Anna Halpern, MD, Fred Hutchison Cancer Center, Seattle, Washington, provides an overview of the advantages and challenges of providing outpatient care in oncology. She moderated a panel session on this topic titled “Balancing Inpatient and Outpatient Oncology Care” at the 2024 National Comprehensive Cancer Network annual conference.

Transcript:

Anna Halpern, MD: My name is Anna Halpern. I'm an associate professor in the hematology and oncology division in the department of medicine at the University of Washington, and in the clinical research division in the Fred Hutchison Cancer Center in Seattle, Washington.

What are the main topics you’ll be covering in your session?

Dr. Halpern: So we're going to be talking about in this session on how to balance inpatient and outpatient oncology care. And we're going to have people from all areas represented. So providers, payers, pharmacists, many people who would be involved in the care of patients in both settings.

And we are going to talk about a few main areas. We're going to look at the external pressures that are driving the trend of moving oncology care to the outpatient setting. We're going to compare the benefits and challenges of providing outpatient care, particularly for higher intensity treatments that have been previously or traditionally provided in the inpatient setting.

And we're going to describe what kind of infrastructure and leadership support is needed to successfully move care from the inpatient to the outpatient setting.

What are some of the advantages of patients receiving outpatient care compared to patients receiving care in an inpatient setting?

Dr. Halpern: There are benefits both for the patient and the system. For patients, there are benefits in terms of quality of life about being outside rather than inside of the hospital, potentially sleeping in one's own bed and having more time at home, decreased risk of nosocomial infections or other increased risks in the hospital such as delirium, and many patients certainly prefer getting their treatment outside the hospital rather than inside the hospital. And for institutions, it is a time of critical bed shortages at many hospitals.

Our inpatient capacity has been very strained, particularly since the pandemic. And so moving some of this care to the outpatient setting may open up the beds in hospitals for acutely ill patients that need care.

Why are more patients able to receive drug therapy in the outpatient setting than before?

I think there's been a lot of changes. This has been going on, you know, for decades, but has been really spurred along with the pandemic. So there are improvements in supportive care. We have better sort of oral antimicrobials and oral supportive care therapies. The infrastructure has been developed for this, infusion centers with longer hours, with weekend hours. There's been an increase in home services, so services that allow the patient to get some laboratory evaluations, infusions and provider evaluations in their own homes. Those services have expanded as well as the increase of oncology medications that are oral rather than necessarily just infusional.

What are you the most excited to share with attendees from your session?

Dr. Halpern: I think that we're hoping to provide sort of a wide perspective on the benefits and challenges of outpatient care. You know, how do places who have successfully moved aspects of their care outpatient, how have they done this? What is the workflow? What are the pathways? What needs to be taken into account? Does a site of the setting or geography, is there a certain patient population that this works better for? You know, maybe outpatient care is harder for elderly folks who can't come back and forth to clinic as much. So, making sure to impart those kinds of considerations onto the audience and figure out where in their own institution this might be able to be implemented.

And then thinking about what infrastructure, particularly for hospital leadership or sort of oncology center leadership is required to support this. What resources do teams trying to implement this need to be able to succeed and do well, and what kinds of creative strategies have been used to overcome challenges?

Is there anything else you'd like to add? Any final thoughts?

Dr. Halpern: I think outpatient oncology care is probably sort of where it's going for most diseases, including some of our really complex treatments such as CAR T cell therapy and cellular therapy. I've done a lot of work at my own institution in moving host AML care into the outpatient setting, which has been supported by an infrastructure that was developed here to allow most of bone marrow transplant to be done in the outpatient setting. And so I think that this has been coming for a long time and amplified by the pandemic and the critical acute care bed shortage as well as ICU bed shortage. This along with different requirements from payers in terms of oncology drugs, I think is kind of going to cement the deal. So I think that we all have to be prepared for this push to outpatient care.

And so if we can figure out ahead of time about how best to prepare the institution and patients for these shifts that are certainly coming, I think foresight is better than aftersight here.