In May of 2020, Justin Bekelman, MD, an Advisor to Reimagine Care, Director of the Penn Center for Cancer Care Innovation, and Professor in the Departments of Radiation Oncology, Medicine and Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania, sat for an interview with The ASCO Post, the online publication of the American Society of Clinical Oncology (ASCO).
Dr. Bekelman offers in-the-moment perspective on how the pandemic shifted the calculus for home-based care, opening the way for this powerful new care model for patients, clinicians, and health systems.
Below are highlights from the interview, which focused on the experience of Penn Medicine’s Cancer Care @ Home program, as well as updates Dr. Bekelman shared in a talk at Duke Margolis Center for Health Policy in December 2021.
- Penn Medicine’s Cancer Care @ Home program now provides care at home to over 3,000 patients with cancer annually.
- As of May 2020, 13 cancer drugs were provided at home as well as supportive services such as hydration and antiemetic therapy for chemotherapy-induced nausea and vomiting. In 2021, the program expanded to over 30 cancer drugs.
- Multidisciplinary team, all trained in home infusion therapy—including clinical pharmacists and Oncology Nursing Society–certified nurses as well as palliative care clinicians.
- Safety and quality protocols match those in the hospital or clinic facility.
- Expanded out from an existing program that had been providing rehabilitative and supportive nursing services in the home setting for cancer patients.
- Planned and launched before pandemic. But even more essential now to reduce risk of Covid infection, to decrease density in infusion suites, and to boost hospital capacity.
- Individualized for patients. Patients opt into home-based treatment and can opt out too.
- Not all cancer care moves to home setting: only appropriate patients receive appropriate care that does not require outpatient or inpatient-level resources.
- Reduces fragmented, unnecessary, and suboptimal care and utilization.
- Lower patient financial burden—travel, childcare, missed work and incidental expenses.
- Much improved patient experience—especially for patients with pre-menopausal breast cancer who often have to take leuprolide monthly, sometimes for 5 to 10 years.
- Reimbursement policies need to incentivize or promote, and at least not obstruct, innovation in the delivery of cancer care at home that is more patient-centric.