Hematology: Precursory for chemotherapy delivery at home?

Therapeutics has changed in the past years for cancers and malignant hemopaties. Galenic forms have diversified, increasing particularly in the last decade with per os and subcutaneous administration. Those new formulations have changed in depth the patient's pathway, facilitating home care. In a report published in 2015, the French Haute Autorite de sante emphasized the added value for young children, elderly persons and metastatic patients of home chemotherapy particularly when chemotherapy is short (intravenous or intracutaneous injections). As pharmaceutical industries are offering an ever-increasing number of new therapeutics, in oral or subcutaneous forms, health workers, and particularly hospital personnel, have to adapt to the challenge of coordinating and organizing safe procedures to prescribe and to deliver new therapeutics outside the hospital. The question raised is not so much choosing between home and hospital care, rather than organizing a wide variety of therapeutic treatments, making home care possible when quality and security of care is possible. Hematology is considered by the HAS as a priority for the development of home chemotherapy. In view of the patients' quality of life, possibilities created by new therapeutic forms making injections easier, conditions seem to be met to facilitate transfer from hospital to home care. Following the HAS report, this paper presents the challenge of home care for hematology, focusing on the constraints that it will create and the financial conditions for its evolution, particularly in the context of subcutaneous forms.