# Choose regimens by infusion-chair hours, not just efficacy, where chairs are the constraint

Source: https://onco.cc/ideas/idea-acc-infusion-sparing-regimens/  
OnCo record `idea-acc-infusion-sparing-regimens` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When a hospital's real limit is the number of chemotherapy chairs and nurses, guidelines should favour treatments given by mouth or in fewer, shorter visits, if they work about as well.

## Summary

Guidelines optimise efficacy and toxicity assuming unlimited delivery capacity. In systems where the chair, nurse, or pharmacy is the constraint, a regimen that is marginally less effective but needs a third of the visits may cure more people because more people get treated at all. Oral capecitabine-based regimens, three-weekly rather than weekly schedules, subcutaneous formulations, and shorter adjuvant durations are candidates. The proposal is a resource-stratified guideline layer that explicitly trades chair-hours against outcome, and trials to fill the evidence gaps.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: In capacity-limited systems, adopting infusion-sparing regimens for the five most common indications will increase the number of patients starting curative treatment within 60 days by at least 25% without a measurable fall in two-year survival.
- Rationale: Population-level outcome is efficacy multiplied by coverage; the field measures the first and ignores the second. Resource-stratified guidelines (NCCN Harmonized Guidelines for Sub-Saharan Africa) exist but do not model capacity explicitly.
- Proposed test: A health-systems simulation of chair capacity in three hospitals, then a pragmatic switch study comparing coverage, time to treatment, and survival before and after regimen policy change.
- Maturity: speculative
- Actor: research

## Sources

- NCCN Harmonized Guidelines for Sub-Saharan Africa: https://www.nccn.org/global/what-we-do/harmonized-guidelines

## Connected records

- collections: [NCCN Guidelines](https://onco.cc/collections/nccn/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/)

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