{"entity":{"id":"idea-acc-infusion-sparing-regimens","kind":"idea","name":"Choose regimens by infusion-chair hours, not just efficacy, where chairs are the constraint","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"NCCN Harmonized Guidelines for Sub-Saharan Africa","url":"https://www.nccn.org/global/what-we-do/harmonized-guidelines"}],"tags":[],"related":["nccn"],"cancers":[],"sections":["chemotherapy"],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["carboplatin","paclitaxel"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-global-access","b-care-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":4},"route":"/ideas/idea-acc-infusion-sparing-regimens/","neighbours":{"collection":[{"id":"nccn","kind":"collection","name":"NCCN Guidelines","route":"/collections/nccn/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"drug":[{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"paclitaxel","kind":"drug","name":"Paclitaxel / nab-paclitaxel","route":"/drugs/paclitaxel/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"}]}}