Post-pandemic, home-based cancer care faces challenges

When COVID-19 hit the United States in early 2020, radiation oncologist Dr. Justin Bekelman was ready for the challenge.

The director and team of clinicians at the Penn Center for Cancer Treatment Innovation in Philadelphia already had plans to launch the center’s home cancer treatment program. Within six weeks of its February 2020 launch, the program was able to treat 39 of her patients at home, with more than 300 available.

“When the pandemic peaked in the summer, this was one of the key avenues for people with breast cancer, prostate cancer, lung cancer and lymphoma to get treatment,” said Bekerman.

Today, Penn Medicine treats approximately 3,000 patients through programs with 30 different cancer treatments, including chemotherapy and immunotherapy. The health system treats approximately 19,000 cancer patients annually.

Pen Medicine isn’t the only company embracing at-home cancer care. In the past three years, several other health systems, including Jefferson Health in Philadelphia and Fairview Health in Minneapolis, Minnesota, have begun home care for cancer patients.

Cancer care is big business, and delivering that care at home is not a new idea. It’s estimated that 5% to 10% of his oncology drugs are administered at home worldwide, but the practice has been slow to catch on in the United States.

About 1.8 million Americans are diagnosed with the disease each year. Cancer will cost $209 billion in 2020, making it the fourth most expensive disease, according to the National Cancer Institute. Intravenous administration of chemotherapy and immunotherapy drugs at home could free up space in hospitals and outpatient facilities and save costs for the healthcare system.

Treating cancer patients at home is more convenient and less stressful, especially for patients who have to travel to remote facilities. Fairview Health treats cancer patients up to 90 miles from Minneapolis. About 380 of the 2,500 home IV patients are being treated for cancer.

Brett Benfield, director of home infusions at Fairview, said many patients with brain tumors benefit particularly from home visits because they have difficulty traveling for treatment.

Despite these benefits, a white paper published Wednesday by the American Cancer Society outlines the many challenges of bringing oncology treatments more broadly into the home, including safety concerns, economics and patient acceptance. bottom.

For treatments that can be safely transported, stored, and delivered at home, an IV nurse travels to the patient’s home to administer the treatment. The nurse remains at home during the dosing period, but the patient may experience side effects after the clinician leaves. Patients receiving on-site care often remain on-site for up to 1 hour for observation.

Dr. Arif Kamal, chief patient officer of the Cancer Society, said that at home, “you’re going to be the eyes and ears for patients and caregivers, letting them know what to do.”

Health care providers say that while economic reasons drive home care, it can also get in the way. Many private health insurance companies will pay for home treatment, but may offer less reimbursement. Large providers such as Penn Medicine can make up the shortfall by making more beds available for other patients. Low reimbursement can be a financial challenge for small oncology clinics that rely heavily on revenue from facility-based treatments.

Health care providers and the American Association of Oncologists argue that Medicare is an even bigger problem. More than half of patients diagnosed with cancer he is over 65 years old. Medicare Part D covers some of the cost of home infusions, but not all. This means that patients who want home care will have to pay some out-of-pocket costs.

Not only does this discourage many patients from receiving care at home, it can also contribute to healthcare disparities.

Oncologist Dr. Jyoti Patel, editor of the website, said, “The practice of treatment at home worries us.” “This means that the rich can afford treatment at home, but the poor cannot afford it.”

Still, Patel said this home will be part of the future of cancer care once reimbursement issues are resolved and Medicare more fully embraces value-based care.

A new generation of providers is entering the market. Based in Nashville, Tennessee, Reimagine Care was founded early last year with his $25 million in funding from six investors. The company has partnered with the University of Colorado in Denver and the Center for Cancer and Blood Disorders in Dallas to provide in-home services for cancer patients, including remote patient monitoring, hydration and testing services. Devin Carty, co-founder and CEO of Reimagine Care, said the company wants to bring some infusions into the home.

Correction: An earlier version of this article stated that the hospital treats approximately 380 of its 2,500 patients at home.

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