Infusion of antineoplastic medications in nontraditional settings, including the home, is not a new concept. However, the emergence of the novel coronavirus, COVID-19, has accelerated conversations around ensuring patients with cancer can continue timely cancer treatment regimens while minimizing their risk of COVID-19 exposure and infection. Administration of antineoplastics through home infusion has been offered as a potential solution and continues to gain momentum among healthcare facilities and third-party payors.
When considering the feasibility of home infusion of cancer treatment, the safety of patients, families, and healthcare workers is of prime importance. Healthcare facilities must take a programmatic approach to evaluate their ability to offer home infusion of antineoplastics, and not all facilities will have the capacity, staff, and resources to do so. Determining the feasibility of home infusion of cancer treatment requires careful patient selection, provider and patient education, and extensive planning (Gorski, 2020).
The Oncology Nursing Society and American Society of Clinical Oncology published joint standards for chemotherapy administration safety. The standards focus on safety concerns related to environment of care; treatment planning and patient education; ordering, preparing, dispensing, and administering chemotherapy; and monitoring for toxicities, adherence, and complications following administration (Neuss et al., 2017). Adhering to the safety standards ensures that policies and procedures are in place to minimize risk for error and patient harm, and is intended for all care settings, including the home.
In addition to adherence to administration safety standards, healthcare facilities must consider the elements of antineoplastics that make their administration a specialty, requiring focused training and competency validation of staff involved. Specialized education, preparation, and training of RNs who administer the therapies ensures a safe level of care (Oncology Nursing Society, 2017). The principles of antineoplastic administration that require additional training and specialty knowledge apply in the home setting as well.
Antineoplastics used for cancer treatment are often hazardous drugs (HDs) that demonstrate one or more of the following characteristics: carcinogenicity, genotoxicity, teratogenicity, reproductive toxicity, or organ toxicity. Any HD-handling activity, regardless of setting, can result in healthcare worker exposure (Oncology Nursing Society, 2019). With less control over the care environment, home infusion of HDs may pose an additional level of complexity and challenge to ensuring the safety of the nurse and those in the home with the patient. Great caution needs to be taken to prevent occupational exposure to HDs and the well-documented complications that occur as a result of surface contamination and exposure. Staff must receive thorough training on safe-handling principles, risk-reduction behaviors, and appropriate use of personal protective equipment (Polovich & Olsen, 2018).
Just as nuances and intricacies of antineoplastic administration require training and skill for oncology nurses, home infusion, a specialty within home care, necessitates a level of skill and expertise in elements such as home assessment, safety considerations, and resource utilization (Gorski, 2020). The infusion of antineoplastics in the home requires a careful synthesis of the oncology nursing and home infusion nursing specialties to yield optimal patient outcomes and quality care.
The decision to proceed with home infusion of cancer treatment should be done with caution and consideration of the risk of harm for nurses, patients, and other members of the household. Interprofessional considerations from providers, nurses, pharmacists, patients, and families are required, and policies and procedures that reduce the risk for medication error and staff and family
exposure to HDs must be securely in place.
It is the position of ONS that any healthcare organization planning to provide antineoplastic drug infusions in the home setting must establish the following:
Approved by ONS Board of Directors August 2020.
Gorski, L.A. (2020). Infusion therapy: A model for safe practice in the home setting. American Nurse Journal, 15(6), 8–11. https://www.myamericannurse.com/infusion-therapy-a-model-for-safe-practicein-the-home-setting
Neuss, M.N., Gilmore, T.R., Belderson, K.M., Billett, A.L., Conti-Kalchik, T., Harvey, B.E., . . . Polovich, M. (2017). 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards, including standards for pediatric oncology. Oncology Nursing Forum, 44(1), 31–43. https://doi.org/10.1188/17.ONF.31-43
Oncology Nursing Society. (2017). The education of the nurse who administers and cares for the individual receiving chemotherapy, targeted therapy, and immunotherapy [Position statement]. https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/positionstatements/education-nurse-who
Oncology Nursing Society. (2019). Ensuring healthcare worker safety when handling hazardous drugs [Position statement]. https://www.ons.org/make-difference/ons-center-advocacy-and-healthpolicy/position-statements/ensuring-healthcare
Polovich, M., & Olsen, M. (2018). Safe Handling of Hazardous Drugs (3rd ed). Oncology Nursing Society.