A Telemedicine-Supported Home-Injection Model for Patients With Breast Cancer

Importance: Premenopausal patients with breast cancer are treated with gonadotropin-releasing hormone agonist (GnRHa) therapy to suppress ovarian function. Therapy requires subcutaneous or intramuscular injection and is routinely administered during clinic visits. Objective: To evaluate the feasibility and acceptability of a telemedicine-supported home-injection program for patients with breast cancer receiving GnRHa therapy. Design, Setting, and Participants: This quality improvement study was conducted between October 2024 and August 2025. Patients were followed up for up to 2 home injections over a 6-month period. Patients were recruited from 4 outpatient medical oncology practices at a comprehensive cancer center. Eligible participants were adults with breast cancer who used the patient portal and had ongoing therapy with a GnRHa. Intervention: Patients received in-clinic training from nursing staff on injection preparation and administration. Telemedicine nursing visits for supervision of home injections were optional. Main Outcomes and Measures: The primary outcome was feasibility, assessed by home-injection completion rates. Patient and clinician satisfaction were assessed using net promotor scores and rates of continued home injection following the pilot. Patients were invited to participate in semi-structured exit interviews. Results: Of 105 eligible patients, 54 chose to participate, and 24 obtained coverage to dispense medication for self-injection at home. Among the 24 participants (median [range] age, 44 [33-53] years) all were female. All participants were trained in GnRHa intramuscular administration; 10 of 20 (50.0%) had no prior injection experience. Overall, of the 24 participants, 23 (95.8%) successfully completed at least 1 injection at home, 19 (79.2%) completed 2, and 18 (75.0%) opted to continue home administration beyond the study end. Only 1 patient discontinued due to challenges related to injection administration and telemedicine scheduling. Of 17 patients, time savings (15 [88.2%]) and convenience (13 [76.5%]) were cited as key benefits. The model was strongly endorsed, according to a net promoter score of 69 for patients and of 61 for clinicians. Of the 54 patients who chose to participate, 19 (35.2%) were unable to proceed due to a lack of insurance approval for home administration of the eligible medication, and among 30 patients who received insurance authorization, 18 (60.0%) incurred a copayment for the medication when injection coverage shifted from clinic-based administrations to home-based administrations. Conclusions and Relevance: In this quality improvement study of a telemedicine-supported home injection model for women with breast cancer, strong feasibility was demonstrated by high injection completion rates and acceptability by participants. The findings suggest that insurance approval and the copayments associated with at-home, but not in-clinic, administration were an impediment to participation and need to be addressed before scaling.