The Benefits and Challenges of Subcutaneous Injection in Cancer Care

Subcutaneous (SC) injection in cancer treatment is an emerging administration method, carrying benefits and challenges for patients and health care providers. The evolution of intravenous (IV) to SC chemotherapy has resulted in significant cost savings for patients and reduced administration times, easing hospital burden and helping improve resource allocation. Despite these benefits, regulatory and payer challenges remain.¹

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In a presentation at the Association of Cancer Care Centers (ACCC) 51st Annual Meeting and Cancer Center Business Summit (AMCCBS) in Washington, DC, Raghava Induru, MD, medical oncologist and director of operations at Atrium Health Levine Cancer Institute in Albemarle, North Carolina, emphasized the need for better drug development, clinical trials, and payer acceptance, as well as a multifaceted approach to optimize SC administration and improve patient experience.¹

As medical science and the understanding of cancer pathology advance, treatments become more efficacious, safe, and precise, giving patients a less-invasive therapeutic experience. The development of SC administration has been a long journey, built on a history of accumulated knowledge and cancer treatment advancements. It marks a significant step forward in pursuing patient-centered care and treatment efficiency.¹

“Cancer is not new,” Induru said during the ACCC AMCCBS presentation. “It’s been there for centuries. In fact, it’s described in Egyptian and Greek civilizations. But for the longest time, the treatment was predominantly surgical or cauterization, [which] was the best they could offer at the time.”¹

After surgery and the discovery of radiation in the 1800s, chemotherapy was eventually discovered during World War II. Mustard gas, a chemical warfare agent, was known to cause severe damage to rapidly dividing cells, including white blood cells. This led researchers to investigate whether similar compounds could be used to target cancer cells, which also divide rapidly. In 1942, the first chemotherapy drug, nitrogen mustard (mechlorethamine), was administered intravenously to a man aged 48 years with radiation-resistant, terminal non-Hodgkin lymphoma, which resulted in the disappearance of his tumors by the end of treatment. Although he relapsed with each subsequent line of therapy, this was proof that chemicals could treat cancer.^1,2

Financial Implications of SC Administration

Targeted therapies and immunotherapies, such as immune checkpoint inhibitors, have revolutionized cancer treatment, offering patients agents that precisely and selectively target cancer cells, which can limit toxicities and adverse effects. Similar to chemotherapy, IV administration has been standard for these agents. However, the emergence of SC injection may be a solution to overcome financial and operational burdens associated with IV infusion and expand patients’ treatment options.¹

SC injection offers several benefits that can significantly improve patient experience, reduce operational burden, and potentially lower health care costs. From the patient perspective, SC injection yields reduced administration times, leading to less time spent in the hospital and more time engaging in everyday activities. For example, using SC daratumumab (Darzalex; Janssen Biotech) saved 62 minutes in total patient treatment time, 54 minutes in total drug administration, 78 minutes in drug preparation, and 82 minutes in total patient treatment experience. Shorter treatment times significantly impact nondrug costs, reducing expenses related to clinic visits and administrative overhead.¹

“The direct costs [of treatments] are something for the health care system,” Induru said. “[But] what is the cost of the drug, what is the cost of preparation of this drug, and what is the cost of administration of this drug?”¹ Induru explained that these additional questions are important to address in order to understand the nondrug costs of treatment.

Induru highlighted the operational and financial costs of drug preparation times, noting that drug preparation time can cost both the patient and the health care provider time and money. In this way, SC injection can be beneficial from an operational perspective for clinics and health care staff, as it can improve efficiency of treatment delivery, helping reduce clinic burden and burnout, as well as optimize workforce operations and enable better resource allocation. Induru also proposed in-home administration of SC injections, which would further reduce treatment burdens for staff and expenses for patients.¹

“Some patients would prefer [SC] injection,” Induru stated. “In fact, they might even prefer actually [receiving it] at home. Is that a reality? It could be.”¹

Despite these benefits, SC injection methods present significant clinical, patient-related, operational, and systemic challenges. Clinically, although the effectiveness of SC administration is promising, the skin’s abundance of antigen-presenting cells could increase the likelihood of immune reactions, which may lead to drug resistance. Moreover, the bioavailability of drugs delivered subcutaneously, particularly when combined with chemotherapy, remains under-researched, necessitating further studies to fully understand how these drugs are absorbed and how they perform.¹

Addressing Challenges With SC Administration

From a patient perspective, the transition from IV to SC administration can be daunting, and patients may be uncertain about self-injection. Many may also find comfort in the established method of IV administration.

On the operational side, integrating SC injection into existing health care systems poses challenges, including the need for updated electronic medical record systems and formulary approval. Additionally, regulatory hurdles remain, with complex approval processes and a lack of clear reimbursement models complicating the financial feasibility of SC injections.¹

There is no clear solution to addressing these problems. It will require a comprehensive, collaborative approach involving manufacturers, health care providers, payers, and patients, rather than a unilateral strategy.¹

“The solutions are challenging,” Induru explained. “The solution requires a collaboration between every single party that’s involved in taking care of the patient.”¹

Some approaches may include improving formulation design, optimizing delivery devices, and addressing patient preferences. Additionally, a shift in payer perspectives, considering direct and indirect costs, could support more flexible treatment models, including home injections. By integrating patient experience, focusing on quality of life, and fostering collaboration across stakeholders, the health care system can move toward more effective and patient-centered cancer care.

REFERENCES

1. Induru S. The value of subcutaneous injection in community oncology. Presented at: Association of Cancer Care Centers 51st Annual Meeting and Cancer Center Business Summit; March 5-7, 2025; Washington, DC.

2. Chemotherapy: from the trenches of warfare a weapon to fight cancer. Yale School of Medicine. Accessed March 6, 2025. https://medicine.yale.edu/ycci/clinicaltrials/learnmore/tradition/chemotherapy/