Modernizing injectable cancer care delivery: A telemedicine-supported home injection model for breast cancer care.

Abstract

1581 Background: Among the growing population of premenopausal patients with breast cancer, years-long endocrine therapy often requires repeated clinic-administered injections, creating substantial time burden and adherence challenges. This pilot evaluated the feasibility of a telemedicine-supported home injections program designed to improve access, convenience, and patient experience. Methods: Patients were recruited from 4 outpatient medical oncology practices at a comprehensive cancer center between October 2024 and January 2025. Eligibility criteria included a breast cancer diagnosis, an active treatment plan including leuprolide and/or denosumab, and use of the patient portal. Patients proceeded to pilot participation after insurance approval for outpatient administration of medications and (if applicable) acceptability of copay cost. Patients and/or caregivers received in-clinic training by nursing staff on injection preparation and administration, were provided both written and video-based educational material and were followed for up to 2 home injections over a 6-month period, with telemedicine support. The primary outcome was feasibility, assessed by home injection completion rates. Patient and clinician satisfaction were assessed using the Net Promotor Score (NPS) and rates of continued at home injection administration post pilot completion. Patients were also invited to participate in 60-minute semi-structured exit interviews. Results: Of 105 eligible patients, 54 agreed to participate in the pilot and 24 obtained insurance approval for the medication with an acceptable copay. All 24 patients were trained in injection administration of intramuscular leuprolide, of whom 50% had no prior injection experience. Overall, 96% successfully completed one home injection, 79% of patients completed two home injections, and 75% continued home administration after follow-up. Notably, only 1 patient discontinued home injection administration due to telemedicine scheduling related issues. Patients reported high satisfaction, citing time savings and convenience as key benefits. Both patients and providers strongly endorsed the model with highly compelling net promoter scores of 69 and 61, respectively. Conclusions: This pilot demonstrated the feasibility of a telemedicine supported home injection care delivery model for breast cancer patients in the oncology setting, evidenced by high completion rates and patient preference to continue home administration. Educational materials and optional telemedicine visits for initial injections were leveraged to support adherence without increased healthcare utilization. Further evaluation across broader geographic, demographic, and payor mix is warranted to inform scale up. An ongoing pragmatic trial (NCT06954337) is testing this approach as part of an innovative model of care: Enhanced Telehealth.