Preliminary results of a combined home and rural outpatient clinic-based infusion program through the Veterans Health Administration: A single-center experience.

172 Background: The Veterans Health Administration (VA) is the largest integrated healthcare system in the United States, serving over 9 million Veterans yearly. Approximately 4.7 million Veterans live in rural areas, however, most VA centers providing specialty care (e.g. oncology) are in urban areas, leading to significant travel-related barriers to cancer care. Many Veterans live closer to smaller, VA community-based outpatient clinics (CBOCs) that do not have specialty care or infusion capabilities. To address these barriers, the VA Ann Arbor Healthcare System (AAVA) and VA National Oncology Program have developed the Close to Me (CTM) program which provides CBOC-based infusion treatments and patient self-administration of subcutaneous (SQ) bortezomib at home. The goals of AAVA CTM are to reduce travel time for patients and to improve patient access to VA specialty care. Methods: CBOC program: Patients who are receiving care at AAVA with a nearby CBOC site are considered eligible for the program. Services are not restricted to oncology-related treatments only. On the day of treatment, CTM nurses travel with compounded drugs from the main hospital to the local CBOC where patients receive their treatment. Home program: Patients who are receiving myeloma care at AAVA with bortezomib therapy, have a reliable caregiver, and can complete a virtual visit are considered eligible for the program. Patients receive initial treatment at the main hospital for patient/caregiver education and monitoring for adverse events. If no issues, patients receive their pre-filled bortezomib syringe via overnight mail and self-inject at home under observation of CTM nurses on the day of treatment. Results: The AAVA CTM program was opened on 10/1/2024. As of 5/1/2025, 115 patients were screened with 77 patients enrolled (67%), 232 completed visits, and 238 treatments administered. Reasons for non-enrollment include provider (72%) and patient preference (19%). There were no adverse events leading to discontinuation, with 1 hospitalization unrelated to treatment (acute CVA). Most oncology-related treatments were for prostate cancer (16%), neuroendocrine tumors (16%), and multiple myeloma (6%). Patients saved a total of 18,908 miles of travel distance during this period, or an average of 245 miles travel distance and 101 of travel costs saved per patient. Overall patient satisfaction was high, with most patients rating the CTM experience as “excellent” (94.9%) and that they would “strongly” recommend the service to others (87.2%). Total estimated drug cost savings, as calculated by the manufacturer’s average wholesale price vs. VA price, was 411,275. Conclusions: The AAVA CTM program demonstrates the feasibility and safety of home SQ bortezomib and outpatient clinic-based infusions, resulting in high patient satisfaction and travel-related savings.