Opportunities for Home Cancer Care: The Final Frontier.

Bringing cancer care to the patient's home through telemedicine and remote care services, including remote patient monitoring, cancer treatment at home, and hospital-at-home programs, has become an increasingly appealing opportunity to optimize patient experience, access, and value. Although these forms of remote care services came to the fore during the Covid-19 pandemic as a result of operational disruptions, their current use, future directions, and successes and barriers are largely unknown. The authors partnered with the Alliance of Dedicated Cancer Centers to conduct a landscape analysis through structured interviews with clinical leaders who have knowledge of these technologies across the United States. The interview was divided into five main sections, with questions focused on (1) telemedicine; (2) remote patient monitoring, including laboratory testing at home and the use of electronic patient-reported outcomes and biometric devices; (3) cancer treatment at home; (4) hospital-at-home programs; and (5) the use of AI to facilitate remote care. The authors interviewed 17 clinical leaders across 15 institutions. Several pertinent themes emerged during the interviews. The authors discovered that telemedicine visits are available to oncology patients across the country but vary in scope and capacity on an institutional level. Institutions share common barriers, including technical infrastructure, state licensure requirements, concerns about reimbursement parity, and institutional culture. A few institutions have prioritized telemedicine visits based on clinical operational strategy, made institutional investments to support it, and were able to surpass some of these barriers, serving as case studies for potential solutions. Other remote care services were rarely implemented in the institutions interviewed. A few institutions have received the necessary support, funding, and infrastructure to successfully implement programs and practices related to the five care delivery interventions and have demonstrated positive outcomes. Key aspects of their success include research efforts to provide an evidence base to support the transition of these interventions to standard of care, high-level (C-suite) institutional support, and the use of third-party vendors. Although telemedicine and remote care services are recognized as appealing options to improve patient care and experience, based on input and insights from the interviewees, the optimal implementation of such care delivery solutions in the home setting will require ongoing research investment, collaborative efforts, reimbursement security, changes in the regulatory and legislative environment, and advocacy.