ideasIdea
Hospital-at-home for oncology: treating low-risk febrile neutropenia and dehydration at home
Many hospital stays for cancer patients, such as for fever after chemotherapy in low-risk cases, could be delivered at home with daily nurse visits and remote monitoring, which patients prefer and which is cheaper.
Hospital-at-home programmes deliver acute-level care (IV antibiotics, fluids, monitoring, daily nurse and physician oversight) in the patient's home and have shown equivalent or better outcomes, fewer complications, and lower costs in general medicine. Oncology-specific programmes (such as Huntsman at Home) report reduced admissions and emergency visits. Expanding the model to defined oncology conditions, with payer recognition, would reduce hospitalisation, which is particularly harmful for older patients.
Hypothesis
Oncology hospital-at-home will reduce inpatient bed-days for eligible conditions by at least 40% with no increase in 30-day mortality or escalation, and higher patient satisfaction.
Rationale
Hospital stays cause deconditioning, delirium, and infection in older patients; the interventions for many oncology admissions are deliverable at home.
What would test it
A randomised trial of hospital-at-home versus admission for low-risk febrile neutropenia, dehydration, and symptom crises in 500 patients with bed-days, safety, and satisfaction as endpoints.
Maturity
being tested at scale
Who has to act
clinic
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.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.