Can You Get Chemotherapy for Cancer at Home? The New Push During COVID-19

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The Centers for Medicare and Medicaid Services, or CMS,  is a huge force in the health care system because it determines what the government will pay for when it comes to care. MS has proposed allowing more flexibility for people to receive chemotherapy at home during the COVID-19 pandemic. And CVS and Cancer Treatment Centers of America (CTCA) announced their partnership earlier this month that will allow them to provide care at home to people receiving certain types of chemotherapy or immunotherapy for breast, lung, prostate, colorectal, head and neck, and some genitourinary cancers. Patients will get their first infusions at a clinic and, as long as they do well, they'll get the remaining infusions at home.

At-Home Cancer Care is Possible

Changes at medicare and programs such as CTCA's could bring care to a large number of patients with many different types of cancers. For many types of cancers, this will be the first time such care has been available. But, some chemotherapy regimens already take place at home.

For example, people who take the chemo drug 5-FU may get a pump that they can take home. That way, they can receive drug over the course of several days without staying in the hospital for all that time.

Dr. Heather Yeo talks about first-line 5-FU chemotherapy for colon cancer.

The University of Utah's Huntsman Cancer Institute offers some cancer care at home, too. The program sends health providers to patients' homes for acute medical care and post-surgical care. For example, patients who might have had to go to the hospital for debilitating side effects of their treatment, such as severe nausea, receive treatment for that at home through this program.

Dr. Leslie Boyd explains how to handle chemo-induced nausea with ovarian cancer.

At some cancer centers, injectable medications have started moving to patients' homes during the COVID pandemic. "Patients who have prostate cancer or breast cancer, for example, need hormone therapy, which is usually given as a shot that's once a month, or once every three months. Some of our patients would come into the clinic for that, but it is feasible, oftentimes, for patients to have the medications sent to their home where they can do it themselves," Handley says.

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Private home infusion services through home health agencies, separate from hospitals, offer some cancer treatments, too.

Care At Home Could Be Cheaper, Safer and Better

Research shows that at-home health care programs reduce the total number of days that people stay in the hospital and reduce the risk for hospital readmissions and unplanned hospital and ER visits. They substantially cut patients costs by 30 to 50 percent and increase satisfaction.

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When you get your care at home, you lower your exposure to hospital-acquired infections and COVID-19, too. And, for people who otherwise might travel long distances for treatment, in-home care gives you more time at home with your family, which can greatly improve your quality of life.

Pushback from Professional Organizations

Though there's emerging evidence for the benefits of in-home care, professional associations including the American Society of Clinical Oncology and the Community Oncology Alliance have released statements in strong opposition of at-home infusions. Both organizations cite patient safety concerns and overall lack of data on the safety of at-home care.

"There's good data from other countries that a home-based regimen can be safe and effective," Handley says. "There's just less experience with that in the U.S."

As at-home cancer care programs expand though, more data will become available.

Reimbursement Barriers

One reason that at-home cancer treatment may not be any more prevalent than it is: Hospitals may not have a straightforward way to bill insurance for care that doesn't take place inside their walls. But, Handley says, as evidence grows that this type of care could save insurers money, these reimbursement barriers may become easier to overcome.

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"Insurance companies are increasingly interested in moving care out of the hospital and into the clinic or into the home setting," Handley says, "but there's not universal alignment on it just yet."

Find Out If You Can Get Care at Home

Though at-home cancer care is still in its infancy in the US, it's worth asking your care team and your insurance provider whether this type of care is available to you.

Start by asking a member of your care team these questions:

• Can I receive any component of my treatment at home?
• Are there other ways that I can reduce my exposure to the health care system?
• Can any of my doctor visits be telehealth visits?

"We often forget just how burdensome it can be for patients to travel to hospitals for their care," Handley says. "So, even if you can get a telemedicine appointment instead of an in-person visit, that would be somewhere to start."

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