Home infusion therapy for cancer care

A new type of care delivery has become increasingly popular: home infusion therapy.

Home infusion therapy is a medical service in which patients receive intravenous (IV) treatments—medications, nutritional support, or other fluids—at their home. This approach, designed to provide more convenient care to those who require ongoing IV therapy, allows patients to remain in a familiar environment under the supervision of healthcare professionals.

The practice of home infusion therapy began in the 1970s, but then it was primarily used for parenteral nutrition. In the 1980s, more practitioners started using it to administer IV-based rehydration therapy and anti-infectives (e.g., antibiotics, antivirals, and antifungals). It’s only within the past several years, largely driven by the pandemic, that some oncologists have started prescribing home-based infusion for cancer care.

Home infusion therapy for cancer care can fall under two main buckets: supportive care (e.g., hydration and antiemetics, both of which can help address chemo-related symptoms and side effects) and systemic therapy (e.g., chemotherapy and immunotherapy).

For the purposes of this post, we will be focusing on home-based infusions for chemotherapy.

In theory, home infusion therapy for cancer care (administering chemotherapy drugs, specifically) seems like a great idea—and it can be incredibly helpful in certain situations—but there are factors we must take into account.

Considerations of home infusion therapy for cancer care

Home infusion therapy can provide several benefits. Perhaps one of the most significant is the convenience it offers, as patients can avoid traveling to and from the treatment center. This aspect could be helpful for patients’ caregivers as well. In addition, home infusion therapy could lead to potential cost savings for payers, as it can eliminate the high expenses (e.g., facility fees and other overhead costs) typically associated with facility-based care.

However, despite these perks, there are several possible issues that shouldn’t be ignored:

1. There are substantial safety concerns

Administering chemotherapy at someone’s personal home carries inherent safety risks. Unlike a hospital or other outpatient facility, the providers cannot control the cleanliness or safety of a person’s living conditions. Furthermore, there’s a limited number of chemotherapy drugs that are a good fit for home infusion given the toxicity and varying stability of many chemotherapy drugs.

In addition, the absence of immediate access to a full medical team and emergency facilities becomes a problem if a patient experiences severe side effects or adverse reactions to treatment. While home infusion therapy nurses are typically trained to handle emergencies, the limited resources available in a home setting can still pose significant challenges.

In a statement about home infusion therapy for cancer, the American Society of Clinical Oncology expressed concerns that “routine use of home infusions for anticancer therapy could potentially fail to provide the safeguards to both patients and healthcare providers called for in existing safety standards.”

Perhaps most concerning is that this type of cancer care delivery lacks broader oversight. In a hospital or clinic, patients are monitored by a team of healthcare professionals, which provides multiple layers of oversight and quality control. In a home setting, the responsibility for monitoring and managing the patient’s treatment falls on the nurse and the patient’s caregivers, which can lead to inconsistencies in cases and increase the risk of errors.

2. It could lead to higher costs

While home infusion therapy can lead to cost savings for health plans and sponsors, it can ultimately end up being more expensive to the overall healthcare system due to inefficiencies in the care delivery model—and of course, when the healthcare system incurs higher costs, this eventually impacts everyone involved in the system (e.g., payers, patients, and more).

In the hospital or community oncology center, a single nurse can manage multiple patients simultaneously, optimizing resource utilization. Home infusion therapy, on the other hand, requires one-on-one care, which leads to higher labor costs, travel expenses, and added strain on the healthcare labor market.

These factors can offset the savings achieved through reduced overhead and make home infusion therapy a more costly option in some cases.

3. It’s not always more convenient

Despite the fact that one of the primary benefits of home infusion therapy is patient convenience, the simple truth is that this isn’t the case for every person.

As Dr. Arjun Gupta, a gastrointestinal medical oncologist and self-proclaimed advocate for home-based infusions, says, “Home-based care might present more of a time drain for some patients.”

This proved true for one of Gupta’s patients, Jennifer. When Jennifer was considering home infusion therapy to treat her stage 4 pancreatic cancer, writes Charlotte Huff for STAT, “She added up the time involved: waiting for a nurse to arrive to draw her blood; waiting for a courier to pick up her blood; waiting for another courier to drop off the chemotherapy drugs; waiting for a nurse to arrive to connect her to the infusion pump and later for another nurse to return to disconnect her.” In the end, she decided to continue receiving infusions at her cancer center as, ultimately, it would eat up less of her time.

4. Reaching rural patients is still challenging

Getting cancer care to patients who live in rural areas can be quite difficult. In theory, home infusion therapy could be a great way to close this care gap.

However, this is not necessarily the case. Many patients in rural areas may still have limited access to healthcare providers capable of administering home infusion therapy, which presents logistical difficulties and can still lead to treatment delays. Imagine trying to get one home infusion therapy nurse to travel three hours each way to deliver treatment. That’s a big time and money investment for a provider (and will impact the cost for the patient and payer as well).

5. The patient experience may be fragmented

For some patients, being able to receive chemotherapy treatments in the comfort of their home could positively impact their cancer care experience.

However, if the home infusion provider operates independently from the patient’s oncologist (i.e. if they’re a third party), this could lead to a fragmented care experience, as there are greater risks for communication breakdowns between providers.

Ideally, the primary treating oncologist ultimately controls the decision—along with the patient and family—on whether or not infusion at home is appropriate given the drug’s properties, patient preferences and comfort level, and patient comorbidities, along with a number of other factors.

In addition, limiting the patient’s visits to the clinic also reduces their interactions with and opportunities to receive support from their cancer team, emphasizing the importance of virtual or other tools to ensure patients don’t fall through the cracks of the healthcare system.

Home infusion therapy for cancer care: Yes or no?

Home infusion therapy for cancer is a compelling option. However, there are also several challenges it presents. Ultimately, the decision should be based on a thorough evaluation of the patient’s specific circumstances, the comfort level of their treating oncologist, and the availability of reliable home healthcare services. By carefully weighing the pros and cons, providers and patients (and their caregivers) can work together to determine the best course of action.

When it comes to what employers should provide access to, home infusion therapy should only be one of many treatment modalities considered for their cancer benefits—especially if they want to provide a truly comprehensive cancer care solution to their population.

Focusing solely on home infusion therapy is a myopic approach that excludes surgery, radiation, and the majority of medical oncology patients for whom, for a myriad of reasons, home infusion isn’t appropriate. And that becomes a big problem if it’s the only treatment method employers focus on.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.