Oncologists Advocate for Home-Based Cancer Care

To reduce costs to payers and improve outcomes for patients, more types of health care continue to move into the home. To further benefit patients, hospitals and payers, cancer treatment should be next, a recent article in the Journal of Clinical Oncology argues.

While not common in the United States, home-based cancer treatment programs have carved out important roles in health care systems abroad. In their Journal of Clinical Oncology article, for example, authors Nathan Handley and Justin Bekelman point to the success of oncology hospital-at-home (HaH) programs in countries such as France and Italy.

They also highlight the positive outcomes generated by other types of home-based care programs in the U.S. to make their case.

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“The building blocks for an oncology HaH are already in place in the United States,” the oncologists wrote. “Management of many specific cancer-related symptoms and complications is feasible in the home setting. Outpatient management of low-risk febrile neutropenia is as safe and effective as inpatient management, at half the cost. Delivery of certain types of treatment in the home environment, such as intravenous fluids and certain types of chemotherapy, is common.”

Creating oncology HaH programs would require navigating past a few roadblocks — such as uncertainty regarding patient selection, operational logistics and reimbursement processes — but the benefits of the program would outweigh those challenges, Handley and Bekelman argue.

Some providers are already testing that theory out. In December, the University of Utah’s Huntsman Cancer Institute launched “Huntsman at Home,” a program designed to provide hospital-level care for cancer patients in the comfort of their own homes in partnership with Community Nursing Services. The goal of the program is very similar to the one outlined in the article.

“Patients could have greater satisfaction with equal or greater quality,” Handley and Bekelman wrote, noting that home-based treatment would lower patients’ risk of hospital-related infections and complications. “Hospitals, by diverting a subset of patients from inpatient units, could reallocate inpatient beds, decreasing the wait time for scheduled hospitalizations and increasing the ability to accept hospital-to-hospital transfers and, by downsizing outpatient infusion centers, could decrease overhead and total costs.”

Meanwhile, payers would save money, as treatment in the home is among one of the least expensive care interventions.

While not specific to cancer treatment, HaH program data supports the authors’ claims.

Take Johns Hopkins, for example, which has been offering HaH for more than 20 years. When compared to in-patient settings, the program has shortened average length of stay by one-third, lowered cost by 30% and improved patient satisfaction.

Still, to be successful, oncology HaH programs would need guidelines to govern which cancer patients can appropriately be seen at home — much like the guidelines that currently exist for general home health patients. Additionally, the Centers for Medicare & Medicaid (CMS) would need to ensure appropriate reimbursement models, methods and codes exist.

Ultimately, the authors hope — and expect — to see the role of acute care hospitals evolve when it comes to cancer patients, as the industry is also pushing for other types of care.

“Rather than being a routine site of care, acute hospitalization should become the exception: a site reserved for expert and intensive care of our sickest patients, with, it is hoped, a rapid transition to home as soon as possible,” Handley and Bekelman wrote.

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