Домашнее введение гормональной терапии при раке молочной железы признано безопасным и удобным для пациентов

Home-based injection of gonadotropin-releasing hormone agonist (GnRHa) therapy such as leuprolide is both feasible and acceptable to patients with breast cancer, according to research published in JAMA Network Open. However, insurance coverage and copayments are a barrier to use, study researchers reported. The researchers recruited adult patients diagnosed with breast cancer from 4 outpatient medical oncology practices at a single site from October 2024 to August 2025. All patients were actively receiving leuprolide and were enrolled in the patient portal. Those with an appointment scheduled within the upcoming 2 weeks were identified. Patients with a confirmed interest in GnRHa self-administration completed an intake survey on demographics, the time and cost burden of clinic visits, prior experience with administering injections, and telemedicine use. Their oncologist completed a brief survey and submitted prior authorization requests for insurance approval for home administration. After insurance authorization was obtained, the next scheduled injection visit was transformed into a dedicated teaching appointment with a registered nurse on injection preparation and administration. The patients were given supporting written educational materials, and offered the option of telemedicine nursing visits for their first 2 at-home injections. Patients were required to confirm administration of the home injection via a secure patient-portal messaging service. The researchers sent surveys after each of their first 2 home injections. Nineteen of the 54 patients (35.2%) who agreed to participate were unable to proceed due to lack of insurance approval for home administration. Five other patients (9.3%) continued with clinic treatment due to the prolonged insurance authorization process. Eighteen of the 30 patients who wanted to participate and received insurance approval incurred a copayment for leuprolide due to its conversion from a medical benefit covering clinic-based administration to a pharmacy benefit covering home-based administration, at a median cost of $61 (range, $3 to $2000). Six patients then declined to participate because of the high out-of-pocket cost. “Although home administration may reduce facility-based expenditures, including administration and facility fees, additional efforts are needed to address patient cost-sharing, copayment structures, and assistance programs to ensure that home-administration models remain feasible and equitable,” the researchers noted. Ultimately, 24 women with breast cancer took part in the home-injection pilot. Their median age was 44 years, and 83.3% were White. The majority (95.0%) were college-educated, and 65.0% had an annual household income of more than $100,000. Half of participants had no prior experience of injection administration. All but 1 patient (95.8%) completed at least 1 home injection of intramuscular leuprolide. The exception was a woman whose insurance copayment changed, creating a financial barrier before she carried out the injection. Just over half (54.2%) of the patients had a telemedicine visit to support their first home injection. Nearly 80% of participants completed a second injection, and 75.0% continued with home-injection administration after completing the study. Among 17 patients who completed a satisfaction survey, 88.2% said home injection was associated with time savings, 88.2% said it gave them greater control over scheduling, and 76.5% said at-home injection was associated with overall convenience. In qualitative interviews, patients said the home injections reduced disruption to daily life. Eighteen oncologists completed a satisfaction survey. They endorsed the idea of recommending self-administration of injection medications at a net promoter score, calculated as the percentage of promoters minus the percentage of detractors, of 61. “High rates of successful home administration, strong patient and clinician endorsement, and sustained continuation beyond the initial pilot period underscored the potential of this model to meaningfully reduce treatment burden without compromising safety or adherence,” the researchers concluded.. “Although insurance coverage remains a critical barrier to equitable implementation, the high willingness of patients to engage in home administration, including among those without prior injection experience, highlights an important opportunity to modernize the delivery of commonly used injectable medications.” To encourage broader adoption of at-home injection, future work should focus on policy alignment, cost-effectiveness, and implementation across more diverse populations and treatment settings, they added. Disclosures: This research was supported by the National Cancer Institute, the National Institutes of Health, and the ASCO Conquer Cancer Career Development Award. Some study authors disclosed conflicts of interest. Please see the original reference for complete disclosures. References: Malling CD, Bange EM, Reiner AS, et al. A telemedicine-supported home-injection model for patients with breast cancer. JAMA Netw Open. Published online August 21, 2026. doi:10.1001/jamanetworkopen.2026.29406