Nurse Treatment Preferences Survey for Intravenous Rituximab Infusion Versus Subcutaneous Rituximab Injection: A Real-World Study
Authors: Gandhi Mitul D. , Shapouri Sheila , Ravelo Arliene , Sudharshan Lavanya , Clark Jamyia , Dawson Keith L. 
Published: November 2019

Introduction: The 2017 US FDA approval of a subcutaneous (SC) injection form of rituximab made available an alternative means of administering rituximab for patients with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and chronic lymphocytic leukemia (CLL). Although patients have reported a preference for SC rituximab injection (R-SC) over intravenous rituximab infusion (R-IV), nurse provider preferences for R-SC versus R-IV in the real-world setting have not been studied. Here, we report the findings of a survey designed to assess nurse treatment preferences for R-SC versus R-IV.
Methods: A descriptive, cross-sectional survey of 208 oncology nurse providers was conducted via a web-based questionnaire between June 6, 2019 and July 10, 2019. Nurses who administered at least one R-IV and at least one R-SC treatment between July 1, 2017 and April 30, 2019 in US Oncology Network (USON) clinics were eligible to participate. The survey comprised 21 items, and evaluated nurses' experience with R-SC versus R-IV, preference for SC or IV administration, convenience, and overall experience.
Results: Of the 208 nurse providers invited to participate in the survey, 43 completed the survey (20.7% response rate). Almost all nurses who completed the survey were familiar with administering R-IV, with 70% of the respondents administering >20 infusions in the past year. Nurses were also familiar with administering R-SC, with 56% of respondents administering 1-10 injections in the past year and 44% administering >10 injections in the past year. Fifty-three percent of respondents preferred administering R-SC over R-IV, with time saving, convenience, and patient preference chosen as the most common reasons. Most respondents (58%) had a positive/very positive experience with R-SC over R-IV, as a result of patient time saved, clinic/staff time saved, and quality time with patients. In total, 19% of respondents had a neutral experience with R-SC compared with R-IV. Of those reporting a neutral experience with R-SC, a comparable ease of administration was the most common reason. Twenty-three percent of respondents reported a negative/very negative experience with R-SC, with discomfort with the R-SC route of administration (i.e. physical effort) chosen as the most common reason for the negative experience. Eighty-four percent of respondents reported spending 1.5 to over 2 hours of nursing time monitoring and administering R-IV for each patient. The majority of respondents (98%) agreed that chair time could be saved with each administration of R-SC compared with R-IV. Respondents reported that the time saved could be used to see more patients (50%), complete nursing procedures (36%), and complete administrative work (14%). Forty-four percent of respondents reported that 1.5 to 2 hours could be saved with each administration of R-SC as compared with R-IV, with 67% of respondents agreeing that the quality of patient care was not impacted by the shorter administration time of R-SC. In terms of convenience, 63% of respondents reported R-SC is more convenient than R-IV, and 49% reported their overall impression of injecting R-SC as easy. Moreover, 49% reported that they agreed or strongly agreed that they would recommend R-SC to their medical colleagues, and 63% agreed or strongly agreed that they believe patients would prefer R-SC over R-IV.
Conclusions: Based on an online survey of nurse providers with experience administering R-IV and R-SC, a majority of nurse providers preferred administering R-SC over R-IV. Time saved, convenience, and patient preference contributed to the positive experience with R-SC.
Acknowledgements: This study was sponsored by Genentech, Inc. Third party editorial assistance, under the direction of Mitul Gandhi and Sheila Shapouri, was provided by Katie Buxton of Gardiner-Caldwell Communications and was funded by F. Hoffmann-La Roche Ltd.

Disclosures
Gandhi: Seattle Genetics: Other: Education ; Pharmacyclics: Other: Food and beverage ; AbbVie: Other: Food and beverage ; Pfizer: Other: Education ; GSK: Other: Food and beverage ; Genentech, Inc.: Other: Food and beverage ; Acerta Pharma: Research Funding. Shapouri:Genentech, Inc.: Employment; Roche: Equity Ownership. Ravelo:Genentech: Employment, Equity Ownership. Sudharshan:McKesson: Consultancy, Employment. Clark:McKesson: Consultancy, Employment, Equity Ownership. Dawson:Genentech: Employment; Roche/Genentech: Equity Ownership.