Early in the COVID-19 pandemic, a key discussion in the oncology world was whether patients with cancer should continue to receive office-based administration of chemotherapy, given the risk for exposure to the virus. “We are 4 months down the line and are basically having the same discussion,” said Michael Kolodziej, MD, Senior Advisor, ADVI Health, who moderated a session on the future of oncology home infusion in a post–COVID-19 world. “To my knowledge, there have been essentially no reports of transmission in infusion suites, while the statistics suggest that office infusions have not gone down too much during the pandemic. All that said, we are in a circumstance where people are anxious about exposure and infection, and there is evidence that oncology patients, when exposed, don’t do so well.”
He noted that the Centers for Medicare & Medicaid Services has announced a permanent home infusion therapy benefit for Part B drugs. “Now we are hearing rumors about commercial health plans being enthusiastic about home administration,” he added.
Panelists were conflicted about the prospects for expansion of home infusion for anti-cancer therapy. “It’s not about whether or not cancer treatment can be delivered in the home; it’s about which drugs. There are some drugs that probably have very little potential for reaction, can safely be administered in the home, and are not hazardous to the patient and family,” said Lisa Kennedy Sheldon, PhD, ANP-BC, AOCNP, FAAN, Scientific and Clinical Affairs Liaison, Oncology Nursing Society. “But there are some drugs given for cancer treatment that have life-threatening and potentially life-ending reactions requiring rapid response from an emergency team and life support.”
Barbara McAneny, MD, MACP, FASCO, Past President of the American Medical Association, and CEO, New Mexico Oncology Hematology Consultants, noted the irony of advancing US Pharmacopeia Chapter <800> standards for pharmacies and Oncology Nursing Society standards for oncology infusion centers, only to send nurses out by themselves to provide infusions in patients’ homes. “In my office, we are cleaning everything—disinfecting doorknobs, chemo chairs, poles. Then we send a nurse to someone’s house where we don’t know who’s done the cleaning? In our office, we have had no staff members infected because we are taking incredible precautions. I am not sure I want to send my nurses out to someone’s home where there may be a very high risk of COVID.”
Chevon Rariy, MD, National Director, Telehealth, Cancer Treatment Centers of America, noted that some chemotherapies have been provided in the home for certain patients for at least 20 years. “Two key issues are the selection of the appropriate chemotherapy and the selection of the appropriate patients. There are some individuals who may not be in an ideal situation to have their treatment in the home. But at the same time, we have many factors driving us in this direction.” She described a patient with pancreatic cancer who had missed many months of treatment because of fear of infection at the infusion facility. “When he re-presented to us, his pancreatic cancer had metastasized, and he was clearly going to have a poor outcome. That is an issue we are seeing time and time again.”
Several key issues should drive the conversation around home infusion of cancer therapy, said Steve Peskin, MD, MBA, FACP, Executive Medical Director, Population Health and Transformation, Horizon Blue Cross Blue Shield. “Safety first. First and second doses, for example, should be done in an infusion center. Second, the environment. Sometimes the home setting may be equally or more problematic. Third, economic issues. Right now, the patient cost burden can be higher in the home. We are looking at how we work with plan sponsors, so patients are not disadvantaged.”