Mayo Clinic's at-home chemotherapy signals a new era in cancer care

Technology, training drive the at-home cancer care program

According to Dronca, who is also director of Mayo Clinic Cancer CARE Beyond Walls, the program grew from a simple idea: What if cancer care were designed around the patient's life rather than having patients reorganize their lives around cancer care?

The Cancer CARE Beyond Walls program launched in 2023, right as home-based care was gathering steam, spurred by CMS' Acute Hospital Care at Home initiative. The initiative waives certain Medicare Conditions of Participation for participating hospitals, allowing them to provide inpatient-level care in patients' homes. As of April 29, 2026, 365 facilities were participating in the initiative, which has been linked to high-quality outcomes and positive patient experiences.

With the initiative enabling health systems to establish acute care infrastructures in the home, Mayo Clinic's cancer care leaders decided to build on the momentum and reimagine the cancer care delivery system.

Dronca stated that the Cancer CARE Beyond Walls program is designed to mimic the safety and quality of on-site cancer care. The program is supported by coordinated infrastructure with a central command center. Chemotherapy-trained nurses and advanced practice practitioners, with oversight from oncologists. The in-home care services, which include laboratory testing, vital sign monitoring and cancer therapies like chemotherapy and immunotherapy, are administered by the health system's home health organization partners.

Mayo Clinic trains the home health nurses to follow all the steps that on-site nurses do in the facility, such as dual-person verification of medication, Dronca noted.  

Mayo Clinic nurses check in with the home health nurse online at the beginning of treatment and complete a 'check-out' process at the end, which includes removing hazardous materials from the home, she said. The Mayo Clinic nurses are also available for the home health nurses at any time during the infusion administration, if needed.

Additionally, the program is supported by a technology platform that's integrated with the health system's EHR. This platform has a built-in logistics system to ensure the timely delivery of medications and supplies and enable virtual visits with the patients, Dronca shared.

Patients receive a technology pack to take home that includes a tablet to enable communication with the command center and access education resources, as well as Bluetooth-enabled blood pressure cuffs, pulse oximeters, scales and thermometers for vital sign monitoring.

Patient safety must remain top of mind

Providing cancer therapies in the home requires a laser focus on patient safety. Dronca highlighted several protocols the health system has in place to ensure the at-home cancer care is delivered safely.

For example, cancer patients typically begin their infusion treatment on site in the infusion unit and move home only after the clinical staff has determined they tolerate treatment well, without any unexpected reactions, Dronca said.

"And then once they move into the home, we do a social screening, a stability screening questionnaire by our social workers, to make sure the home is suited for treatment administration and that the patient is willing to have strangers come into their home, and that kids or pets can be removed if needed," she added.

Patient eligibility for the program is based not on cancer type but on drug type. Dronca stated that the drug needs to be stable so that it can be safely shipped and must have a low potential for an infusion reaction.

"In oncology, for instance, Carboplatin has a high risk of infusion reaction, so we're not doing those types of drugs," she noted. "But we're doing all the drugs that have a lower rate [of reaction risk], which actually turns out is quite a few drugs."

Home health nurses also have access to an anaphylaxis kit that includes all the medications on-site nurses use in case of infusion reactions. The nurses receive didactic and hands-on training from Mayo Clinic nurses on how to provide anaphylaxis care in the event the patient has a reaction.

Another patient eligibility consideration to ensure safety is geographical distance. Currently, to be eligible for the program, patients must live within 75 miles of the Mayo Clinic Comprehensive Cancer Center in Florida. However, the health system has launched a clinical trial to examine whether patients beyond that geographical range can safely participate in the program using drugs shipped to their homes and reconstituted by the home health nurses.

Assessing program safety, impact  

When new technology-supported programs are launched, health systems must continually assess them to ensure program safety and efficacy.

That is precisely why Mayo Clinic conducted a pilot study of the program, publishing the results in NEJM Catalyst. The researchers examined data for 10 patients enrolled in the Cancer CARE Beyond Walls program pilot from April 1, 2023, to Aug. 31, 2023. The patients received 93 intravenous chemotherapy infusions at home.

There were no infusion reactions or catheter-related infections during the pilot, the study revealed. Additionally, minor complications, including two cases of hypokalemia and two unrelated falls, were successfully managed within the home setting.

"One of the great benefits of this program is that we're proactive in addressing symptoms that patients may have, such that they don't have to wait until they see us next time or they don't necessarily need to start calling the care team, but they can address these symptoms directly with our command center nurses," Dronca said.

Being able to respond quickly to potential challenges patients may have with their medication enhances outcomes and reduces emergency room visits, she added.

Not only that, but the program proved popular among patients enrolled in the pilot. Every patient who did not transition out of the program due to changes in their regimen or disease progression wanted to stay in the program at the end of the pilot, Dronca shared.  

The health system launched a randomized clinical trial in August 2023 to validate the pilot results. The trial has enrolled 78% of the 200 patients it aims to enroll. The trial will also soon be open to Mayo Clinic patients in Rochester, Minnesota.

The pilot results point to a promising future for the Cancer CARE Beyond Walls program, which will ultimately change how cancer care is delivered. In Dronca's opinion, it will change cancer care for the better.

"This model really is putting the patient at the center," Dronca said. "I think we have been so site-centric with care, with healthcare, with cancer care. And this is really creating an opportunity for us to think about cancer care from the patient's perspective, and really making it flexible and bringing the care to patients, making sure that more patients have access to care, including patients who live in rural areas, remote areas."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers healthcare IT and innovation, including artificial intelligence, digital healthcare, EHRs and interoperability.