Oncology Nurses Weigh the Promise and Perils of Giving Chemotherapy at Home

Bringing hospital-grade cancer treatment into the living rooms and bedrooms of patients has long been one of the most tantalizing promises of modern healthcare. Hospital-at-home models have been shown to reduce mortality, cut readmissions and lower costs across a range of conditions, and health systems under growing pressure from rising cancer caseloads are increasingly tempted to move care out of the ward. But when the drugs in question are hazardous antineoplastic agents—cytotoxic compounds linked to carcinogenicity, genotoxicity and reproductive harm—the question of whether chemotherapy can safely be delivered in a patient’s home becomes far more complicated. A new qualitative study from Sweden, published in Nursing Open, offers one of the most detailed looks yet at how the nurses who would actually perform these treatments feel about the idea, and their answers reveal a profession caught between genuine enthusiasm and deep-seated caution.

The research team, based at Uppsala University and a large Swedish hospital, interviewed nine oncology nurses working at a policlinical daycare cancer ward. All of the participants were registered nurses with Bachelor of Science degrees, averaging 16.2 years of nursing experience and 10.6 years working specifically with cancer therapy. Three of the nine had prior homecare experience, and together they represented roughly 75 percent of the ward’s nursing staff. None had yet administered antineoplastic therapy in a home setting, which made them ideal candidates for exploring how clinicians imagine transitioning from a fully equipped hospital environment to the unpredictable terrain of a private residence. The researchers used semi-structured interviews lasting between 25 and 56 minutes, guided by a ten-section interview framework developed from existing literature on oncology homecare programs and validated by hospital policymakers.

The methodological approach was deliberately rigorous for a small qualitative study. The researchers followed the Consolidated Criteria for Reporting Qualitative Research checklist, employed thematic analysis in an inductive fashion, and took several steps to strengthen trustworthiness. The interviewer spent a day shadowing nurses to build rapport and learn the ward’s vocabulary, transcripts were member-checked by five of the nine participants, and a coding workshop and independent audit were conducted to reduce bias. The authors were also transparent about their preunderstandings: the first author, a pharmacy student, initially expected nurses to be sceptical about handling hazardous drugs at home, and was surprised to find that drug-handling practicalities were among the topics the nurses emphasized least. Instead, the conversations kept returning to something the researchers had not fully anticipated—the nurse-patient relationship itself.

The analysis produced five themes, and the first of them, establishing rapport in the home environment, captures the emotional core of the findings. The nurses consistently portrayed home-based treatment as a way to deliver deeper, more person-centred care. In a hospital, attention is divided among many patients and tasks; in a home, the nurse can focus entirely on one person. Participants described the home as a relaxing setting that promotes undivided dialogue, allows advice to be integrated into the patient’s own environment, and offers a richer understanding of the patient’s health, life situation and needs. One nurse imagined a patient receiving an infusion while watching a favourite television show in an armchair, noting that the act of giving the medication would be no different from the hospital but the experience for the patient would be transformed. Many believed immobile or palliative patients would benefit most, gaining precious additional time with family by avoiding travel.

Yet the home is not a hospital, and the second theme—the complexity of a home—catalogued the practical anxieties that follow from that fact. Nurses worried that private residences could be unhygienic compared with clinical settings, particularly when preparing drugs, and stressed that clean, disinfectable surfaces would be essential. They were willing to prepare medications at home only if given proper training and equipment such as closed-system transfer devices and sterile solutions. Ergonomics emerged as a recurring concern: hospital beds can be raised and adjusted, but patients at home may be sitting on a couch or kitchen chair, forcing the nurse into awkward positions that could prove tiring or injurious over time. Nurses also worried about burdening patients, who might feel obliged to act as hosts, offering refreshments and treating the visit as a social call rather than medical care, potentially altering the therapeutic relationship in uncomfortable ways.

Waste handling provoked particular alarm. Many nurses insisted that responsibility for cytotoxic waste should never fall to the patient, since it could expose family members, pets and the household to drug residues. One participant noted that even the hospital’s re-sealable cytostatic bags and transport boxes had tested positive for traces of cytostatic contamination, and argued that the safest option would be for nurses to carry all waste back to the hospital in secure portable containers immediately after each treatment. The logistics of simply getting to the bedside also weighed on the participants, who described the prospect of hauling drip stands, emergency bags and assorted equipment through patients’ homes as a considerable hassle, even if the medications themselves posed little transport problem.

The most prominent theme, however, was not about practicalities at all. It was fear—specifically, fear of adverse events. The nurses were strikingly confident in their technical abilities: inserting a needle, accessing a PICC line or setting up an infusion were described as simple tasks any competent nurse could perform anywhere. The difficulty, they said, lies in what happens when things go wrong. Antineoplastic agents can trigger unpredictable reactions, including anaphylaxis, even in patients who have tolerated previous cycles without incident. Less experienced nurses in particular described feeling unequipped to manage such emergencies alone, without the immediate assistance that a hospital provides. Many concluded that only low-risk drugs with short infusion times should ever be given at home, though they doubted that many drugs would satisfy that criterion. There was also an accountability problem: who would prescribe, who would be responsible, and who would answer if a patient deteriorated in a living room far from any code team?

That anxiety flowed directly into the fourth theme, solitary nursing. Even in the hospital, where nurses already work relatively independently, colleagues function as a constant safety net—a nearby source of collective knowledge for double-checking prescriptions, discussing side effects and providing acute help. Nurses reported asking colleagues questions nearly every day, including those with two decades of experience. Removing that network, they said, would be stressful and potentially unsafe, especially for junior staff. The absence of an on-call doctor who can arrive within minutes loomed large in their worst-case scenarios. Many participants felt they would need additional education and experience before they could responsibly make assessments and decisions alone, and several questioned whether one nurse treating one patient at a time could ever be an efficient use of scarce staffing resources.

Crucially, the nurses were not merely listing problems—they were designing solutions. The fifth theme, planning enables performance, brims with concrete proposals: working in pairs, carrying mobile acute-care bags and spill kits, using portable waste containers, bringing foldable stools and protective pads for ergonomics, transporting drugs in the same robust sealed bags already used for inter-hospital deliveries, and employing closed-system transfer devices to prevent exposure during preparation. Nurses with prior homecare experience were notably more enthusiastic, suggesting that familiarity breeds confidence. Access to electronic health records and computerized physician order entry systems was flagged as essential for verifying prescriptions and lab values on the road. The nurses also acknowledged that a home-based service would demand heavier administration and careful scheduling, and some doubted the resources could be found without compromising existing ward care. Still, the overall verdict was conditional optimism: if proper equipment, education, risk evaluation and support were guaranteed, home-based antineoplastic therapy was seen as feasible and, for patients, potentially transformative.

The study’s implications reach well beyond one Swedish ward. The authors note that guidelines for handling hazardous drugs overwhelmingly focus on hospitals—only 19.5 percent address the home setting—and that evidence on parenteral antineoplastic therapy at home remains fragmented and disputed. The findings suggest that any successful program must address the safety climate around occupational exposure, define the knowledge and experience required of a home-based oncology nurse, and preserve some form of the collegial safety net that hospital nurses take for granted. Encouragingly, the nurses’ own proposals mirror practices already used by established services such as the Christie NHS Foundation Trust outreach program in the United Kingdom, which deploys mobile emergency kits and restricts home treatment to low-risk drugs with short infusion times. As cancer survival rates climb and patient volumes grow by roughly five percent annually at the study hospital, the pressure to move care closer to home will only intensify. This study makes clear that the nurses who would carry that responsibility are ready to embrace it—not blindly, but with a clear-eyed demand for the training, equipment and backup that would make treating cancer in a living room as safe as treating it in a ward.

Subject of Research: Oncology nurses' perspectives on administering parenteral antineoplastic cancer therapy in patients' homes

Article Title: Administering Antineoplastic Parenteral Cancer Therapy in the Patient's Home: Perspectives of Oncology Nurses—A Descriptive Qualitative Study

Article References: Albin, T., Sofia, K.-S., & Mattias, P. (2026). Administering Antineoplastic Parenteral Cancer Therapy in the Patient's Home: Perspectives of Oncology Nurses—A Descriptive Qualitative Study. Nursing Open, 13(10), Article e70891. https://doi.org/10.1002/nop2.70891

Image Credits: AI Generated

DOI: 10.1002/nop2.70891

Keywords: hospital-at-home, oncology nursing, antineoplastic agents, hazardous drugs, chemotherapy, qualitative research, patient safety, adverse events, home healthcare, person-centred care, Sweden, nurse workload