Clinical and economic impact of community-based cancer care: Results from the S.M.A.R.T. Care Project in metastatic breast cancer patients.

Abstract

Objectives: To evaluate the clinical and economic impact of shifting from hospital-based to community-based administration of oral, subcutaneous, and intramuscular anticancer therapies for patients with metastatic breast cancer (mBC).

Methods: This prospective observational study enrolled 50 mBC patients receiving oral, subcutaneous, or intramuscular anticancer therapies in Cremona, Italy. After 12 weeks from starting the oncological treatments / first radiological evaluation (baseline), patients were transitioned from hospital-based (Day Hospital) to a community healthcare facility at the Croce Rossa Headquarter in Cremona. Quality of life was assessed using Functional Assessment of Cancer Therapy-Breast (FACT-B) and EORTC QLQ-C30 questionnaires at baseline, two months, and six months. Economic outcomes were assessed from the healthcare service perspective and included healthcare resource utilization (chair occupancy time, nursing time per patient, consumables per cycle), patient productivity loss, and total non-drug-related costs per treatment cycle; drug acquisition costs were excluded as they did not differ between the two care settings.

Results: Mean FACT-B subscale scores improved significantly over six months: Social Well-Being (SWB) increased from 10.3 ± 2.0 at baseline to 14.8 ± 2.6 (p < 0.001), Emotional Well-Being (EWB) from 9.9 ± 2.1 to 11.2 ± 2.0 (p = 0.002), and Functional Well-Being (FWB) from 15.0 ± 3.0 to 16.9 ± 3.3 (p = 0.003). EORTC QLQ-C30 global health status improved from 40% to 70%. The territorial model reduced caregiver burden from 50% to 30% of visits, eliminating the need for caregiver work leave (from 52% to 20%), and decreased mean treatment duration from 180 ± 45 to 43 ± 18 minutes. The economic analysis showed an 85% reduction in chair occupancy time (3.2 ± 0.6 vs 0.48 ± 0.2 hours), a 76% reduction in nursing time per patient (180 ± 45 vs 43 ± 18 minutes), a 69% reduction in consumables cost per cycle (€42.50 ± 10.8 vs €13.18 ± 6.5), and a 65% reduction in patient productivity loss (€85.40 ± 24.3 vs €29.89 ± 12.7), translating into an approximately 80% reduction in total non-drug-related costs per cycle (€158.30 vs €31.66 per patient).

Conclusions: Community-based administration of oral, subcutaneous, and intramuscular anticancer therapies in mBC patients significantly improves quality of life, reduces caregiver burden, and generates substantial economic savings while maintaining clinical safety. This reorganization model represents a sustainable and patient-centered approach to oncology care delivery.