ideasIdea
Home administration of selected chemotherapy and immunotherapy for older and frail patients
For frail older patients, the journey to hospital can be the hardest part of treatment. Nurses can safely give some cancer treatments at home, which may help more people complete their course.
Home chemotherapy programmes exist in several countries for low-risk regimens and for subcutaneous formulations of antibodies, with high patient satisfaction and safety. For older and frail patients, travel and waiting are major causes of missed doses and early discontinuation. Extending home delivery to this group, with remote monitoring and clear escalation routes, could improve completion and quality of life; payment models are the main barrier.
Hypothesis
Home administration for eligible patients over 75 will increase treatment completion by at least 15 percentage points and reduce patient-reported treatment burden, with equivalent safety.
Rationale
Home delivery of complex therapies (dialysis, parenteral nutrition, IV antibiotics) is safe and preferred by patients; oncology has lagged for institutional rather than clinical reasons.
What would test it
A randomised trial of home versus clinic administration for defined regimens in patients over 75, with completion, adverse events, quality of life, and cost as endpoints.
Maturity
being tested at scale
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.