Cancer Care at Home: Opportunities, Risks, and How to Prepare

On Saturday morning of the 2023 Clinical Pathways Congress with the Cancer Care Business Exchange, panelists Aaron Gerber, MD, MBA, Reimagine Care, Inc; Raj Hazarika, MD, Point32 Health; Barbara McAneny, MD, New Mexico Oncology Hematology Consultants and former AMA president; Barry Russo, MBA, The Center for Cancer and Blood Disorders; and Lindsey Zinck, PhD, RN, OCN, Penn Medicine, Abramson Cancer Center, shared their institutions’ approaches to home-based care and what some of the potential benefits and challenges are for bringing cancer care into the home.

Dr Gerber began the discussion by going over the “forces driving the move to cancer care at home.” He stated that the constituents—patients and providers—are the ones pushing for this option. For instance, patients and their loved ones are greatly impacted by time toxicity, or the time it takes to get patients to appointments and the ER. In many cases, people have to take time off work to attend and get to these appointments, sometimes without getting paid. Patients and their caretakers see at-home care as a convenient alternative.

From a medical business perspective, Dr Gerber stated that “cancer is a strategic and competitive service line.” There has been a rise in digital advancements that make cancer care at home more feasible, such as remote patient-monitoring devices, telemedicine, and AI-driven chatbots that assist patients with self-managing their treatment. In addition, companies like DispatchHealth, who are able to provide comprehensive at-home support to patients, are being launched. Dr Russo stated that The Center for Cancer and Blood Disorders uses AI chatbots to check in with patients twice a week post-therapy to ask patients specific questions about their symptoms. The Center also utilizes DispatchHealth with a mobile unit of advanced practice providers and EMTs to take care of the many patients who require services after normal working hours. With these tools, the Center can complete more assessments and get feedback back to their practice.

Dr Zinck provided the viewpoint of a large academic medical center. Penn Medicine began their cancer care at home program in 2019 due to an increased demand for patients to access their center. Their goal was to improve quality of life and capacity as their infusion centers were “bursting at the seams.” They put together a multidisciplinary team to develop their home-care program, which consists of oncology-certified nurses who are sent to patients’ homes. They follow the same safety protocol for chemotherapy as they would in the hospital.

The center found that patients “loved the service” and participation increased by 700% in the first few weeks of launch. Currently, they have 3000 patients that are receiving care (symptom management and supportive care) at home.

While there are many benefits and opportunities for cancer care at home, Dr McAneny warned that there are major safety concerns to consider as well, both for the patients and staff sent to provide care. For example, if a patient has an adverse reaction to treatments that were not predicted and they are not close to a medical facility or provider, there is more danger to the patient in addition to increased liability risk for the physician who ordered the treatment.

There is also the issue of the cost to maintain such a program. Dr McAneny stated that compared to a large academic center, community practices such as hers cannot hire enough oncology-certified nurses to travel and treat patients. She agrees that time toxicity is an issue, but believes it’s better addressed by adhering more closely to recommended timelines in the treatment process (see patients on time, answer phones on time, etc).

Although there are many opportunities to expand and develop at-home care, Dr Gerber advised providers to look at “where and for whom cancer care at home makes sense.” In his view, for patients in metropolitan areas and those who are upper- or middle-income, at-home care can work well. However, Dr McAneny noted that this approach can exacerbate inequity issues in access to health care. On the other hand, Dr Zinck said that health equity has not been an issue with their program. In fact, a Kaiser Permanente study found that the patients who used their program the most were at the lowest socioeconomic level.

Dr Hazarika stated that overall there has been movement following the COVID-19 pandemic to move a lot of care into the home, not just cancer care. “It’s an upward trajectory and we need to be ready for the change,” he said. Part of this change will be in how payers will work with providers to arrange at-home care coverage.