Drug Wastage Management in Oncology

Drug wastage in oncology represents a critical challenge both economically and environmentally. The high unit cost of cytotoxic and targeted therapies coupled with the frequent use of single-dose vials often leads to residual volumes that cannot be administered, generating substantial financial losses and safety hazards. Management approaches encompass strategic scheduling of chemotherapy sessions, dose rounding within clinically acceptable margins and centralised compounding to optimise vial use. Technological innovations include electronic prescribing systems that aggregate orders for vial sharing, automated dispensing robots and dose-banding protocols that standardise concentrations to minimise leftovers. Interdisciplinary collaboration between oncologists, pharmacists and nursing teams underpins effective stewardship, while policy initiatives such as drug vial optimisation and flexible packaging standards further enhance resource utilisation. Globally, tailored waste reduction models have delivered durable cost savings, improved access to high-cost agents and reduced environmental impact, underscoring the importance of integrated operational and policy measures in advancing sustainable oncology care.

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Drug Wastage Management in Oncology publication trend

The graph below shows the total number of articles in drug wastage management in oncology across all publications each year (not limited to Nature Index journals).

Technical terms

Dose rounding: Adjustment of calculated drug doses to the nearest clinically acceptable value to match available vial strengths and reduce leftover volume.

Vial sharing: Coordinated use of a single drug vial for multiple patients’ doses within a defined time frame to minimise residual waste.

Dose banding: Standardisation of chemotherapy doses into fixed bands or tiers to simplify preparation and reduce variability in vial usage.

Drug vial optimisation (DVO): Systematic calculation of total daily drug requirements to determine the optimal combination of vial sizes and quantities.

Centralised admixture services: Dedicated pharmacy units that prepare multiple oncology infusions in a batch workflow to enhance accuracy, safety and waste reduction.

References

1. Cost analysis of implementing a vial-sharing strategy for chemotherapy drugs using intelligent dispensing robots in a tertiary Chinese hospital in Sichuan. Frontiers in Public Health (2022).
2. Quantification of Chemotherapy Drug Wastage and Incurred Financial Loss in Paediatric Cancer Care: A Cross-Sectional Study at a Tertiary Care Public Hospital in India. Cureus (2024).
3. Vial Sharing of High-Cost Drugs to Decrease Leftovers and Costs: A Retrospective Observational Study on Patisiran Administration in Bologna, Italy. Healthcare (2023).