Development and implementation of a home bortezomib injection program in the US (Ann Arbor VA Close to Me).

Abstract

e13559 Background: Veterans in Michigan, northwestern Ohio, and northern Indiana have only two Veterans Health Association (VHA) facilities available that provide chemotherapy, one of which is the VA Medical Center in Ann Arbor, MI (VAAAHS). Many patients face barriers to care involving travel costs, wait times, and psychosocial distress, which may negatively impact treatment adherence and survival outcomes. Patients with multiple myeloma receiving bortezomib-containing regimens must travel to our infusion center weekly to receive subcutaneous (SQ) bortezomib. Home administration of bortezomib was shown to be feasible, safe, and cost-effective in several European and Australian studies, and led to quality of life improvements and cost reductions. We sought to establish proof-of-concept of the feasibility and safety of a home bortezomib program for patients at VAAAHS. Methods: Adult patients receiving care at VAAAHS for active multiple myeloma who had not previously progressed on bortezomib were eligible for enrollment. Day 1 of SC bortezomib was administered at our infusion center. Subsequent weekly injections were mailed to patients’ homes. On the day of injection, patients checked their vitals, underwent a telehealth evaluation, and self-administered SQ bortezomib. Enrollment opened 10/1/2024 and is ongoing. Study outcomes include patient satisfaction, financial toxicity, and quality of life via FACIT-COST and PROMIS surveys. Results: Since 10/1/2024, one patient enrolled and self-administered 3 doses of SQ bortezomib at home. This patient experienced one delayed dose due to incorrect syringe needle adapter, and no adverse events related specifically to bortezomib. Two additional patients are in the process of enrollment. Additional safety and patient satisfaction data will be collected. Barriers to implementation of the program have been identified and addressed (Table). Conclusions: The Ann Arbor VA Close to Me program demonstrates the feasibility and safety of a home-based self-injection program for patients receiving bortezomib for treatment of multiple myeloma. This single-center experience is currently being leveraged to develop a VA-wide implementation toolkit through VA National Oncology Program. Barriers and solutions to implementation of the Ann Arbor VA Close to Me program. Category Barrier Solution Regulatory Level of service designation Level of service did not require home care or home infusion designation Quality/Safety Unknown safety of home bortezomib injections Pre-implementation risk assessment (HFMEA) was conducted without major concerns Pharmacy Provision of medication to patients and concern for missed or forgotten doses An overnight shipping system is utilized Nursing Lack of a protocol for home administration of bortezomib Educational materials, consent forms, checklists and standardized notes for documentation were developed