Patient-Focused Benefits of at-Home Versus in-Clinic Administration of Cancer Therapy: New Considerations for the COVID-19 Era

• Published in: Blood 2020-11, Vol.136 (Supplement 1), p.35-36
• Main Authors: Sandman, Karen E., Bell, Timothy J.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2020-137560

Introduction: Cancer treatment includes conventional clinic-based infusions and various options for home administration of medication. Clinic-based treatment can be disruptive and costly to patients and caregivers, requiring transportation, time away from work/family responsibilities, and stressful clinical settings. The COVID-19 pandemic has increased concerns that patients may be exposed-or experience anxiety about exposure-to viruses and other pathogens. Potential benefits to home-based chemotherapy include cost/healthcare resource utilization savings and decreased infection exposure by avoiding clinical settings. In the COVID-19 era, ASH, ASCO, ESMO, and other groups have recommended home administration of chemotherapy, including infusions at home and self-administered oral and subcutaneous treatments, for certain cancer types where feasible. This literature review evaluated patient- and caregiver-relevant advantages of home-administered cancer therapy. Methods: A strategic literature review was conducted using the pearl growing/snowball method, wherein core publications were identified using an initial PubMed search strategy with the MeSH heading “Antineoplastic Agents/Administration & Dosage” and the search terms “Home Care Services” and “Patient Satisfaction.” Results were limited to English-language publications dated January 2000 to July 2020, ≥10 study subjects, adult subjects only, with no limits for geography or cancer type. A total of 21 initial results were retrieved in PubMed. Six core publications were used to establish keywords and for bibliographic and prospective citation searches to identify additional relevant publications relating to patient preference and patient/caregiver-reported outcomes regarding cancer treatment administration settings. In addition to PubMed, the following congresses were searched: ASH (2004-2019), ASCO (2011-2020), EHA (2016-2019) and ESMO (2010-2019). Results: Thirty-one studies involving both hematologic cancers and solid tumors were identified from North and South America, Europe, Asia, and Australia. Cancer therapy was administered by patients/caregivers (ie, oral or subcutaneous) or a visiting nurse. All the studies reviewed reported benefits for home- vs clinic-based treatment. Patient expressed preference/satisfaction and willingness to continue with home-based regimens; while methodologies varied among studies, 70% to 100% of patients preferred home administration. Across studies, over half of patients