Mayo Clinic researchers have published data showing that cancer patients can safely get chemotherapy treatment away from hospitals and clinics, in their homes instead.
The study looked at Mayo’s Cancer Care Beyond Walls program, and included 93 chemo infusions to 10 patients at home. Researchers say those patients did not experience any infections or reactions.
The Show spoke about this earlier with two of the researchers who worked on this study: Dr. Roxana Dronca is a medical oncologist and site director for Mayo Clinic’s Comprehensive Cancer Center in Florida; Dr. Cheryl Willman is a cancer genome scientist and enterprise director of Mayo Clinic’s Comprehensive Cancer Center in Arizona, Minnesota and Florida.
The conversation started about how common it is that cancer patients who are taking IV chemotherapy can do so in a non-clinical setting.
Full conversation
ROXANA DRONCA: Cancer Care Beyond Walls really was built to address needs, cancer patients' needs and a persistent challenge, I would say, in cancer care, which is the fact that the burden of access and the logistics of cancer care is often more difficult for patients than the disease itself.
So Cancer Care Beyond Walls was really built to wrap up care around the patient rather than building care around institutions, which has been the historical way to treat patients.
MARK BRODIE: Dr. Willman, what does it entail to get chemotherapy at home?
CHERYL WILLMAN: Well, Mark, you need a safe system. So one of the most important things about delivering care at home, as Dr. Dronca said, is it dramatically reduces the strain and what we call financial toxicity for our cancer patients. Having to travel back and forth from work or home to a treatment facility repeatedly for care.
Some of our first patients, our first patients did that 36 times driving three hours each way to get to our Jacksonville site. People miss work, they miss their lives, they miss their children, they miss their families. So the idea that we could deliver a large fraction of patient care in the home environment is wonderful and the program in its early stages is very successful.
The challenge is we have to assure, as you're indicating or suggesting, that that care at home is the same as care we would give in every facility, meaning safe, tolerable by the patient, and that we're ready for any emergency situation. So that requires 24/7 virtual monitoring by an advanced practice nurse or healthcare provider to the care team on the ground that we send to the home: wearable devices, remote monitoring of the patient and their healthcare needs, and the ability to mount an emergency response to that home rapidly if needed.
We also have to have immediate, real-time connection between the team on the ground and the team in what we call our command center. And importantly, all of this information and data is being fed to that patient's electronic medical record in real time, so there are no gaps.
MARK BRODIE: Dr. Dronca, is there sort of a technological component to this? It sounds like what Dr. Willman is saying that there is, but I wonder if for some patients that might even itself be a bit of a challenge depending on the internet connection at home or their ability to have Wi-Fi or maybe even their comfort with using technology.
ROXANA DRONCA: Those are all very valid points. So we have actually thought about all of this. Patients get a technology pack in the home and they actually get training when that is installed. The technology is very user-friendly. For patients who may have difficulty with internet connection, we actually provide a backup internet router that is allowing them to connect and also have had some packages that provide also cellular services for hotspots.
MARK BRODIE: Dr. Willman, do patients also need another human where they are? Like, are you having patients inserting their own IVs here?
CHERYL WILLMAN: No, Mark, we don't. We do send a healthcare team, a sort of a traveling healthcare team to the patient's home to facilitate with perhaps injecting a drug into a port or setting up a chemo line or even overseeing an oral medication.
So there is a trained healthcare provider entering the home as we're doing this care. The nice thing about that is that can be a local care team, and so the patient is never alone. Often, though, a family member can assist and help.
MARK BRODIE: Dr. Willman, what is the cost of this? Like, it sounds like there's a lot involved in allowing a patient to do this not in a clinical setting. So I'm curious, like, what is the cost for somebody to have chemotherapy at home versus in a clinic or a hospital or something like that?
CHERYL WILLMAN: So, Mark, this is a major challenge of the project, and I'll say a little bit about it. So the cost to deliver care in the home right now is about the same as the cost of delivering care as if you're being treated in an infusion center. It's our goal over time to continue to adapt the toolkit and the model to reduce that cost.
Interestingly, though, the insurers who we're working with, like Blue Cross Blue Shield in Florida, Florida Blue, Blue Cross in North Dakota, and other insurers we're talking to, are holding our current reimbursement cost harmless — in other words, we're being reimbursed in the home for what we would be reimbursed in the care facility.
But one of the really important pieces of data we're collecting are, what's the cost reduction by keeping a patient in the home and precluding the need to come to an ER, come into a hospital setting? We're catching events really early in the home when we can intervene more rapidly. So what we're actually doing, if you think about it, is from the beginning of a patient's treatment to the end, we're reducing, we believe, their total healthcare cost significantly through treatment in the home and a much more 24/7 monitoring of their conditions.
MARK BRODIE: Dr. Dronca, are there some patients for whom maybe this is not the right approach, or certain types of cancers even, maybe where the treatment is better suited for a clinical setting, or is this something that pretty much any cancer patient could in theory use?
ROXANA DRONCA: No, I would agree that we have to select patients very well. And the way we actually approach this initially was to choose the drugs that we felt were safe to be done in the home. So we chose drugs that are safe in terms of having a lower rate of infusion reaction, also drugs that are stable for transport for at least 24 hours. Patients also have to be tolerating the first one to two cycles of treatment in the clinic without any unexpected reactions to really be good candidates for this program.
But at least a third to 40% of cancer patients actually are on maintenance chemotherapy or immunotherapies or biologicals that really are easy and safe to administer, so we really feel there is a large patient population that can benefit from this program.
MARK BRODIE: Dr. Willman, I mean, Dr. Dronca mentioned that this could be a pretty sizable percentage at some point of cancer patients who would be well-suited for this and could in theory do this.
Do you see that as sort of the future of cancer treatment, at least as far as chemo goes, that patients maybe don't have to go to a clinic or a hospital, they can really just sort of do it from their couch?
CHERYL WILLMAN: Mark, that's exactly what I think. And people ask me to give a percentage of the care that I see transferring to home. So clearly we will be doing surgery or external beam radiation therapy still in clinic and hospital settings. Some intensive types of chemotherapy we'll still want to do in a hospital setting.
But I would guess as much as 70% of the current immunotherapies and chemotherapies that we give today could be done in the home setting. Our process has been to let that patient try the first few therapies in the hospital or clinic setting so we can monitor toxicity, make sure they're tolerating the drug well, and then let them take the next several treatments at home.
But if you think about any cancer patient taking treatment every three to six weeks, to be able to do even a half of those treatments at home versus facility would be a dramatic impact on their lives.
MARK BRODIE: There's been so much talk about telemedicine and, you know, getting medical care and treatments outside of the traditional clinical setting or doctor's office setting. Do you see this as sort of a way to test out other kinds of medications or other kinds of treatments that people traditionally have gotten in a clinical setting that might also be used at home instead?
ROXANA DRONCA: I definitely see this, I see this as a potential, you know, template for other chronic illnesses where patients need to have treatment administered over a long period of time. I think once the infrastructure is established, you know, just like telemedicine started during the pandemic, I think this is now being integrated in our, you know, way of living and delivering care.
So I definitely think this platform can go outside of cancer and serving patients who have other type of illnesses that may potentially benefit from, from this framework.
MARK BRODIE: Dr. Roxana Dronca is a medical oncologist and site director for Mayo Clinic's Comprehensive Cancer Center in Florida. Dr. Cheryl Willman is a hematopathologist and enterprise director of Mayo Clinic's Comprehensive Cancer Center nationwide.
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