The health care sector is rushing toward the home to improve outcomes and lower costs. At-home cancer care lags behind other areas, but COVID-19 could be a major push to a new future for treatment and screenings.
In 2020, the virus has disrupted traditional cancer care in several ways, including by delaying procedures originally scheduled for long ago. COVID-19 has also made some seniors affected by cancer wary about the idea of voluntarily entering hospitals while being immuno-compromised.
Entering patients’ homes for cancer treatment could go a long way in curbing at least some of these issues. While meeting senior cancer patients where they are helps with accessibility and comfortability, it also potentially improves outcomes, according to health experts.
But there are still barriers to surpass to get to a point where in-home cancer care is more prevalent across the U.S. And as of now, there is no real data even being kept on how common in-home cancer care is, Rachel Cannady, the strategic director of cancer caregiver support for the American Cancer Society, told Home Health Care News.
“In terms of at home care for cancer treatment, I just don’t know that we have data to report on that yet,” Cannady said.
Established in 1913, the Atlanta-based American Cancer Society (ACS) is a health organization dedicated to eliminating cancer. It has more than 250 regional offices throughout the U.S.
Cannady specifically has been working on support mechanisms for caregivers dealing with ancillary cancer treatment in the home. Without additional help, cancer can sometimes become as much of a burden on the caregiver as it is on the patient, especially for ones who are not medically trained.
As a useful tool, the ACS and Cannady have developed a comprehensive guide for caregivers to better deal with patient issues that caregivers may be unfamiliar with.
COVID-19’s impact on cancer care has been considerable in 2020, Cannady noted. It’s likely that the fall out will take a while to fully materialize, too.
“There’s just been so much uncertainty around COVID. Also facility liability [is a concern], if there’s exposure to immunosuppressed patients and potentially caregivers,” Cannady said. “Those treatment delays are causing major issues.”
Cannady expects that there will be an uptick in late-stage prognoses in patients, particularly when it comes to breast cancer and possibly colon cancer. Late-stage intervention can lead to worse outcomes.
The question, then, is whether or not at-home care could help ease some of the constraints that COVID-19 has put on cancer care, generally. And if so, why more health systems and providers haven’t jumped at the opportunity.
“I do think [at-home cancer care] could be a viable option,” Cannady said.
How at-home cancer treatment works
The concept of at-home cancer care has yet to gain steam in the U.S., but oncologists have pushed its potential worth. In 2019, authors in the Journal of Clinical Oncology (JCO) pointed to the model’s success abroad and argued it could have similar success domestically.
Done correctly, in-home cancer care could mean lower costs for payers and better outcomes for patients.
“The building blocks for an oncology hospital at-home are already in place in the United States,” the authors wrote in JCO. “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.”
The University of Utah’s Huntsman Cancer Institute’s Huntsman at Home program is an example of what the future of cancer treatment could look like.
In tandem with the nonprofit organization Community Nursing Services, the program provides care to patients who want an alternative to the hospital.
“We offer our services primarily to give patients an alternative to being in the hospital, but also to help decompress our hospital,” Dr. Anna Beck, the medical director of Huntsman At Home, told HHCN. “We try to take patients who are on the road to recovery, who are in the hospital, and get them home quicker. Since COVID hit, we also try to offer an alternative to hospitalization for other appropriate patients.”
Huntsman At Home assists with symptom management from chemotherapy or treatment as well as pain management from the cancer itself. The team works collaboratively with the oncologists, as well as other specialists like surgeons on things like post-operative care.
Additionally, the program provides routine home health such as physical therapy and occupational therapy, and also deploys social workers to help out with the psychological effects and caregiver support.
Right now, during COVID-19, Huntsman At Home only works within a 20-mile radius of the hospital, but it is gaining flexibility around that. Patients within that range are typically more comfortable coming into the hospital anyway, partly because the Huntsman Cancer Institute has beautiful facilities, according to Beck.
But there was also a no-visitor policy in place at some points, and there may be another one in the near future as surges persist around the country. In that case, the at-home program allows loved ones to play a bigger part in the patient’s cancer journey, which can be highly beneficial.
“It was a tough thing for many patients to come to the hospital and not be able to have their loved ones or their support system with them,” Beck said. “And for many, that can be a bit of a deal-breaker.”
Without visitors, and without the facility and resources that the Huntsman Institute has, the model could be even more applicable elsewhere, Beck suggested. For patients who have less desirable hospital conditions, being able to be treated at home as much as possible could represent a massive upgrade.
Still, while Beck said she is aware of some institutions conducting some limited chemotherapy in the home, Huntsman At Home is currently not doing so. Instead, the team does more limited intervention-type work with patients.
Huntsman At Home currently offers more than what a traditional home health agency would be able to provide. But in-home cancer care could also be a worthwhile opportunity for home-based care agencies to consider in the future.
Access and potential barriers
The increase in telehealth has been a tailwind for the Huntsman At Home team. Virtual tools allow medical experts to deliver care without driving as much as they did before COVID-19.
But access is still one of the major problems in cancer care — and one that at-home programs could address.
“That’s true especially in a place like Utah, where we have a huge rural and frontier population,” Beck said. “If we want to take care of patients throughout the Intermountain West, we have to be able to do it in such a way that it’s convenient for them, and it keeps them in their environment where their support system and their job is.”
It’s about delivering care where patients need it most — not just where it’s convenient for health systems and providers, Beck said.
Rural patients without nearby hospitals often have massive burdens placed on them during treatment, forcing them to schedule entire days around getting to a place where they can be screened and receive treatment or care.
But you can’t bring everything into a patient’s home — at least not yet. While there are examples of chemotherapy being delivered at home, there are still a slew of logistical struggles to get past.
“You can’t bring a radiation machine to somebody’s house to do proton therapy, you just can’t,” Cannady said. “The top three cancer treatments are surgery, radiation and chemotherapy. Maybe there are times when you can get chemo infusions, but for the most part, those are in very controlled settings.”