Managing aseptic capacity pressures in systemic anti-cancer therapy services: A national mixed-methods evaluation of UK SACT board guidance implementation

IntroductionDemand for systemic anti-cancer therapy (SACT) is increasing, placing pressure on cancer services, particularly aseptic capacity. Aseptic preparation is a safety-critical, regulated component of SACT delivery, and constraints pose risks to resilience and patient safety. In response, the UK SACT Board in 2023, published national guidance outlining principles to manage aseptic capacity pressures.AimTo examine implementation of the recommendations across SACT services and identify organisational, professional, and system-level enablers and barriers, with a focus on safety and quality implications.MethodsA mixed-methods, cross-sectional electronic questionnaire was conducted across UK SACT services. Profession-specific questionnaires for pharmacy, nursing, and medical staff were developed based on the guidance. Quantitative data were analysed descriptively, and free-text responses were analysed using inductive thematic analysis. Reporting followed CHERRIES and SRQR guidance.ResultsEighty-six responses were received (43-pharmacy, 24-nursing, 19-medical), representing ∼140 eligible organisations. Awareness varied. Full implementations of the recommendations were uncommon (7%-pharmacy, 4%-nursing, 0%-medical); discussion without action was more frequent. Adoption was greatest for recommendations aligning with existing workflows or addressing immediate pressures, including dose banding and immunotherapy interval extension. Ward-level preparation of selected monoclonal antibodies was reported by a minority and facilitated by the use of closed system transfer devices and multidisciplinary risk assessment, although implementation remained constrained by workforce limitations, environmental factors, and safety concerns. Workforce shortages, infrastructure limitations, governance complexity, and implementation support were key barriers.ConclusionEarly implementation has been selective and variable. While some organisations adopted capacity-relieving practices, broader uptake is constrained by workforce, safety, and governance challenges. Publication of national guidance alone is insufficient to drive consistent change in cancer service delivery; coordinated implementation support, clearer safety frameworks, and system-level workforce investment are required to ensure efforts to manage aseptic capacity pressures enhance, rather than compromise, safety and sustainability of services.