The American Society of Clinical Oncology (ASCO) released a position statement about the administration of anticancer therapies in the home setting, in which concerns were raised about patient and caregiver safety, lack of adequate oncology nursing staff, and payer reimbursement issues.
The position statement was developed in response to the Centers for Medicare & Medicaid Services’ (CMS) decision to allow for flexibility in the delivery of care, including home infusion of anticancer therapies, in response to the COVID-19 pandemic.
“ASCO does not generally support such an expansion in the context of anticancer therapy services in the absence of circumstances where the benefits of doing so outweigh the potential risks,” the statement indicates.
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The position statement acknowledges that there may be cases in which the benefits of home infusions outweigh the risks. In addition, home infusion could improve patient access to treatment and enable the collection of data to better characterize the role of home infusion in the future.
The position statement also outlined the potential risks of home infusion, with a primary concern including patient and caregiver safety. It may be difficult to implement the same level of verification of patient, drug name, dosage, infusion volume, and route/rate of administration. Patients, caregivers, and health care providers could be exposed to hazardous material and some adverse events may not be safely handled in the home setting.
ASCO also raised the concern of workforce issues, particularly that there may not be an adequate number of specially trained oncology infusion nurses, depending on the level of adoption of home infusion. There may also be payer reimbursement issues, as not only the nurse is involved in home infusions, but there must be teleconferences for the verification process that require the participation of other health care providers.
In its recommendations, the ASCO position statement urged CMS to consult with oncology experts as they develop and implement their home infusion benefit in 2021, and suggested that the agency should not extend the temporary flexibility for home infusions to Part B cancer drugs. Other recommendations included limiting the home infusion benefits to exceptional circumstances, requiring verification to ensure safety policies remain in place, and supporting independent research of the safety and effectiveness of home infusion services with public funds.
Reference
American Society of Clinical Oncology (ASCO). American Society of Clinical Oncology position statement home infusion of anticancer therapy. Published online June 23, 2020. Accessed August 11, 2020.
