Presenting Author: Haydon DuMond, PharmD, Enable Injections, Inc, Cincinnati, OH
BACKGROUND: UK oncology pharmacy services are managing a systemic anticancer therapy (SACT) crisis leading to increased delivery of large-volume subcutaneous (LVSC) oncology treatments in the home setting. Preparation of these LVSC biologics in the home setting via manual syringe introduces increased concerns regarding staff safety, medication errors, and workflow challenges. We assessed UK pharmacists’ and nurses’ preferences for LVSC preparation using a manual syringe process versus an on-body injector (OBI). Although oncology care in the United States remains largely clinic-based, the UK model highlights how at-home LVSC treatment can relieve clinic capacity strain.
OBJECTIVES: To measure pharmacists’ and nurses’ preferences for an OBI versus manual syringe and its relation to home-based LVSC delivery; to determine key factors influencing OBI preference among pharmacists and nurses; and to assess OBI usability and its perceived impact on workload, preparation time, and safety.
METHODS: We ran a cross-sectional, online survey with an embedded paired-profile choice task among UK oncology pharmacists and nurses involved in LVSC oncology preparations. Eligible respondents were practicing pharmacists or nurses with current LVSC preparation responsibilities and familiarity with the SACT crisis in the United Kingdom. The final sample included 162 practitioners (81 pharmacists, 81 nurses). Data collection was completed by August 29, 2025. In the paired-choice task, participants compared manual syringe versus OBI preparation across factors such as steps, time, cost, safety, and setting. They ranked their top 3 decision drivers, rated OBI ease of use and learning, and assessed expected effects on workload, efficiency, and safety.
RESULTS: Among the total sample, 93.8% preferred the OBI to the manual syringe preparation in both the preference question and the scenario. OBI was rated easy to use by 96.9% and easy to learn by 95.7%. Nearly all respondents anticipated reduced workload (96%), time savings (96%), greater efficiency and increased release capacity (94%), and reduced medication preparation errors (91%) with OBI adoption. According to participants, “less effort/time,” “enhanced operator safety,” and “fewer steps/supplies” were top drivers of preference. Most LVSC preparations currently occur in aseptic pharmacy (63%), with approximately 20% to 40% nurse-led (outside of pharmacy) preparations across settings.
CONCLUSION: Pharmacists and nurses strongly preferred an OBI to the manual syringe preparation for LVSC oncology drugs, citing fewer steps, less time, and improved safety. Most participants anticipated a reduced workload, fewer errors, and greater efficiency, supporting OBI adoption as a practical solution amid the UK SACT capacity crisis.
- Desai M, Blewett M, Yaniv A, et al. Evaluating pharmacist preferences: preparation of a novel on-body delivery system vs. high-resistance, manual syringes for large-volume subcutaneous drugs. J Oncol Pharm Pract. 2025:10781552251326574. doi:10.1177/10781552251326574
- Desai M, Faiman B, Gorski LA, et al. Evaluating nurse preferences for a novel on-body delivery system vs. manual syringes for large-volume subcutaneous drug administration: a survey study. Drug Deliv. 2025;32:2484278. doi:10.1080/10717544.2025.2484278
- Rahman O, Faiman B, Gorski L. Enhancing the patient and nurse experience in large-volume subcutaneous drug delivery. ONdrugDelivery. 2024;164: 28-31.
- Royal College of Radiologists. The SACT capacity crisis in the NHS. February 2024. Accessed February 19, 2026. www.rcr.ac.uk/news-policy/policy-reports-initiatives/the-sact-capacity-crisis-in-the-nhs/
- British Oncology Pharmacy Association (BOPA). Written evidence submitted to the House of Commons Committee. A national evaluation of capacity in SACT aseptic services. 2023. Accessed February 19, 2026. https://committees.parliament.uk/writtenevidence/121404/html/