Since the onset of the COVID-19 pandemic, healthcare professionals have struggled with how to care for patients with serious conditions, such as cancer, without increasing the risk of exposing them to the virus at clinics and hospitals.
One option is allowing some treatments to be administered at home. However, the American Society of Clinical Oncology (ASCO), a leading cancer care organization, just issued a warning to patients with cancer to avoid home-based infusion therapy of treatments including chemotherapy, immunotherapy, and related medications.
The warning follows a recent relaxing of the rules allowing such therapy at home during the pandemic.
Last year, the Centers for Medicare and Medicaid Services (CMS) finalized a rule to create a benefit for home infusion therapy beginning in 2021.
As the COVID-19 pandemic unfolded, however, CMS introduced additional flexibility to the rule, immediately allowing healthcare professionals and patients to engage in home-based anticancer infusion therapy.
“The question from our members is: Is this a safe thing to do, and is it something we should address?” Stephen Grubbs, MD, ASCO’s vice president of clinical affairs.
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Can Infusion Based Cancer Therapy Be Given Safely at Home?
According to ASCO position statement, published on the ASCO website, there is insufficient evidence comparing the safety of home-based infusions with traditional infusion center treatment.
Moreover, some of the practices used at infusion centers to ensure safety are impossible to follow at home, according to the statement.
“There is a paucity of data suggesting the safety portion of it,” he said. “ASCO has some very strict chemotherapy safety standards that were developed. … The question is can you apply those very important safety standards into other outpatient settings,” such as a home.
Concerns over home-based anticancer infusion therapy range from the safe handling of the drugs to the potential for allergic reactions that might require emergency treatment, he said.
“Custody of care of the drugs is a concern,” Dr. Grubbs said. “When you’re in the outpatient fusion area, the custody of the drugs remains with the pharmacy and pharmacist. When you’re doing this at home, the custody of drugs changes.”
There are also other practical problems, such as how to clean up a drug spill. Many anticancer infusion medications are toxic.
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Does Home-Based Infusion Therapy for Cancer Ever Make Sense?
There may be unique circumstances where home-based anticancer infusion therapy makes sense, Grubbs said. However, the position statement calls for collecting data to evaluate its safety. “We need more research and evidence to see how it applies in the home setting,” he said.
ASCO has called on CMS to consult with oncology experts before implementing the home infusion benefit in 2021 and recommends home-based infusion be limited to “exceptional circumstances” when the benefits of treatment at home clearly outweigh the potential risks.
The oncology community has grappled with how to continue to care for cancer patients during the pandemic, Grubbs acknowledged. But ongoing studies suggest that many cancer patients can continue with their treatments at hospitals and clinics.