Each year, about 1.8 million Americans are diagnosed with cancer. Historically, nearly all life-extending cancer treatment has been delivered in outpatient or hospital settings. Within a year of diagnosis, three-quarters of those with advanced cancer end up in the hospital; one in six are hospitalized three or more times. And nearly all chemotherapy is delivered in physician offices or outpatient clinics. Patients have to travel in, pay for parking, and spend hours waiting for and receiving care.
Internationally, giving cancer drugs at home has been done safely and effectively across various patient populations and treatment regimens. But it’s uncommon in the United States.
At Penn Medicine, we provide world-class cancer care to more than 26,000 new patients each year. In late 2019, a multidisciplinary team of experts, brought together by the Penn Center for Cancer Care Innovation, began to explore if home cancer treatment could, for appropriate drugs and patient populations, take the place of inpatient or outpatient administration.
Cancer care @ home (CC@H) is an evidence-based, patient-centered program that enables life-extending cancer treatment to be delivered in the home.
The program proactively identifies optimal candidates based on specific criteria agreed upon by clinical teams. Providers discuss CC@H with their patients during telehealth or in-person visits and prescribe home treatment using the electronic health record (EHR).
From there, staff from Penn Home Infusion Therapy (PHIT) obtain insurance authorization, discuss out of pocket cost with patients, and schedule home visits. A courier delivers the medication to the patient’s home, and an oncology-certified nurse arrives on the day of the scheduled visit to administer care. Throughout this process, the prescribing oncologist monitors the patient’s treatments to ensure coordinated care.
Since CC@H launched in February of 2020, hundreds of patients with breast cancer, prostate cancer, and lymphoma have received timely, safe, and effective treatment in the comfort of their homes. The program is now a standard of care at the Abramson Cancer Center.
CC@H patients report dramatically increased satisfaction with care, enhanced convenience and comfort, and a better overall health care experience. With CC@H, patients with lymphoma can spend 25 fewer days in the hospital, and patients with breast or prostate cancer can have up to 12 fewer outpatient visits a year.
Providers are excited to be able to offer CC@H as an option for their patients. And for the health system, CC@H increases capacity while maintaining timely and effective care.
The team is exploring opportunities to make CC@H available for more patients.
CC@H strengthens the health system’s pandemic response by decreasing infusion suite density and increasing inpatient bed capacity. Redirecting immunocompromised patients from the clinic or hospital to receive their cancer treatment at home protects these vulnerable patients from unnecessary exposure.
The COVID-19 pandemic added great urgency to CC@H efforts. When stay-at-home orders were issued, the program scaled quickly. Over seven weeks, CC@H saw a 700 percent increase in the number of patients participating.