91.5 per cent) HER2-positive breast cancer patients preferred the subcutaneous (SC) injection of Herceptin (trastuzumab) – an injection in the skin – to the current practice of intravenous drip delivery. Patients reported less pain and discomfort and spent up to 80 per cent less time in the hospital chair, as a SC injection around five minutes per visit, compared with 30-90 minutes for IV treatment.
Patients preferred this method as it both saved time and was more comfortable: One patient said "It affects me being there for so many hours, with this it is 'Hello and Bye'." Another commented "As a busy mum with four young kids – I want to get on with my life".
Currently, intravenous (IV) treatment (drip) with Herceptin (trastuzumab) via a needle into a vein is the usual method of delivering the drug to patients with HER2-positive breast cancer and significantly increases their chances of survival. However, this mean cancer patients having already had surgery, radiotherapy and chemotherapy, must attend centres every three weeks for a further 12 months to receive this treatment. Each visit is time-consuming and can take several hours in total.
New technology now makes it possible for the drug to be given as an injection into the fatty layer just under the skin. The body is able to absorb the drug this way, and it only takes five minutes to administer in this way.
More than 100 healthcare professionals also completed a questionnaire about their preferences, with 73.8 per cent more satisfied with the subcutaneous administration. Just two (1.9 per cent) preferred the intravenous method and the remaining 25 (24.3 per cent) expressed no preference.
Professor Fallowfield said: "If the NHS adopts SC delivery systems then this could make lengthy hospital visits for Herceptin a thing of the past; breast cancer patients would be able to spend less time in hospital and travelling enabling them to get on with their lives. There is enthusiasm also for selected patients to have this treatment at home or to self-administer."
Dr Valerie Jenkins said "Most chemotherapy centres are very pressured environments. The results of this study are very clear and if chemotherapy units switch to the SC method of Herceptin delivery then everyone wins – the patients and the healthcare professionals."
The new findings were published in the medical journal the Lancet Oncology, Volume 14, Number 10 p962 in September 2013, and will be presented by Professor Fallowfield at the European Cancer Congress in Amsterdam, on 28 September 2013.
About the study
The PrefHer study involved 236 patients with HER2+ breast cancer from more than 50 cancer centres throughout Europe and Canada were involved.
Patients were interviewed by phone at home by trained interviewers using an interview schedule designed by the SHORE-C team. Patients were then randomised to either 4 cycles of the drug given by the usual IV method then 4 via the new SC delivery system or vice-versa. Patients were then interviewed again about preferences, the strength of them and primary reasons for choices.
There was an overwhelming preference for SC delivery with 216 (91.5 per cent) patients preferring SC administration. Only 16 patients (6.8 per cent) preferred the IV method, and 4 (1.7 per cent) had no preference. The strength of preferences was ‘very or fairly strong’ for 88%.
The fixed-dose, SC delivery of Herceptin had previously been found to be safe but, before the PrefHer trial, had not been assessed for patient preference.