The vast majority of patients with Hodgkin lymphoma or DLBCL are likely to benefit from systemic therapy.

Occasionally vascular access devices are required to deliver systemic therapy. Such devices should only be inserted by proceduralists experienced in such procedures.

Timeframes for starting treatment

Treatment should begin within two weeks of diagnosis and staging, unless the patient wants to delay treatment (e.g. to pursue fertility preservation measures).

In cases with critical organ compromise or rapid clinical progression, it may be necessary to start treatment within 24 hours of diagnosis.

Training and experience required of the appropriate specialists

Haematologists, medical oncologists and radiation oncologists must have training and experience of this standard:

• Fellow of the relevant specialist college
• adequate training and experience that enables institutional credentialing and agreed scope of practice within this area (ACSQHC 2015).

Cancer nurses should have accredited training in these areas:

• anti-cancer treatment administration
• specialised nursing care for patients undergoing cancer treatments, including side effects and symptom management
• the handling and disposal of cytotoxic waste (ACSQHC 2020).

Systemic therapy should be prepared by a pharmacist whose background includes this experience:

• adequate training in systemic therapy medication, including dosing calculations according to protocols, formulations and/or preparation.

All patients must be primarily managed and overseen by an appropriately qualified specialist multidisciplinary team. In a setting where no haematologist or medical oncologist is locally available (e.g. regional or remote areas), some components of less complex therapies may be delivered by a specialist physician and an appropriately qualified nurse, and overseen by a specialist team. This should be in accordance with a detailed treatment plan or agreed protocol, and with communication as agreed with the haematologist or medical oncologist or as clinically required.

The training and experience of the appropriate specialist should be documented.

Health service characteristics

To provide safe and quality care for patients having systemic therapy, health services should have these features:

• a clearly defined path to emergency care and advice after hours
• access to diagnostic pathology including basic haematology and biochemistry, and imaging
• cytotoxic drugs prepared in a pharmacy with appropriate facilities
• occupational health and safety guidelines regarding handling of cytotoxic drugs, including preparation, waste procedures and spill kits (eviQ 2019)
• guidelines and protocols to deliver treatment safely (including dealing with extravasation of drugs)
• coordination for combined therapy with radiation therapy, especially where facilities are not co-located.