Skip to content >>

an Economist Intelligence Unit business healthcare

Chemotherapy at home

November 17th 2010

Cancer stats make for depressing reading: The worldwide annual incidence of cancer is 10 million cases per year, and six million people per year die from cancer. In the UK about 289,000 new cases of cancer are diagnosed every year, while the incidence rates for some common cancers in the UK are 120 per 100,000 women for breast cancer, 65 per 100,000 men for lung cancer and 46 per 100,000 people for colorectal cancer.

Cancer touches us all at some point on our lives, and as such we all have a vested interest in ensuring that cancer patients receive the best possible care, at a time and place most suited to their lifestyles.

Chemotherapy forms an integral part of cancer care, and the number of programmes of chemotherapy delivered in the UK increases by about 15% each year. While traditionally performed in the hospital setting, there has been an increasing trend in the past 10-15 years of moving cancer services into the community and towards ambulatory or home-based care. The private healthcare insurance company Bupa had received an increasing number of requests from their patients asking about the availability of home chemotherapy, and as a result they had started a dialogue with their oncologists about whether further treatment choice could be introduced. Bupa also asked Bazian to conduct a wide-ranging and systematic review comparing home chemotherapy for adults with chemotherapy delivered in the hospital or clinic setting. The review was to address effectiveness, safety and acceptability, asking the questions:

  1. What positive and negative outcomes including patient experience and patient outcomes are reported for home chemotherapy compared to hospital-delivered chemotherapy?
  2. What are the advantages and disadvantages of home chemotherapy for different indications analysed by eligibility, subgroups of patients, cancer types or chemotherapy regimens?

The review included randomised controlled trials of intravenous cancer therapies assessing delivery in a home setting compared to a hospital setting, and of oral vs. intravenous chemotherapy where outcomes were reported as safety or satisfaction with home or hospital-delivered services. Observational studies (cohorts and case series) of home chemotherapy were also included. Overall, from the limited evidence available, the review showed that:

  1. home chemotherapy is as safe as hospital or out-patient-delivered care, and
  2. there is evidence for increased preference and patient satisfaction with home chemotherapy.

The report has helped to inform the debate in Bupa about the services it offers its insured members undergoing chemotherapy. While cancer remains a terrible burden, the extra choice for patients about where and when to take their chemotherapy will help ensure they receive their treatment in an environment that is most suitable for them.

The full report and the report summary can be downloaded from Bupa at: