Improving Cancer Treatment for All

The Aria e-prescribing system has been in place across the Wessex CancerNetwork for around 14 years. But with growing pressure on cancer services, particularly prescribing services, the pharmacy team at University HospitalSouthampton (UHS) wanted to explore ways in which the Aria system could further help them to streamline processes, improve patient care and ease the pressure on a busy network of cancer services. We spoke to James Allen and Nanda Basker, who explain how the Aria systemis helping to benefit everyone in the network, patients, and staff, through the changes they’re making.

Collaborating for Efficiency - The Aria System 

NANDA: Aria is a collaborative e-prescribing system for our cancer network which includes Southampton, Portsmouth, Isle of Wight, Basingstoke, Chichester, Salisbury and Winchester. The system is around 14 years-oldbut we wanted to start using it to streamline processes and services further. Chemotherapy protocols (orprescriptions) are often very complex and so the production of standardised protocols enable prescribing to be completed safely, quickly, and consistently. Aria automates many elements of the chemotherapy prescribing process, e.g.users can enter a patient's height and weight, then Aria will automatically calculate their body surface area and subsequently what dose(s) of chemotherapy are required. Prescribers are then able to review this, and makebany additional modifications required for their specific patient before sending this prescription to pharmacy. Using Aria, we created standardised protocols and shared these across all Trusts within our network. This has had numerous benefits for a wide variety of staff within cancer care. Healthcare professionals e.g.nurses, doctors and pharmacists are able move between Trusts all using the same protocols and processes, reducing the need for additional training and ensures staff are very familiar with the prescribing and administration system. Consultants regularly run clinics in multiple hospitals, and Aria enables them to prescribe remotely for any of the Trusts within our network. Staff are able to view all historical prescriptions from all sites across the whole network, allowing us to maintain accurate treatment records for our patients. Additionally, staff are also able to interrogate this data, allowing us to quickly audit a wide variety of prescribing records and trends. It has benefits for prescribers because they can move between trusts and know that the protocols are the same, there’s an efficiency in that, and they can prescribe for patients quickly and with confidence.There are benefits for patients because it improves the safety of their prescriptions. If the treatments are standardised across the Trust, we know that they are effective, and the amounts they need based on the patient’s information. It also has a practical benefit for patients too, if they needed to go for treatment at another centre then there are no gaps in their treatment records. Staff can see their treatment programme and records, including blood test results, so there are no delays. It’s a great continuation of care.

JAMES:This project was about using dedicated ring-fenced specialist pharmacist time to turbo-charge the development of Aria protocols across our already established network. It is expected that we could release the time of our pharmacists and maximise the care we’re giving patients by reducing duplication of effort and delivering a more co-ordinated centralised process. Essentially putting more resourcebehind what we do to build long termcapacity. Additionally, if we can makethe prescriptions in Aria and pre-populate them with standardised dosebands, then we can purchase those products ready to administer from healthcare companies. This frees up time in our already stretched sterilized units to concentrate on medicines which must be prepared on-site due to their short lifespan or complexity of preparation. The additional capacity we have using this approach, means this resource is shared across the entire network ofsites and the capacity we release can improve access to highly specialist treatments such as clinical trials, where they need to be administered within a few hours of making, and patients who need a more bespoke prescription. Our ultimate goal was to share information and reduce the duplication of effort.

Improving Patient Care 

JAMES: We have an increasing number of clinical trials that need to be conducted and we need to maintain the quality of our prescribing across those trials and our patients. This involves using new medicines, old medicines and old medicines that are being used in new ways. On top of this, patients usually need supportive medicines that work alongside their treatment – either to alleviate their symptoms or side effects, or for another medical condition. So, this requires more resources. Aria is helping us to standardise what we can so that we can treat more people with the finite resources we have.

NANDA: Specialist Cancer Pharmacists are rare, so standardising across multiple sites allows patients to benefit from the knowledge of the few we have. By training pharmacists, doctors, nurses, and administration staff on how to fill out the information required in Aria and how to extract information from the data, it will suggest the supportive medications needed for that patient along with a schedule for their treatment. Pharmacists can then validate those prescriptions through the screening checks we have in place, like looking at blood test results that can indicate suitability for that treatment and lessen the likelihood of side effects for them. So, while it sounds more hands-off, it actually delivers more bespoke treatment and an improved quality of care for our patients.

We completed 19 protocols in the first five months of 2023 and 31 protocols in the same period in 2024. However, the funding was only partially implemented during that period, with the second pharmacist post starting in June. We expect thenumbers to improve significantly forthe second half of this year.

Improving Cancer Research 

JAMES:We’re currently halfway through our first year of funding for the project, and I hope that we’ll continue to see improvements by increasing the knowledge and skills of people using Aria in the network. Many of the cancer treatment regimens will exist for years to come, so their value will remain for a long time. And with the advancement of knowledge around cancer and its treatment, it’s possible that we will be able to use the system to hold individual genetic marker data to personalise treatment even further. If we know a patient has a particular genetic marker, then we can provide treatments where we know they’ll either be more effective, or they’ll have fewer side effects – which improves patient outcomes enormously. 

NANDA:With Aria, we’re able to respond faster to expressions of interest from clinicians wanting to set up clinical trials. This means that the trial can be established quicker and patient recruitment can be accelerated, so that we ultimately help more people. This has the potential to impact people across the country.

JAMES:There’s potential for these mechanisms to become centralised to support clinical trials across the UK. But we need the workforce to be trained for succession and continuation if we are to achieve that. It could help many more people to access clinical trials. It also provides a career pathway for cancer pharmacists, who can help make the delivery of chemotherapy faster and more personalised for patients. The streamlining of the process alone has been a great result from the study, we’ve seen better capacity across all our sites. But it will be nice to look at more patient focused targets towards the end of the study, to see if we have higher numbers of people in clinical trials and what our patient outcomes have been.