BY SHELBY NIEHAUS
A new vehicle sits parked next to Crossroads Cancer Center in Effingham on a Monday morning. The next day, it will sit beside Fairfield Memorial Hospital; the day after, it will be at HSHS St. Joseph’s Hospital in Breese, then at Fayette County Hospital in Vandalia the day after that.
Though its outside looks like any vision or hearing testing van that might crisscross the state for stops in rural centers, the blue-and-green vehicle in question is novel, and is, to its staff’s knowledge, the first of its kind in the nation: a mobile compounding vehicle, which is designed for onsite mixing of chemotherapy drugs at locations without a compounding pharmacy, opening up a host of possibilities for rural cancer patients and their oncologists.
At the heart of the mobile compounding vehicle’s story is Allison Braden, PharmD, director of pharmacy services at Cancer Care Specialists of Illinois. About three years ago, Braden says, she first had the idea to start a mobile compounding vehicle; “it was a kind of wake-me-up-in-the-night idea,” she said, “of how we could get better care to the patients and financially help our practice.”
After first conceiving of the mobile compounding vehicle, Braden researched her idea by speaking to other medical providers and vehicle-builders while waiting for physicians at Cancer Care Specialists to get onboard with the idea. A contact in Winnebago county referred her to Summit Bodyworks, a Colorado-based company that builds a number of specialty vehicles from bookmobiles to tool trucks to mobile police command centers to mobile mammography and dental suites, who became a source of knowledge due to their experience with similar medical vehicles.
Braden says that the program didn’t run into any significant roadblocks while acquiring permits for the vehicle from the State Board of Pharmacy, the Medical Licensing Board, the Department of Transportation, and others. “Most people were not familiar with anything like this, so they really didn’t have an opinion,” she said. “This really hasn’t been done before.”
However, the physical requirements of the mobile compounding vehicle were a primary concern. Braden said that the vehicle’s largest problem pre-launch was in meeting in-room requirements for a compounding vehicle. “We have to have so many air changes for sterile compounding and… balancing room pressures,” Braden says. “We didn’t know exactly how the thing would function when we turned it on. …It was kind of some trial and error.”
When the Altamont News and St. Elmo Banner visited the mobile compounding vehicle on Monday, Jan. 20, the vehicle had only been on the road for about two weeks, having served as a clean room in Decatur during a remodel at Cancer Center of Decatur. So far, the vehicle has served them well, with no incidents reported during its first outings.
The vehicle’s chassis is a 2020 Freightliner; inside, it includes a general staging and prep room with a wheelchair lift, a pushbutton lock that closes securely once technicians are inside, storage for equipment and tools, a nonhazardous-material refrigerator, an exterior monitoring panel which allows technicians to see any potential crashes or intruders outside the vehicle, and a laptop that allows the technicians to communicate with nursing staff (this keeps the vehicle in HIPAA compliance). Behind the staging area is a containment segregating compounding area (C-SCA), separate from the staging area so that the C-SCA can operate as a negative pressure environment, and containing a hood for sterile compounding, two tool racks, and a hazardous-materials refrigerator.
Despite it all, the mobile compounding vehicle’s interior looks sparse—all its most necessary functions are built into the walls, with the C-SCA and its built-in hood as the most important components.
The vehicle is “free-standing,” and can function on its own generator power or by plugging into a building at its destination. Two of Cancer Care Specialists’ technicians are licensed to drive the mobile compounding unit—both hold a non-CDL Class C driver’s license and both are fully trained to mix chemotherapy drugs. The two technicians now travel to Fairfield on Tuesdays, Breese on Wednesdays, and Vandalia on Thursdays, though with ten satellite locations on Cancer Care Specialists’ roster, Braden hopes to increase the unit’s travel schedule, or to put another similar vehicle on the road.
A press release from Fayette County Hospital concerning the mobile compounding vehicle says that its “benefits are significant” for rural cancer patients in its area. “Right now, all the work is done up-front by physicians as far as labs and making sure patients are okay for chemo,” says Braden. “So then we mix it here and then the courier takes it, already mixed, to the clinic.”
With the mobile compounding vehicle, though, each order is prepared as usual, but is shipped to the clinic unmixed with the expectation that it will be mixed onsite. “Then if the physician cancels it or if the patient doesn’t show up… it comes back here and goes into our stock, so there’s no waste.” And while cutting down on waste is a plus for any practice, it can quickly become a top priority for an institution like Cancer Care Specialists—depending on the treatment, chemotherapy drugs can cost between $20 and $10,000, a cost in waste that may or may not be reimbursed. “I think that, overall… lowing the cost of waste lowers the cost overall.” Additionally, “onsite mixing allows patients access to more drugs, including those with a short shelf life,” Braden says.
Braden also says that satellite clinics can now offer clinical research participation options to patients; previously, patients who wished to participate in research studies and clinical trials needed to travel to Effingham, as eligible locations needed to be able to mix a drug onsite.
Braden believes that such a vehicle could be useful outside of central Illinois, as long as a prospective program or institution has access to orders, a home lab to pack orders from, and technicians willing to travel; the vehicle isn’t designed to service unforeseen, on-demand drug orders, though. “For us, we prepare all our stuff in the morning, so we don’t necessarily carry anything that hasn’t been pre-planned on the truck. … If you had a program where you knew what you were going to do, and you could load the truck up like that, I think it could work for about anything.”
So far, a few other institutions have approached Cancer Care Specialists to inquire about renting the mobile compounding vehicle. Cancer Care Specialists has not done much to publicize the program yet, though, as the legality of the mobile compounding vehicle is not entirely set in stone in its youth.
Despite that, Braden says, Cancer Care Specialists is open to helping other institutions explore mobile compounding vehicle possibilities. After all, “The whole idea behind [the mobile compounding vehicle] is to increase access to care.”