Excellent Practices

Onco@home

Practice Category: Treatment

Centre: Kortrijk Cancer Centre AZ Groeninge

Laura Tack

Quality Lead Oncology

Laura.Tack@azgroeninge.be or Vanslambrouck@azgroeninge.be

Challenge addressed by the practice

As a result of the increasing cancer prevalence, the demand for cancer care is growing. In the oncology day clinic of the Kortrijk Cancer Centre, we reached the maximum capacity a few years ago. At the same time, the importance of providing integrated, high-quality, patient-centred, and cost-efficient care is globally emphasised. As a consequence, there is an urgent need to evaluate alternative healthcare models meeting these challenges. A different approach was developed with our onco@home model, targeting cancer patients receiving ambulatory systemic cancer therapy at the Kortrijk Cancer Centre. This model allows us to redesign ambulatory cancer care and optimise the capacity of the oncology day clinic by providing two circuits that allow a reduction in the number of hospital visits and/or the duration of hospital stays by shifting certain specialised procedures from the hospital to the patient’s home.

Solution

The onco@home models are standard of care (when applicable):

  • Model A: On Day 1, a certified primary home care nurse visits the patient at home and performs blood sampling, symptom assessment, and vital sign measurements. This enables the treating physician to assess treatment safety in advance and prepare therapy or select matched blood units for transfusion ahead of arrival at the oncology day clinic (Day 0). This proactive approach avoids unnecessary hospital visits when treatment cannot proceed due to impaired blood values or poor tolerance of side effects. It also facilitates anticipation of additional investigations, resulting in a more efficient day admission and earlier discharge.
  • Model B: Subcutaneous administration of certain anticancer therapies at home by a specialised hospital nurse visiting the patient at home, after a telephone-based symptom assessment on Day 0. Unlike Model A, the patient no longer needs a therapy administration in the hospital.

Impact

  • Care coordination and continuity: Delivering oncological care in the home setting requires close coordination between hospital-based teams, home care services, and primary care providers. Ensuring seamless communication and continuity of care across settings can be complex. To manage this logistical and organisational complexity, 1 FTE administrative employee organises home visits, medication delivery, monitoring and follow-up of all home visits.
  • Careful patient selection: Not all patients or treatments are eligible for home-based oncological care. Adequate patient selection, risk stratification and clear clinical protocols are essential to maintain patient safety and treatment quality.
  • Training healthcare professionals: Nurses involved in the onco@home circuit need specific clinical competences.

Previous RCT highlighted the following impact in numbers:

  • Equivalence of both models in terms of patient-reported QoL with 77% and satisfaction (88%)
  • Model A: reduced waiting times for therapy administration at the day care unit by 45% per visit
  • Model B: significantly fewer hospital visits
  • 60% preferred onco@home above usual care

Critical success factors

  • Adequate patient selection following established guidelines (including safety and risk management)
  • Multidisciplinary approach with all stakeholders included
  • Clear and efficient communication between all healthcare professionals and the patient 
  • Digital infrastructure and monitoring: to follow up on our patients included in the onco@home circuit, an accessible and patient-friendly EHR is essential
  • Diminished waiting times: a thorough quality-improvement study resulted in a 42% reduction in the average patients’ waiting times for therapy administration (Model A). No hospital visit is required to receive anticancer therapy (Model B).
  • Available financial framework
  • Available legal framework
  • Education of staff and other partners involved 
  • Above all, the population of patients needs to be supportive of this type of intervention, as well as all stakeholders involved 

Next steps

In future, onco@home models are indispensable for providing integrated cancer care. The concept is believed to meet the new needs of an ageing population with chronic illnesses and increasing multimorbidity by providing continuous patient-centred care. Furthermore, it is believed to improve population health, improve individual experiences of care and reduce costs of care per capita, known as the Quintuple Aim Objectives for healthcare.

For Model A, we will have to deal with blood draw further in advance than Day 1, as cleanroom PIC/S regulations are set to become mandatory in Belgium starting January 1, 2026. For Model B, there is a positive trend in the reimbursement of several anticancer therapies eligible for subcutaneous treatment. It will be a challenge to prepare our organisation for this and/or the potential transfer of this activity to external, specialised home care services.

Laura Tack