Oncology Insights: Cancer treatments are making their way home

February 14, 2024

Many health care services provided in the hospital can be safely delivered in the privacy of a patient’s home. This includes the administration of medications used to treat cancer

Oncology Insights: Cancer treatments are making their way home

Many health care services provided in the hospital can be safely delivered in the privacy of a patient’s home.1 This includes the administration of medications used to treat cancer. 1-5

Cancer therapy administration was initiated in the hospital because of the need for close monitoring and toxicity management.1 As the understanding of early side effect management increased and the requirement to decrease hospital stay grew, cancer therapy transitioned from the hospital to the outpatient setting, and over the last twenty years, has increasingly shifted into the patient’s home.1-2  The COVID-19 pandemic and the health care ecosystem have created the drive to alternate sites of care.1-9 Considerations for transition to home include care coordination, patient tolerability of initial doses, and availability of trained staff.

In May 2023, the FDA released a draft guidance for “Decentralized Clinical Trials for Drugs, Biological Products, and Devices” which was created to increase clinical trial accrual and facilitate the movement of some or all clinical trial components to alternate locations including participant’s home.6 Using telehealth and digital health technologies to decrease in person visits to clinical trial sites we may see enhanced trial participation, decreased caregiver burden and facilitation of research in rare diseases to increase recruitment, enrollment, and retention of a meaningfully diverse clinical population. This translates to less time and funding wasted.

Cost is one of the biggest drivers for site of care change.1-9 Between 2009 and 2012, chemotherapy services provided in the hospital cost Medicare beneficiaries $4.05 million more in out-of-pocket cost than they would have paid if the same care was provided in a community setting.7 An exhaustive number of trials and analysis of reimbursement rates for services provided have highlighted the role of site of care in the markup for cancer therapy and its administration.1-9

Unfortunately, the higher cost does not translate into improved quality of care or outcomes.1-9

Notable drivers for movement to the home setting:

  • Cost savings (24-76% compared to inpatient treatment)
  • Demand for consumer-centered models
  • Enhanced access to care

It is essential to meet the patient where they are most able to receive care. With the transition of cancer therapy and potentially clinical trials to the home, we move closer to increased access to care and diversity in clinical research while decreasing health care cost and maintaining quality of care.

References
  1. The Oncology Hospital at Home. Available at https://ascopubs.org/doi/10.1200/JCO.18.01167#:~:text=Oncology%20Hospital%20at%20Home%20(HaH,cost%20than%20traditional%20inpatient%20care. Accessed February 12, 2024.
  2. Laughlin, AI, Begley M, Delaney, T, et al. Accelerating the Delivery of Cancer Care at Home During the Covid-19 Pandemic. Available at https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0258. Accessed February 11, 2024.
  3. Kier MQ, Lubetsky S, Schller G, et al. Hospital at Home in an oncology setting: Updated analysis. ACO abstract 257 Available at https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.28_suppl.257. Accessed February 11, 2024.
  4. Mayo Clinic launches advanced care at home model of care. Available at https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-launches-advanced-care-at-home-model-of-care/ . Accessed February 11, 2024.
  5. Mayo Clinic Advanced Care at Home. Available at https://www.mayoclinic.org/departments-centers/hospital-at-home/sections/overview/ovc-20551797#:~:text=Mayo%20Clinic%20Advanced%20Care%20at,to%20meet%20each%20person’s%20needs. Accessed February 12, 2024.
  6. US Food and Drug Administration. Decentralized Clinical Trials for Drugs, Biological Products, and Devices. Available at https://www.woodtv.com/news/national/leaving-the-lab-fda-urges-researchers-to-expand-access-to-clinical-trials/. Accessed February 12, 2024.
  7. US Oncology Network: Community-Based Cancer Care: A Better All-Around Value. Available at https://usoncology.com/news/community-based-cancer-care-a-better-all-around-value/. Accessed 2-13-24.
  8. Hopson S, Casebeer A, Stemkowski S, et al. Does site-of-care for oncology infusion therapy influence treatment patterns, cost, and quality in the United States? J Med Econ. 2018 Feb;21(2):152-162. doi: 10.1080/13696998.2017.1384736. Epub 2017 Oct 17. PMID: 28945163. Available at https://www.tandfonline.com/doi/full/10.1080/13696998.2017.1384736. Accessed February 12, 2024.
  9. Fisher MD, Punekar R, Yim YM, et al. Differences in Health Care Use and Costs Among Patients With Cancer Receiving Intravenous Chemotherapy in Physician Offices Versus in Hospital Outpatient Settings. J Oncol Pract. 2017 Jan;13(1):e37-e46. doi: 10.1200/JOP.2016.012930. Available at https://ascopubs.org/doi/10.1200/JOP.2016.012930 Accessed February 13, 2024.

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