Home-Based Chemotherapy for Cancer: Issues for Patients, Caregivers, and the Health Care System

In this report, the term ‘home chemotherapy’ denotes any modality of administration of chemotherapeutic agents for cancer cure or control at home (intravenous, subcutaneous, oral, etc.), with or without on-site supervision by a nurse. This assessment reviews the evidence concerning effectiveness, safety, patient preference and satisfaction, patient quality of life, and costs of home chemotherapy. Organizational, access, and patient choice issues were also examined. Published information was enriched with interviews with home chemotherapy providers at selected institutions in Québec and, for comparison, in Ontario, a province with similar demographics but a markedly different organizational structure for cancer care.

Establishing safe chemotherapy practices at home is resource intensive and requires a well-integrated, collaborative team of health care professionals. The home delivery model cannot wholly replace out- patient nor inpatient treatment, but can be a safe and acceptable option for some cancer patients who choose it, particularly those receiving continuous infusion therapies. The report recommends standardization of home treatment programs, enhanced collaboration between health care providers, and a comprehensive model of provincial cancer services that ensures the patient’s continuity of care. However, due to insufficient evidence on effectiveness, the perspective of cancer patients in Québec and particularly cost implications in comparison with outpatient settings, there is a need for well-designed evaluations of home chemotherapy before its use is greatly expanded in Québec.