Home Self-Administration of SC Trastuzumab and the Infusion Chair

The Article

Infusion chairs and oncology nurses are two of the tightest resources in cancer care. A study published November 3, 2026 in JCO Oncology Practice asks whether some of that load can move out of the clinic. Researchers at Erasmus University Medical Center and partner hospitals in the Netherlands compared two ways of giving subcutaneous (SC) trastuzumab, a HER2-targeted antibody used in breast cancer.

The first was the usual approach, where a nurse gives the injection in a hospital oncology day care unit. The second was home self-administration, where trained patients inject the drug themselves. The team used a microcosting method, which adds up the staff time, supplies and patient costs of each approach one item at a time.

What the Study Found

According to the published abstract, home self-administration was associated with large drops in time for both patients and staff.

• Patient time fell by 74.3 minutes per administration, a reduction of 86.9%.
• Health care professional time fell by 29.9 minutes per administration, a reduction of 87.4%.
• Administration cost, not counting the drug, was €35.72 at home compared with €61.61 in the hospital.
• Of the 25 patients who answered the preference questionnaire, 23 preferred giving the drug at home.

The authors also modeled a hypothetical scenario in which 90% of eligible Dutch patients switched to home administration. In that model, the country would save about 21,323 hours of patient chair time and the equivalent of 12 full-time health care professionals.

What the Study Didn't Measure

This was a cross-sectional study at one Dutch hospital, and the hospital comparison came from previously published data. The preference result rests on 25 patients. The national figures are a model, not observed results. Costs are in euros under the Dutch system, so they don't translate directly to U.S. reimbursement.

Our Response

We think this study is worth reading for one reason above the others. It measures nurse time and chair time per administration, which are the numbers practice leaders struggle to see clearly. Most capacity discussions in oncology start with a full schedule and end with a request for more chairs or more nurses. This paper treats capacity as something you can measure by drug, visit type and minutes.

Short subcutaneous injections still take a chair, a nurse and a check-in. Pre-treatment lab review, vital signs and observation time add to that. When a practice can see those minutes by regimen, it can plan staffing and scheduling with fewer surprises.

What It Means for U.S. Oncology Practices

Moving a drug out of the clinic in the United States raises questions the Dutch study didn't have to answer.

• Labeling. Check the FDA-approved labeling for who may administer a product and where, before any discussion of home use.
• Medicare Part B. Part B generally covers drugs given incident to a physician's service and excludes drugs that are usually self-administered. Medicare Administrative Contractors publish Self-Administered Drug (SAD) exclusion lists.
• Commercial payers. Many plans run their own site of care policies and prior authorization rules, so coverage can differ by plan.
• Practice revenue. For practices that buy and bill, moving a drug out of the clinic changes both drug revenue and drug administration revenue.
• Patient safety. Training, adverse event monitoring and cardiac monitoring schedules stay the responsibility of the treating Oncologist and care team.

Questions for Your Team

1. How many chair minutes and nurse minutes does each of our common regimens use per visit?
2. Which visits are short injections that still take a full chair slot?
3. Do our medication administration records capture start and stop times consistently enough to answer these questions?
4. For any drug we might move to another site of care, what do the labeling, the patient's payer and our MAC's SAD list say?
5. How would a change affect drug administration charges and drug margin for patients we bill under the buy and bill model?

Northstar records infusion care in a medication administration record, and its chemo billing starts from the documented dose. That shared record is where questions like these begin. If you want to see how it works, request a walkthrough or read about chemo and infusion in Northstar.

More Insights · This Week's Oncology News