USA: Researchers have found in a quality improvement study that telemedicine-supported home administration of gonadotropin-releasing hormone agonist (GnRHa) injections for women with breast cancer was feasible, with high treatment completion and strong patient acceptability. However, insurance approval and higher copayments for home versus in-clinic administration were important barriers. Addressing these financial and coverage issues will be essential before wider implementation.

The study, published in JAMA Network Open, was conducted by Charlotte D. Malling, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, and colleagues. The researchers evaluated whether a telemedicine-supported model could allow patients receiving long-term GnRHa therapy to administer their injections at home rather than making repeated clinic visits.
GnRHa therapy is commonly used in premenopausal women with breast cancer to suppress ovarian function. Because the treatment requires either subcutaneous or intramuscular injections, administration is traditionally performed during clinic appointments. The investigators explored whether training combined with remote nursing support could provide a practical alternative.
The quality improvement study was conducted between October 2024 and August 2025 across four outpatient medical oncology practices at a comprehensive cancer center. Adults with breast cancer who were receiving ongoing GnRHa therapy and using the patient portal were eligible. Participants first received hands-on training from nurses covering medication preparation and injection administration. Telemedicine nursing appointments were available to supervise injections performed at home.
Among 105 eligible patients, 54 elected to participate, but only 24 obtained insurance coverage allowing medication dispensing for home administration. The participants had a median age of 44 years, and all were women. Notably, half of 20 patients with available information had never administered an injection previously.
The main findings were:
  • 23 of 24 patients (95.8%) successfully completed at least one home injection.
  • 19 patients (79.2%) completed two home injections.
  • 18 patients (75.0%) chose to continue home administration after the pilot period.
  • Only one participant discontinued because of difficulties involving injection administration and telemedicine scheduling.
  • Among 17 patients providing feedback, time savings (88.2%) and convenience (76.5%) were the most frequently cited advantages.
  • Patient and clinician satisfaction was high, reflected by net promoter scores of 69 and 61, respectively.
Insurance coverage remained a key barrier: 19 of 54 participants (35.2%) could not access home injections due to insurance denial, while 18 of 30 (60%) with approval faced medication copayments after switching from clinic- to home-based administration.
The study was limited by its small sample, four participating practices, homogeneous patient population, and single-center setting, limiting generalizability.
Overall, telemedicine-supported home GnRHa administration appears feasible and may reduce the burden of repeated clinic visits. Still, insurance coverage and out-of-pocket costs must be addressed before wider adoption.
Reference:
Malling CD, Bange EM, Reiner AS, et al. A Telemedicine-Supported Home-Injection Model for Patients With Breast Cancer. JAMA Netw Open. 2026;9(8):e2629406. doi:10.1001/jamanetworkopen.2026.29406


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Article Source : JAMA Network Open

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Medha Baranwal

Medha Baranwal holds a Bachelor’s degree in Biomedical Sciences from the University of Delhi and a Master’s degree in Biotechnology from Amity University. Since May 2018, she has been contributing to Medical Dialogues, writing and editing medical news articles that translate complex research into clear, accessible information for healthcare professionals.

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