Cancer CARE (Connected Access and Remote Expertise) Beyond Walls — Safety, Feasibility, and Patient Experience of Home-Based Chemotherapy

As patients live longer with cancer, traditional treatment models centered around hospitals and infusion centers increasingly burden patients, caregivers, and health care systems alike. These burdens are logistical, financial, and emotional, and they are especially profound for older adults and individuals in rural or underserved areas, who face added challenges in accessing centralized care. To address these growing inequities and systemic pressures, Mayo Clinic piloted an innovative model of home-based chemotherapy through its Cancer CARE (Connected Access and Remote Expertise) Beyond Walls program - CCBW. This program reimagines oncology care by integrating virtual oversight, remote patient monitoring (RPM), mobile health services, and a unified software platform connected to the electronic medical record. From April 1, 2023, to August 31, 2023, the CCBW pilot enrolled 10 patients who, collectively, received 93 intravenous chemotherapy infusions at home. Clinical safety was closely monitored through a virtual command center, with RPM data and mobile care teams enabling timely intervention when needed. Across the pilot, there were no infusion reactions or catheter-related infections, and the minor complications, including two cases of hypokalemia and two unrelated falls, were successfully managed within the home setting, avoiding emergency department visits or hospitalization. Feedback from seven patients underscored the acceptability and advantages of this home-based approach. From the original 10 pilot participants, 8 patients received surveys, of whom 7 responded. One respondent skipped select survey items. Among respondents, six of six reported feeling comfortable remotely interacting with the care team by phone or tablet, and seven of seven reported feeling emotionally supported by the care team. These early findings suggest that delivering chemotherapy in the home is not only clinically feasible and safe, but that it is also valued by patients. The CCBW model holds promise for reshaping oncology care delivery by leveraging digital health tools and decentralized service models to meet patients where they are. With a larger randomized trial launched in August 2023, just after this pilot implementation study, further evaluation will help determine the model's scalability, cost-effectiveness, and long-term outcomes. If successful, this approach could serve as a scalable blueprint for expanding access to cancer treatment across diverse populations and geographies, while supporting broader shifts in U.S. health care policy toward more patient-centered, home-based care.