Trinity St James’s Cancer Institute first in Ireland and UK to introduce chemotherapy drug-making robot

Reference: August 2024 | Issue 8 | Vol 10 | Page 64

The Trinity St James’s Cancer Institute at St James’s Hospital in Dublin has become the first hospital in Ireland and the UK to introduce a compounding robot which produces cytotoxic chemotherapy drugs. The new initiative is part of the ongoing robotic programme at the hospital and is anticipated to enhance production of these labour-intensive drugs, as well as patient and staff experiences, in a variety of ways. Director of Pharmacy at St James’s Hospital Gail Melanophy described the development as “a major step forward for our staff and our cancer patients at the hospital”.

“We aim to produce up to 50 per cent of the oncology/haematology day ward’s chemotherapy needs within weeks of introduction and we hope this will significantly increase when at full capacity, including inpatient needs. This will free up time for our pharmacists to produce other products that the robot does not make and ensure that our valued patients never have to wait for their treatments.”

Chemotherapy is traditionally produced using a highly manual process by pharmacists and pharmacy technicians that is physically intensive and involves measurement of doses, reconstitution of commercially sourced drugs, and dilution into patient-specific doses. Therefore, there is a risk of human error and a need for high levels of quality assurances and verifications. Staff globally often report repetitive strain injuries due to the labour intensity of production, as well as burnout.

The Aseptic Compounding Unit at St James’s Hospital is the busiest in the country, producing 30,000 products annually. With cancer levels rising alongside a growing and ageing population, demands are set to rise in coming years.

A total of 13 of the most commonly used cytotoxic chemotherapy drugs used at St James’s Hospital have been initially selected to be produced by the robot. Trials at the hospital have demonstrated that the advance preparation of the drugs is readily achievable, meaning they are available in the clinics when patients arrive for their sessions. Patients can also be assured of the quality of the chemotherapy produced due to the environment in which the robot is housed, as well as the flexibility to use the range and scope of products previously produced in the pharmacy.

For the pharmacy staff, use of the robot protects them from the work-related injuries and adverse effects commonly associated with this type of manual process, as well as from exposure to hazardous drugs used in the compounding of chemotherapy. There are also potential cost savings to be realised as the robot can store partially used drugs for use in the production of subsequent doses, thus maximising the use of expensive drugs.

CEO of St James’s Hospital Prof Mary Day said: “The Trinity St James’s Cancer Institute aspires to being a comprehensive cancer centre where patient care, research, clinical trials, and cutting-edge treatments combine to lead to better patient outcomes and experiences. Being the first hospital in the UK or Ireland to use this new robot to make chemotherapy drugs is another example of how we are constantly striving to find new and better ways to serve our patients and assist our staff.”

The first patient received their treatment made by the new robot at the Trinity St James’s Cancer Institute in April 2024 on the hospital campus. She said: “I noticed no difference at all when I received my dose of chemotherapy today at St James’s Hospital, but I am reassured by the wonderful staff here who have told me that the new robot will help to ensure the chemo for all the cancer patients like me will be of very high quality.”

Funds for the new robot were raised by the St James’s Hospital Foundation. Director of Development at the St James’s Hospital Foundation Aisling Nolan said: “I am delighted that the hard work of the Foundation supporters, from patients to families to our own staff, has paid off with the installation and use of this new robot. Cancer care is a core service at St James’s Hospital and this robot will help our cancer patients and the staff who care for them every day.”