The University of Pennsylvania, Philadelphia, had begun a small pilot study to assess the possibility of cancer treatment at home for safety and patient satisfaction. Early in the pilot, COVID hit, and demand for the Cancer Care at Home service ballooned by 700%.

“We had been working on [the program] for about 6 months prior to COVID and, of course, facing some challenges around provider buy-in…how can we do this safely, what are the right patient populations, what are the right drugs,” Lindsey Zinck, RN, PhD, OCN, NEA-BC, said in an interview with Medscape Medical News. Then COVID hit, with the recognition that patients were safer at home. Zinck is chief nursing officer at Penn Medicine’s Abramson Cancer Center, Philadelphia, and a lead for the program.

Penn wasn’t alone in recognizing that, under the right conditions, safe cancer treatment didn’t always have to mean a trip to the clinic. A similar program, with its own unique features, has been growing at the Mayo Clinic Comprehensive Cancer Center in Jacksonville, Florida.

Other major centers have tested home-based oncology care. Memorial Sloan Kettering piloted a quality improvement study of adult patients with neuroendocrine and breast cancers in 2022 that involved nurses delivering outpatient pharmacy-dispensed in-home intramuscular/subcutaneous treatments. The researchers concluded that at-home administration of cancer therapies was safe and patient-centric, but several administrative barriers existed including pharmacy benefit denials. These barriers prevented the study from achieving its primary endpoint.

Johns Hopkins pioneered the broader hospital-at-home model for geriatric and acute care patients in the late 1990s. A home infusion service under this umbrella has treated a handful of patients with cancer with colony-stimulating factor but does not operate a dedicated oncology program.

Early data showed that home-based cancer therapy is feasible and safe and highly acceptable; patients reported excellent care experiences, with the majority preferring home-based treatment, according to a poster presented at the 2025 Annual Meeting of the American Society of Clinical Oncology (ASCO). The Mayo team shared with Medscape Medical News comments from patients, who reported positive experiences with the program.

One patient said, “I couldn’t be any happier. My quality of life is up. I’m able to be with my sister.” Another commented, “This program has changed my life. As a teacher, I don’t have to miss school days anymore. I can teach without worry.” A third noted, “My quality of life has changed significantly to a point I never thought I’d be.”

The Mayo Clinic’s Cancer CARE Beyond Walls (CCBW) program started with a pilot trial with 10 patients. A second pilot study was completed, but data have not been published for either of these. In addition, the program has expanded to include three active clinical trials, Roxana S. Dronca, MD, told Medscape Medical News in an interview. Dronca is a hematologist and oncologist and site deputy director of the Mayo Clinic Comprehensive Cancer Center. She is also the physician lead for the program on the Florida campus and the principal investigator for two clinical trials studying administration of chemotherapy and immunotherapy in the home vs the clinic setting.

“With our initial pilot, we started with just building the infrastructure…we offered patients the choice of receiving treatment in the home for 6 months, and none of the 10 patients wanted to return to exclusive in-clinic care,” she said.

Dronca reported the results of a larger randomized trial of the CCBW program in a poster at the ASCO annual meeting this year. This study included adult patients receiving chemotherapy or hormonal therapy at Mayo Clinic Florida, who were randomized 1:1 after experiencing treatment tolerance in clinic. Patients were randomized to home-based care for 24 weeks or in-clinic care for 8 weeks, followed by home-based care for 16 weeks.

As of February 2025, 52 patients were enrolled (26 per arm), and 36 began treatment. The patients had several types of common cancers — breast (38%), colorectal (21%), prostate (19%), and multiple myeloma (14%).

The primary endpoint was care satisfaction at 8 weeks, evaluated using the Consumer Assessment of Healthcare Providers and Systems tool, which ranges from 0 to 10, as well as patient preference for the site of care. Satisfaction was high in both arms: 9.69 for in-home care and 9.54 for in-clinic care. However, almost three quarters (73%) of patients preferred home care at 24 weeks; only 9% preferred the clinic, and 18% had no preference. In addition, all respondents reported being comfortable with home infusions. In terms of safety, there were no grade 3 or greater adverse events related to either care location.

Same Goal, Different Approaches

While both the Mayo Clinic and Penn programs rely on infusion nurses with physician oversight, their operational models differ. The Penn Cancer Care at Home program works through the Penn Home Infusion Therapy (PHIT) service. Medication is delivered to the patient’s home via courier. A nurse arrives on the day of the scheduled visit to administer care. These nurses have the same certification, training, and competency validation as nurses in the infusion suite. The prescribing oncologist monitors the patient’s treatments to ensure coordinated care.

Mayo’s CCBW integrates four key components: a centralized command center for virtual oversight, in-home remote patient-monitoring technology, mobile care delivery services, and a software platform with electronic medical record integration. Home-based services include laboratory testing. As with the Penn program, medication is delivered by courier, and infusion therapy is performed by home health nurse providers.

Drug and Patient Selection

Not every chemotherapy drug is suitable for home-based cancer care, and both programs rely on strict criteria to guide selection.

At Penn, the team deliberately chose two ends of the spectrum for its demonstration: patients with lymphoma receiving the complex EPOCH [etoposide, prednisone, vincristine, cyclophosphamide, and hydroxydaunorubicin] regimen to show that even more involved regimens could be shifted safely from hospital to home. The other end of the spectrum was patients with breast or prostate cancer receiving Lupron injections to illustrate a lower complexity, infusion-to-home transition, Zinck explained.

“That allowed us to demonstrate feasibility across very different types of treatment,” she said.

From there, Penn developed a framework of roughly 20 criteria, including drug stability, risk for reaction, black box warnings, and nursing logistics. This list of criteria helps the Penn team evaluate whether shifting a particular drug to the home is safe, and this process also has multidisciplinary stakeholder input, Zinck said. Only agents with long safety records and appropriate monitoring were moved into the home setting.

All nurses delivering care at home carry the same Oncology Nursing Society chemotherapy certification and competencies as those in infusion suites, she noted.

Mayo’s program uses a similar approach, excluding drugs known for unpredictable late reactions — such as carboplatin or oxaliplatin — even if patients have tolerated them for weeks. By contrast, drugs where reactions typically occur early in treatment can be shifted to the home after the first few cycles are completed safely in the clinic. Infusions are delivered by trained home health nurses with real-time oversight from Mayo’s command center and oncology team.

Patients and Caregivers

PHIT staff obtain insurance authorization, discuss out-of-pocket costs with patients, and schedule home visits.

“Patients valued convenience. Even when copays were higher — for example, with some prostate cancer drugs — many were willing to pay for the trade-off of avoiding traffic, parking, and lost work time,” said Cassandra Redmond, PharmD, now associate chief operating officer at Penn Medicine.

“[At Mayo,] patients overwhelmingly say that if they had the option to be treated at home again, they would,” Dronca said. Beyond convenience, she pointed to the “financial and time toxicity” of clinic-based care — the hours spent traveling, waiting, and arranging childcare or caregiver support. Coming into the clinic once every few months instead of every other week gives patients back control over their schedules and their lives.

Zinck’s doctoral research confirmed the impact of Cancer Care at Home. Patients treated at home reported clinically meaningful improvements in quality of life and satisfaction compared with those receiving care in infusion suites. Caregivers, too, reported fewer emergency department trips and hospitalizations, as well as more meaningful time at home with family members, she said.

Foundations and Growth

Scaling up cancer treatment at home programs requires having rigorous nursing safety standards.

“You need a strong nursing model and infrastructure,” said Zinck. “The business side, the pharmacy side, and dispensing are all critical components. But if you don’t have solid nursing, [the program] is going to fail.”

Dronca noted that the next frontier may involve more subcutaneous drugs, remote-controlled devices, and even empowering patients to administer treatments themselves under close oversight from a command center. “That’s how you scale,” she said.

Dronca and Redmond reported having no relevant financial relationships.

Zinck reported extramural consulting with Leap Health, an employer-based provider of home infusion services.