Multidimensional impact of fixed-dose subcutaneous trastuzumab-pertuzumab on oncology workflow and patient time burden in a real-world study

Fixed-dose subcutaneous (SC) trastuzumab and pertuzumab (HP) (Phesgo®) offers a clinically non-inferior alternative to intravenous (IV) administration for HER2-positive breast cancer, with potential advantages in treatment efficiency. However, real-world evidence on its impact on healthcare workflow and frontline staff remains limited. We conducted a single-center, mixed-methods evaluation comparing SC Phesgo® with conventional IV HP in the perioperative setting. Outcomes included patient treatment time, institutional reimbursement, and the operational burden on nurses and pharmacists, assessed through structured surveys, time-motion observations, and administrative records. Phesgo® reduced active treatment and clinic visit times by up to 96% and 53%, respectively. Cumulative chemotherapy suite time decreased by 332 h over eight months, indicating a potential for resource reallocation. Nurses and pharmacists reported reduced task complexity and improved workflow satisfaction, particularly during monotherapy. .Although combination regimens introduced procedural complexity, professional motivation remained stable. While SC administration is not eligible for chemotherapy-specific reimbursement add-ons in Japan, efficiency gains may partially offset revenue loss. Patient out-of-pocked costs increased slightly in lower-weight individuals but remained modest overall. Phasgo® improves both patient time burden and staff workflow efficiency, supporting more sustainable and patient-centered delivery of HER2-targeted therapy. These findings highlight the broader system-level value of fixed-dose SC regimens in high-volume oncology settings under real-world conditions.