Choose regimens by infusion-chair hours, not just efficacy, where chairs are the constraint
When a hospital's real limit is the number of chemotherapy chairs and nurses, guidelines should favour treatments given by mouth or in fewer, shorter visits, if they work about as well.
Guidelines optimise efficacy and toxicity assuming unlimited delivery capacity. In systems where the chair, nurse, or pharmacy is the constraint, a regimen that is marginally less effective but needs a third of the visits may cure more people because more people get treated at all. Oral capecitabine-based regimens, three-weekly rather than weekly schedules, subcutaneous formulations, and shorter adjuvant durations are candidates. The proposal is a resource-stratified guideline layer that explicitly trades chair-hours against outcome, and trials to fill the evidence gaps.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.