Daily outpatient chemotherapy appointment scheduling with random deferrals

Abstract

In this paper we propose a heuristic approach that computes the order in which patients will be treated in an ambulatory chemotherapy center. Each patient follows an individual treatment plan that fixes dates for series of drug injections separated by recovery periods. The daily care process has three steps: consultation with the oncologist, drug preparation in the pharmacy and drug injection in medical beds. The facility closes after the last injection. As drug injection varying considerably in duration—from 15 min to 6 h—bad schedules lead to excessive overtime. In addition, after the consultation the oncologist may decide to cancel the injection because of a weak patient’s health condition. In the current setting of the chemotherapy facility we work with, First Come First Served policy controls the care process. In this study, we propose to compute a common priority list of patients for consultation and injection phases. A unique list of patients is a simple tool used by nurses to manage the flow of patients and to react to uncertain events. A GRASP algorithm is developed to compute optimized list of patients in few seconds as the operating planning context requires. Two objectives are considered; the closing time and the overworking time of the facility. Numerical experiments show that our GRASP is able to quickly reach near optimal solutions and that list of patients policy performance is comparable to more complex scheduling policies. Benchmark data sets are built based on historical data of the French chemotherapy facility, ICL in Saint-Étienne.