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The flexibility level allowed in nursing care delivery and uncertainty ininfusion durations are very important factors to be considered during thechemotherapy schedule generation task. The nursing care delivery schemeemployed in an outpatient chemotherapy clinic (OCC) determines the strictnessof the patient-to-nurse assignment policies, while the estimation of infusiondurations affects the trade-off between patient waiting time and nurseovertime. We study the problem of daily scheduling of patients, assignment ofpatients to nurses and chairs under uncertainty in infusion durations for anOCC that functions according to any of the three commonly used nursing caredelivery models representing fully flexible, partially flexible, and inflexiblecare models, respectively. We develop a two-stage stochastic mixed-integerprogramming model that is valid for the three care delivery models to minimizeexpected weighted cost of patient waiting time and nurse overtime. We proposemultiple variants of a scenario grouping-based decomposition algorithm to solvethe model using data of a major university oncology hospital. The variants ofthe algorithm differ from each other according to the method used to groupscenarios. We compare input-based, solution-based and random scenario groupingmethods within the decomposition algorithm. We obtain near-optimal schedulesthat are also significantly better than the schedules generated based on thepolicy used in the clinic. We analyze the impact of nursing care flexibility todetermine whether partial or fully flexible delivery system is necessary toadequately improve waiting time and overtime. We examine the sensitivity of theperformance measures to the cost coefficients and the number of nurses andchairs. Finally, we provide an estimation of the value of stochastic solution.

Scheduling chemotherapy appointments under uncertainty by considering different nursing care delivery schemes