New Directions in Chemotherapy-Induced Neutropenia - Episode 12

At-Home Administration of CIN Prophylaxis

The pros and cons of at-home administration of granulocyte-colony-stimulating factors as treatment for chemotherapy-induced neutropenia prophylaxis, and programs organized by payers to best support members.

John Fox, MD, MHA: Where and how CIN [chemotherapy-induced neutropenia] prophylaxis occurs is a decision for the provider and patient alike. In many circumstances, patients, because they must get this treatment 24 hours or more after their chemotherapy, choose to get this treatment at home, eitherthrough an on-body device that many people are familiar with, or through self-administration. There is also the potential, as we noted earlier, that patients could have a home health agency come in to do teaching with subsequent self-administration. In many circumstances, if patients need to come back to the office, that can be done in the office as well. But I think most administration with colony-stimulating factors for CIN prophylaxis is done in the home setting. Are there barriers to this? Increasingly, with the ability to do this in the home, there are fewer and fewer barriers. And in fact, doing so in the home has a lot of benefits to the patient. First of all, they don’t have to travel back to the physician’s office 24 hours after their administration, avoiding the cost and logistics of travel.

Another question that is commonly asked of health plans is, do we have any programs for improving access to CIN prophylaxis? This is a therapy that’s been around for well over a decade now, and most health plans are in a maintenance mode. They’re not working to develop any new programs. But as we noted earlier, with COVID-19 [coronavirus disease 2019] there is an increasing interest in trying to make sure that patients have access to home administration, either through home health, through an on-body device, or through teaching self-administration.