NHL Patients and Nurses in the US Prefer Subcutaneous Rituximab Injection Versus Intravenous Rituximab Infusion: A Real-World Study
Authors: Gandhi Mitul D , Shapouri Sheila , Ravelo Arliene , Sudharshan Lavanya , Beeks April , Dawson Keith L 
Published: February 2021

Introduction: In 2017, the US FDA granted approval of a subcutaneous (SC) injection form of rituximab as an alternative means of administration 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 (R-SC) over intravenous rituximab infusion (R-IV) in the clinical trial setting, patient and nurse provider preferences for R-SC vs R-IV in a real-world setting have not been studied. We report the findings of two surveys designed to assess patient and nurse treatment preferences for R-SC vs R-IV.
Methods: Two descriptive, cross-sectional surveys of 70 patients and 208 oncology nurse providers were conducted via web-based questionnaires. Patients who received R-SC, and 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 surveys evaluated patients' and nurses' experience with R-SC vs R-IV, preference for SC or IV administration, convenience, and overall experience.
Results: Among the 70 patients invited to participate in the patient survey, 29 (DLBCL n=12; FL n=13; CLL n=4) completed it (41% response rate). Of the respondents, the mean age was 69 years, 59% were male, 86% were Caucasian, 35% had stage IV disease, 72% had an Eastern Cooperative Oncology Group performance status of 0-1, and 69% were retired.
Respondents received a mean of 4 (standard deviation [SD] 2.5) R-SC injections per patient, with the majority indicating preference for R-SC (n=20, 69%) over R-IV infusion (n=9, 31%). Among patients preferring R-SC, less time spent in the clinic (n=20, 69%) and less emotional distress (n=12, 41%) were the most common reasons for their treatment preference. A higher percentage of patients reported R-SC as being very convenient (n=18, 62%) versus R-IV (n=13, 45%). More patients required caregiver assistance during R-IV administration (n=13, 45% patients) compared with R-SC administration (n=8, 28%).
Among 208 nurse providers invited to participate in the nurse provider survey, 36 completed it (17% response rate). In total, 58% (n=21) of nurse respondents preferred administering R-SC over R-IV, with time saving, convenience, and patient preference being the most common reasons. A high proportion of respondents (61%) 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. Most (80%) respondents reported spending 1.5 to over 2 hours of nursing time monitoring and administering R-IV for each patient, and 52% reported that 1.5 to 2 hours could be saved with each administration of R-SC as compared with R-IV. All respondents judged 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, complete nursing procedures, and complete administrative work, and most agreed that the quality of patient care was not impacted by the shorter administration time of R-SC.
Conclusions: Although this study is limited by a small sample size, of the patients and nurses surveyed, the majority expressed a positive experience with respect to receiving and administrating R-SC over R-IV. Reduced time spent in the clinic was the main reason for R-SC preference among patients. Time saved, convenience, and patient preference contributed to the positive experience with R-SC among nurse providers. This survey-based assessment of patient and nurse preference demonstrates a majority of respondents preferring R-SC compared to R-IV. While our analysis is limited by a small sample size, it provides real-world data on patient and provider preferences of rituximab administration.

Disclosures
Gandhi: TG Therapeutics (Advisory board), GlaxoSmithKline (Advisory board): Membership on an entity's Board of Directors or advisory committees. Shapouri:Roche: Current equity holder in publicly-traded company; Genentech, Inc.: Current Employment. Ravelo:Genentech, Inc.: Current Employment; Roche Holdings: Current equity holder in publicly-traded company. Sudharshan:Employee of McKesson. McKesson was paid consulting fees for the conduct of this study: Consultancy; McKesson Life Sciences: Current Employment. Beeks:F. Hoffmann-La Roche Ltd: Consultancy; McKesson: Current Employment. Dawson:Genentech, Inc.: Current Employment; Roche/Genentech: Current equity holder in publicly-traded company.