Lindsay Fischer is the Associate Editor at ONN. She joined MJH life sciences in 2021 after graduating from Rutgers University with majors in both English and Spanish and a minor in creative writing. When she is not writing, or researching the latest oncology nursing news, Lindsay is an amateur backpacker and rollerblader. Email Lindsay at lfischer@mjhlifesciences.com

Providing oncologists with a geriatric assessment (GA)–guided intervention effectively promoted communication regarding comorbidities in older patients with advanced cancer, according to findings from a secondary analysis recently published in 

The study enrolled 541 patients with advanced cancer, all aged 70 years or older, and of whom 94.6% had at least 1 comorbidity. The average number of comorbidities was between 1.9 and 3.2. On average, the intervention increased the number of conversations surrounding comorbidities from 0.52 to 0.99 (

Furthermore, the number of concerns that were communicated by patients to their providers increased from 0.32 to 0.52 (

= .03). Similarly, the odds that a physician would address a comorbidity-related concern via referral, handout, or other modes increased by 2.4 (95% CI, 1.3 to 4.3; 

Most oncologists (76%) who participated in the study and received the intervention consequently considered comorbidities in regard to treatment plans, and nearly half (41%) adjusted their treatment plans accordingly.

ASCO recommends the GA to evaluate age-related conditions in all patients with cancer who are aged 65 years older. The multidimensional evaluation assesses function, cognitive, psychosocial, and medical needs to identify treatment gaps in a patient’s treatment plan.

Furthermore, some studies, but not all, have demonstrated that the GA improves physical function, quality of life, and even overall survival in community-dwelling older adults.

 Because the assessment provides clinical care teams with the necessary tools to identify and address common health-related needs associated with aging, incorporating the GA often yields more appropriate and specific treatment modifications, facilitated care coordination, and an elimination of potentially in appropriate medications.

“The interaction between cancer, cancer treatments, and specific comorbidities is extremely complex, and management of all conditions simultaneously can be a formidable challenge for care teams,” lead study author Amber S. Kleckner, MD, of University of Rochester Medical Center, and coinvestigators wrote in the study. “Consideration of comorbidities in cancer care is important because it can affect a patient’s prognosis, tolerance of treatment, quality of life, and mortality.”

The findings from this study were based on a secondary analysis of the COACH study (NCT02107443)—a nationwide, multisite cluster-randomized trial, which enrolled patients older than 70 years who had advanced cancer (either solid tumor or lymphoma), and impairment in at least 1 GA domain besides polypharmacy. Thirty oncology practices were randomized to conduct either standard care (no GA intervention) or to provide intervention in the form of the “GA-guided assessment” to understand the GA’s impact on guided decision making.

Researchers audio recorded the post-GA clinic visit. The conversation was transcribed and coded for topics related to comorbidities; linear mixed models were then developed to assess the impact of the intervention.

Researchers assessed comorbidities via the Older Americans Resources and Services (OARS) comorbidity questionnaire. The questionnaire helps identify the presence of 15 comorbidities, including diabetes, depression, and poor eyesight, and queries about the impact of these comorbidities on daily activities. The most commonly reported comorbidities were high blood pressure (55.8%) and arthritis/rheumatism (51.2%). Poor eyesight (56.2%), poor hearing (55.6%), and emphysema or chronic bronchitis (23.9%) were the comorbidities most likely to interfere with daily living activities.

If patients reported 3 or more comorbidities, or 1 comorbidity which greatly interfered with their daily lives, they were considered “impaired.”

Notably, in the non-intervention cohort, patients were responsible for initiating 36% of comorbidity relate conversations while providers initiated 56% of these discussions. In the experimental cohort, however, providers initiated 80% of comorbidities-related conversations, while patients were only responsible for 14%.

“Quality conversations between patients and providers can improve health outcomes in multiple ways, many of which are indirect,” the investigators concluded. “Patients who are satisfied with communication with their providers are more trusting and adhere better to treatments.”

Recommendations for patients who have been categorized as “Impaired” because of their comorbidities are as follows:

Initiate direct communication with the patient’s primary care physician about the treatment plan for their disease. This can be either written, electronic, or by telephone.

If the patient has a history of diabetes, neurotoxic agents should be avoided, provided there is an equivalent option.

If the patient has a history of heart failure, treatments should be administered at a slower infusion rate and the volume of agents should minimized however much possible.

If the patient has a history of renal impairment, nephrotoxic agents should either be avoided, if possible, or administered at an adjusted dosage.

Dosage schedule should be modified if there is concern regarding show patient will tolerate therapy or if there is concern about worsening comorbidities.

If patient currently smokes, smoking cessation counseling should be provided.

The authors acknowledged that, in past studies, nurse-guided interventions have yielded higher quality of life in patients with gynecologic cancers. Future research exploring how various providers can help guide treatment-related decisions post-GA assessments are warranted, particularly in increasing comorbidity-related conversations among people of color and in other minority groups.

“Herein, we showed that patients have a high comorbidity burden and we demonstrated that providing a GA-guided intervention to oncologists doubled the number of conversations that they had about comorbidities, leading to more concerns being acknowledged and appropriately addressed,” the study authors concluded. “These practices have the potential to improve patient satisfaction with cancer care and properly manage comorbidities during treatment of their advanced cancer.”

Kleckner AS, Wells M, Kehoe LA, et al. Using geriatric assessments to guide conversations regarding comorbidities among older patients with advanced cancer

. 2022;18(1):e9-e19. doi:10.1200/OP.21.00196.

Olesen ML, Duun-Henriksen AK, Hansson H, Otteson B, Andersen KK, Zoffman V. A person-centered intervention targeting the psychosocial needs of gynecologic cancer survivors: a randomized clinical trial. 

2016;10(5):832-841. doi:10.1007/s11764-016-0528-5.

Articles

A secondary analysis of the COACH study revealed that a geriatric assessment–guided intervention increased the number of comorbidity-related discussions between patients and providers.

Geriatric Assessments Help Promote Comorbidity-Related Discussions in Patients With Advanced Cancer

Updates to the National Comprehensive Cancer Network (NCCN) guidelines now include 2 recommendations involving neratinib (Nerlynx) for the treatment of patients with HER2-positive breast cancer, according to a news release from Puma Biotechnology.

The first update recommends neratinib for the adjuvant treatment of patients with HER2-positive breast cancer under the designation of Useful in Certain Circumstances. The guideline indicates that extended adjuvant neratinib is recommended for patients with hormone receptor (HR)–positive, HER2-positive disease who have a perceived high risk of disease recurrence.

The second guideline recommends a dose-escalation strategy with neratinib to improve tolerability when the agent is utilized in the adjuvant setting for patients with HER2-positive disease.

Notably, this update is in agreement with the FDA approval of a labeling supplement in June 2021 to the United States Prescribing Information for neratinib. The labeling update includes the dose-escalated use of the agent in patients with HER2-positive breast cancer, as examined in the phase 2 CONTROL trial (NCT02400476), and the new 133-count commercial Nerlynx SKU.

“Oncologists should be aware of an important recent update to the NCCN guidelines that now include adjuvant neratinib to be used in certain circumstances, [including] high-risk HR-positive, HER2-positive, early-stage breast cancer patients,” Joyce A. O’Shaughnessy, MD, co-chair of Breast Cancer Research and chair of Breast Cancer Prevention Research at Baylor-Sammons Cancer Center and The US Oncology Network said in the news release.

“These high-risk patients need access to every available treatment option proven to decrease their risk of recurrence, and the new NCCN guidelines update supports neratinib in this context,” O’Shaughnessy added.

Single-agent neratinib is associated with the following adverse events (AEs): diarrhea, nausea, abdominal pain, fatigue, vomiting, rash, stomatitis, decreased appetite, muscle spasms, dyspepsia, increased AST/ALT, nail disorder, dry skin, abdominal distention, epistaxis, decreased weight, and urinary tract infection.

Furthermore, patients who receive neratinib in combination with capecitabine have reported diarrhea, nausea, vomiting, decreased appetite, constipation, fatigue/asthenia, weight decreased, dizziness, back pain, arthralgia, urinary tract infection, upper respiratory tract infection, abdominal distention, renal impairment, and muscle spasms.

Patients should not receive neratinib with proton pump inhibitors. Similarly, neratinib should be separated from antacids by at least 3 hours and should be separated from H2-receptor antagonists by at least 2 hours before or 10 hours after. Patients should not breastfeed while receiving this medication.

Neratinib has 2 FDA indications in breast cancer. The first is as a single agent for extended adjuvant treatment of adult patients with early-stage HER2-positive breast cancer following adjuvant trastuzumab (Herceptin)-based therapy. The second indication is in combination with capecitabine (Xeloda) for the treatment of adult patients with advanced or metastatic HER2-positive breast cancer who have received 2 or more prior anti–HER2-based regimens in the metastatic setting.

The NCCN guideline updates are supported by findings from the pivotal phase 3 ExteNET trial (NCT00878709), which randomized 2840 women with early-stage HER2-positive breast cancer who had prior trastuzumab-based therapy to 1 year of neratinib given once daily at 240 mg (n = 1420) vs 1 year of placebo (n = 1420).

In patients who completed prior trastuzumab-based therapy within 1 year prior to randomization, the results of the study demonstrated a 5.1% absolute benefit in invasive disease-free survival (iDFS) at 5 years with neratinib vs placebo, as well as a 42% reduction in the risk of disease recurrence. The 5-year iDFS rate was 90.8% (95% CI, 88.1%-93.0%) with neratinib vs 85.7% (95% CI, 82.6%-88.3%) with placebo (HR, 0.58; 95% CI, 0.41-0.82).

In the intention-to-treat population, the 2-year iDFS rate was 94.2% with neratinib vs 91.9% with placebo (HR, 0.66; 0.49-0.90; 

Notably, neratinib demonstrated iDFS improvement vs placebo across several prespecified subgroups, including nodal status, hormone receptor status, and age at randomization.

Regarding safety, neratinib was not found to induce cardiac or serious pulmonary toxicity or increase a patient’s risk for secondary malignancy.

“The NCCN guidelines are utilized by many institutions, practices, and clinicians who treat [patients with] breast cancer. These updates help to increase the awareness of neratinib within the guidelines and should further support neratinib as an appropriate option to reduce the risk of recurrence for patients battling HER2-positive breast cancer,” Alan H. Auerbach, chief executive officer and president of Puma Biotechnology, concluded in the news release.

Puma Biotechnology’s NERLYNX included in two important NCCN clinical practice guideline updates for the treatment of breast cancer. News release. Puma Biotechnology, Inc. January 12, 2022. Accessed January 14, 2022. https://bit.ly/3K9CzzA

FDA approves dose escalation label update for Puma Biotechnology’s NERLYNX (neratinib) in HER2-positive early stage and metastatic breast cancer. News release. Puma Biotechnology, Inc. July 1, 2021. Accessed January 14, 2022. 

Chan A, Moy B, Mansi J, et al. Final efficacy results of neratinib in HER2-positive hormone receptor-positive early-stage breast cancer from the phase III ExteNET trial. 

2021;21(1):80-91.e7. doi:10.1016/j.clbc.2020.09.014

Puma Biotechnology. US Food and Drug Administration Oncologic Drugs Advisory Committee. Accessed January 17, 2021. https://www.fda.gov/media/105941/download

This article was originally published on OncLive as “NCCN Guidelines Include Neratinib-Based Recommendations for HER2+ Breast Cancer”

The update is in agreement with the FDA approval of a labeling supplement in June 2021 to the United States Prescribing Information for neratinib in HER2-positive breast cancer. 

Updated NCCN Guidelines Now Include Neratinib for HER2+ Breast Cancer

Newly designed predictive models demonstrated high accuracy in predicting late grade 2 or higher genitourinary (GU) toxicity following either conventionally fractionated radiotherapy (CF-RT) or stereotactic body radiotherapy (SBRT), according to data recently published in 

Specifically, research demonstrated that germline variants in single nucleotide polymorphisms disrupting microRNA targets (mirSNPs) are highly accurate in predicting late-grade genitourinary toxicity. A predictive model, which used 22 mirSNPs, is able to accurately predict GU toxicity following CF-RF and a model using 32 mirSNPs predicts GU toxicity following SBRT. Notable, the model used to predict SBRT–related toxicities cannot predict CF-RT–related toxicity, and vice versa.

“Given the high effectiveness of definitive treatments for localized prostate cancer, quality of life following treatment is a paramount factor in patient-physician shared decision-making,” lead author Amar Kishan, MD, of the University of California, Los Angeles, and co-investigators stated in the study. “After definitive radiotherapy, a major quality of life­–limiting toxicity is late genitourinary toxicity, which could manifest as increased urinary frequency, retention, pain, and bleeding.”

Currently, the 5-year grade 2 GU toxicity rate ranges from 12% to 15% following modern radiotherapy. These rates appear to be consistent across both CF-RT (1.8–2.0 Gy per fraction over 39-45 treatment sessions) and SBRT (>7 Gy per fraction over ≤5 sessions). Despite the similarities in rates, researchers believe that select patients exhibit fraction-dependent radiosensitivity and might consequently experience higher rates of toxicity after high dose per fraction vs low dose per fraction radiation.

miRNS are known to regulate the stress response pathways, which include the local and system responses to radiations. Furthermore, germline SNPs, which disrupt their target binding or regulatory regions, are highly influential in determining radiation response.

Researchers performed a translational study of germline DNA from 201 prospectively treated patients. These included patients who were treated with 2 forms of definitive radiotherapy for prostate cancer at 2 institutions: Oslo University Hospital and University of California, Los Angeles (NCT01059513 and NCT02296229).

Among evaluable participants, 108 men received CF-RT and 93 received SBRT. Their germline DNA was assessed for the presence of functional mirSNPs. After evaluation, researchers compiled random forest, boosted trees, and elastic net models, to predict toxicity in accordance with the radiation therapy oncology group (RTOG) scale.

The median follow-up period was 8.5 years. Findings revealed that the late grade 2 or higher GU toxicity rate was 16% after CF-RT and 15% after SBRT. The elastic net model utilizing the 22 mirSNPs identified CF-RT patients at high risk for toxicity (71.5%) vs low risk (7.5%), with an area under the curve (AUC) values of 0.76-0.81. Similarly, the elastic net model utilizing mirSNPs identified SBRT patients at high risk for toxicity (64.7%) vs low risk (3.9%), with an area under the curve (AUC) values of 0.81-0.87.

Based on these findings, an ongoing clinical trial (NCT04624256) will seek to test the model on a new set of patients and further validate the results. In this novel trial, the results from the DNA analysis will be shared with each patient and information’s role in shared decision making will be evaluated alongside group toxicity rates.

“This research may ultimately guide a prostate cancer patient’s treatment plan,” Kishan noted in a press release.

"If we can know ahead of time who will tolerate radiation treatment and who may suffer these side effects, we can do a better job of assuring not only the best treatment but the one with least impact on quality of life."

Kishan AU, Marco N, Shulz-Jaavall MB, et al. Germline variants disrupting microRNAs predict long-term genitourinary toxicity after prostate cancer radiation. 

2022;167:226-232. doi:10.1016/j.radonc.2021.12.040

Genetics predicts toxic side effects to prostate cancer radiotherapy. UCLA Health. News release. January 13, 2022. Accessed January 25, 2022. https://bit.ly/3KUkbeD

A newly designed model will outline what genetic patterns put men with prostate cancer at an increased risk of toxic side effects. 

DNA Linked to Genitourinary Toxicity Risk With Radiation in Prostate Cancer 

The FDA has approved tebentafusp-tebn (Kimmtrak) for the indication of unresectable or metastatic uveal melanoma in adult patients whose disease harbors HLA-A*02:01.

 The regulatory decision represents both the first FDA-approved therapy to treat unresectable or metastatic uveal melanoma, as well as the first FDA-approved T-cell receptor therapeutic.

The approval is supported by findings from the phase 3 IMCgp100-202 trial (NCT03070392) which demonstrated that patients who received this drug achieved significantly improved overall survival at 1 year of follow-up compared with investigators choice of therapy (HR, 0.51; 95% CI, 0.37-0.71; 

Overall, 378 patients with previously untreated metastatic uveal melanoma were randomized 2:1 to receive either tebentafusp or investigators choice of pembrolizumab (Keytruda), ipilimumab (Yervoy), or dacarbazine. At a 6-month follow-up, progression free survival (PFS) was also significantly higher among patients in the tebentafusp group than in the control group (31% vs 19%; HR, 0.73; 95% CI, 0.58-0.94; 

“Uveal melanoma is a devastating disease that has historically resulted in death within a year of metastasis for our patients,” John Kirkwood, MD, director of the Melanoma Center at the UPMC Hillman Cancer Center, said in a press release. “The approval of Kimmtrak [tebentafusp-tebn] represents a major paradigm shift in the treatment of metastatic uveal melanoma, and for the first time offers hope to those with this aggressive form of cancer.”

The most common grade 3 or worse adverse events (AEs) included rash (18%), pyrexia (4%), and pruritus (5%). Approximately less than 1% of patients experienced grade 3 cytokine release syndrome (CRS); however, this was reported to be well managed. A consequent warning for CRS will be included in the label due to its ability to become serious or life-threatening.

Manifestations for CRS may include fever, hypotension, hypoxia, chills, nausea, vomiting, rash, elevated transaminases, fatigue, and headache. Immediate access to mediations and resuscitative equipment is crucial for managing CRS. Patients should be euvolemic prior to beginning any infusions. Furthermore, patients should be monitored for fluid status, vital signs, and oxygen levels. In the event of persistent and severe CRS, tebentafusp should be withheld or discontinued.

Skin reactions and elevated liver enzymes were also frequently observed. If skin reactions occur, patients should be administered antihistamine and topical or systemic steroids based on persistence and severity of symptoms. Providers should also monitor alanine aminotransferase (ALT), aminotransferase (AST), and total blood bilirubin prior to the start of and throughout treatment to watch for elevated liver enzymes.

No grade 4 or fatal events were observed throughout the phase 3 trial.

“Until now, effective treatment options for metastatic uveal melanoma patients were virtually non-existent,” concluded Kyleigh LiPira, MBA, CEO of the Melanoma Research Foundation. “The approval of Kimmtrak represents not only a new therapy but a new hope for the individuals and the families of those diagnosed with the deadliest form of eye cancer.”

Immunocore announces FDA approval of Kimmtrak (tebentafusp-tebn) for the treatment of unresectable or metastatic uveal melanoma. News release. Immunocore Holdings Limited; January 26, 2022. Accessed January 26, 2022. https://yhoo.it/3r1C3fk

Nathan P, Hassel JC, Rutkowski P, et al. Overall survival benefit with tebentafusp in metastatic uveal melanoma. 

. 2021;385(13):1196-1206. doi:10.1056/NEJMoa2103485

Tebentafusp is now the first FDA-approved therapy to treat unresectable or metastatic uveal melanoma. 

FDA Approves Tebentafusp to Treat HLA-A*02:01 Positive Uveal Melanoma

It may be feasible to shift certain oncology procedures from the outpatient clinic to patient homes without compromising safety or efficacy, according to data from a study published in the

 Journal of Clinical Oncology Global Oncology

 Furthermore, this high-quality, patient-centered approach may improve quality of life (QOL) and significantly reduce hospital visits and wait times, compared with standard ambulatory care.

Findings from a randomized trial (NCT03668275) revealed that full Oncology Home-Hospitalization (OHH) implementation resulted in significantly less hospital visits. Partial OHH yielded a 45% reduction in wait times for therapy administration in outpatient units at 2 hours and 36 minutes ± 1 hour 4 minutes compared with 4 hours ± 1 hour 4 minutes (

 < .001) in the standard ambulatory care setting (SOC). Among patients who received OHH, 88% reported a high level of satisfaction with system and 77% reported that the care system positively impacted their quality of life (QOL).

By the conclusion of the trial, 60% of all patients reported a preference for OHH over SOC. In addition, the introduction of this care delivery system did not yield any new safety concerns.

“Today, the globally increasing cancer burden has a significant impact on public health,” noted study authors. “The results of this trial demonstrated that a shift of particular procedures from the outpatient clinic to the patients' homes offers a high-quality and patient-centered alternative for a large proportion of patients with cancer.”

Researchers assessed the relationship with OHH and quality of life (QOL) by conducting a randomized-controlled trial, which compared the intervention against current (SOC). There were 74 patients in each cohort. The study was based out of a cancer center in the AE Groeninge general hospital of Kortijk, Belgium. In the OHH cohort, certain subcutaneous cancer drugs were administered at home (full OHH), and home nursing assessment were conducted prior to ambulatory systematic cancer therapy (partial OHH).

According to the standard of care, each patient who is to receive therapy administration must first undergo blood collection and intravenous line access provision; a nursing review, toxicity scoring, and vital signs monitoring must also take place. In the case of partial OHH, these assessments were conducted in the patient home 1 day prior to administration in the oncology day care unit (DCU), whereas in full OHH, all injections were also administered in the patients’ home (except for the first administration of each consecutive treatment cycle). Azacitidine and bortezomib (Velcade) were the 2 drugs chosen for at-home administration. All at-home visits were conducted by oncology nurses employed by the hospital.

Patient-reported outcome measures (PROM) offered updates on QOL and other related end points; the 5 main assessments included QOL, service use and cost data, safety data, patient-reported satisfaction and preferences, and model efficiency. Participant responses were collected during 12 weeks of therapy.

Eligible participants were patients older than 18 years who had an ECOG score greater than or equal to 2, lived within a 30 minutes’ drive from the hospital, and had a diagnosis of either a solid tumor or hematologic malignancy. Patients could be receiving either curative or noncurative treatments, or supportive therapies (such as blood transfusions) at the DCU. Barriers from participation included problematic venous access, preexisting problems with therapy administration, simultaneous radiotherapy treatment, language or communication difficulties, or a therapy plan which included more than 12 weeks of continuous treatment. Stratification between the 2 cohorts was based on the type of treatment (only subcutaneous therapies were eligible for full home administration), prior systematic therapy, and age.

Patients without prior systematic cancer treatment reported better health-related QoL (76.19 vs 72.60, 

=.039). Similarly, baseline scores on EQ-5D VAS (positive association of 0.28; 

 < .001) and baseline scores on CCS (negative association of –0.65; 

 < .001) were found to have an impact on health-related QOL.

Researchers calculated that patients who received full OHH had 7.6 less DCU visits than those who received SOC (average of 5.6 ± 3.0 and 13.2 ± 4.6, respectively, 

 = .011). Furthermore, the average number of hospitalization days in the intervention group was 0 (interquartile range = 0; range, 0-0), compared with 3.5 among those who received SOC (interquartile range = 12; range, 0-12).

Patients who received partial OHH, however, did not experience a difference in number of DCU visits (6.8 ± 2.5 and 7.5 ± 3.1, respectively, 

 > .05) or hospitalization days compared with the control group (average of 3.8 ± 10.6 for the intervention group v 2.8 ± 6.8 for the control group, 

No adverse events (AEs) were associated with model implementation. Among the OHH cohort, 48 patients shared that they felt as safe at home as in DCU, and 7 reported feeling safer in their homes. One patient reported feeling safer in the DCU.

Eight patients experienced a medical error during their general cancer treatment (2 in the SOC group and 2 in the intervention group), but these errors were deemed to be unrelated to the intervention.

After 12 weeks of OHH (full or partial), 43 out of 49 patients reported a high level of satisfaction with the care model. Although 3 patients reported dissatisfaction, they still requested the OHH be continued for the duration of their treatment. Out of 52 patients in the intervention group, 40 reported that OHH had a positive impact on their QOL. Furthermore, while 66 out of 110 patients (60%) of patients declared a preference for OHH over SOC, 72 out of 106 (68%) patients stated that they would recommend the experimental care model to fellow patients.

Overall, 399 home visits were conducted within the context of this trial; 47 visits entailed drug administration and 352 visits were conducted to prepare patients for their upcoming therapy appointment. There were 12 at-home visits, which resulted in a canceled DCU visit based on the information gathered during the home visit. With SOC, the average wait time was determined to be (2 hours 36 minutes ± 1 hour 4 minutes 

 < .001), whereas, with OHH, the average wait time was calculated to be 2 hours and 2 minutes; there was therefore a 45% reduction in wait times following implementation.

“Given the increasing number of patients with cancer in need of systemic treatment and the evolution toward safer treatment options, (partial) oncologic home-hospitalization offers a high-quality and patient-centered alternative to the current ambulatory cancer care for a large proportion of patients with cancer,” the study authors concluded. “Authorities should encourage such initiatives and provide health care providers with suitable legal and financial frameworks allowing implementation of such innovative transmural care models in daily practice. Nevertheless, further research is needed to investigate the financial impact of such models.”

Cool L, Missiaen J, Debruyne P, et al. Oncologic home-hospitalization delivers a high-quality and patient-centered alternative to standard ambulatory care: results of a randomized-controlled equivalence trial. 

. 2021;(7):1564-1571. doi:10.1200/GO.21.00158

Oncology Home-Hospitalization may represent a feasible alternative to standard ambulatory care and allow patients to spend significantly less time in the outpatient clinic.

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