Cancer care has long been a "come to us" model, but a new perspective piece from oncologists at Orlando Health and Memorial Sloan Kettering argues it's time to rethink that approach. At-home cancer care — from leuprolide injections to outpatient CAR T-cell therapy — is safe and viable when patients and regimens are carefully selected. The key factors: drug stability, reaction predictability, patient health literacy, home environment, and social support.

Making it work also demands integrated infrastructure. Staffing models must match treatment complexity — high-risk regimens like EPOCH still need oncology-certified nurses, while simpler injections can be self-administered. Electronic ordering, administration tracking, pharmacy integration, and escalation pathways are non-negotiable to maintain safety standards outside the clinic walls.

But the biggest barrier? Money. Medicare patients face higher out-of-pocket costs for home-administered drugs (covered under Part D) versus the same drug given in a clinic (Part B), and the data reflect it: patients with Medicare were significantly less likely to proceed with at-home leuprolide. Among commercially insured breast cancer patients offered home treatment, 43% who initially agreed ultimately dropped out — all due to cost.

Key Takeaways:

• Home administration is appropriate for stable, low-reaction-risk therapies; complex regimens still require oncology-certified nursing oversight
• Fragmentation between health systems, home-health agencies, and pharmacies is a major safety risk — integrated oversight is essential
• Site of care–agnostic payment models are needed to incentivize health system investment in home cancer care infrastructure

Why it matters: As cancer therapies evolve and patient needs diversify, the ability to deliver treatment at home could reduce burden, improve access, and free up infusion capacity — but only if policy catches up to the clinical reality.