Breast cancer patients can safely take hormone shots home

Clinical takeaway: Clinicians can consider telemedicine-supported home injection for reliable patients on long-term GnRH agonist therapy. Verify coverage first: home dispensing triggered denials or copays for most who sought it. 

For premenopausal women with hormone receptor–positive breast cancer, ovarian suppression means a gonadotropin-releasing hormone (GnRH) agonist injection every month or every three months. Standard practice puts every one of those doses in a clinic. Leuprolide, the most common choice, is drawn up and administered by a nurse at an oncology visit that can consume hours. Because adjuvant endocrine therapy often runs five years or longer, otherwise well busy patients spend years organizing their lives around appointments to deliver a single injection. 

The reason the injection stays in the clinic has as much to do with billing as with medicine. When a nurse administers leuprolide at an oncology visit, the drug and its administration run through the patient's medical benefit, typically with little or no cost-sharing. Dispensing the same drug for home use moves it to the pharmacy benefit, where it needs its own prior authorization and often carries a copayment that clinic administration never did. Home injection is already standard in fertility care, but oncology has largely not tested whether patients would cross that payment divide. A telemedicine-supported pilot at a comprehensive cancer center now has. 

Of 105 eligible patients approached, 54 were interested, and 24 ultimately participated. Nearly all of them, 95.8%, completed at least one home injection of intramuscular leuprolide after a single nurse-led teaching visit, 79.2% completed two, and 75% chose to keep injecting at home after the pilot ended. Half had never administered an injection of any kind before training. 

The attrition between 54 and 24 patients was the study's other finding. Insurance denied home dispensing outright for 35.2% of interested patients, and another handful withdrew when the authorization process dragged on. Among the 30 who did get authorization, 60% were charged a copayment they had never faced in the clinic, a median of $61 per dose and ranging up to $2,000, and a third of those charged walked away over the cost. 

Patients who stayed rated the model highly, with a net promoter score of 69; their oncologists scored it 61. Time savings and schedule control led the reported benefits, each cited by 88.2% of survey respondents. Telemedicine support proved a scaffold rather than a crutch: just over half used a nursing visit for their first injection, and only two wanted one for the second. 

The pilot ran from October 2024 through August 2025 at four outpatient oncology practices of Memorial Sloan Kettering Cancer Center's Westchester regional site, recruiting adults with breast cancer on active leuprolide who used the patient portal. It was a quality improvement study, not a trial: it tracked completion and satisfaction, not clinical or safety outcomes. Participants skewed affluent and well, nearly all college-educated, most with six-figure household incomes, and almost all with fully preserved performance status. 

MSK is folding the pilot into MATCH-UP, an ongoing pragmatic cluster randomized trial of telehealth-delivered cancer care at home for patients with breast or prostate cancer. This should supply the safety and utilization evidence this study could not. The authors see the same template fitting other long-haul injectables, including GnRH agonists for endometriosis and lanreotide for neuroendocrine tumors, and eventually subcutaneous immunotherapy formulations as those come online. 

Before any of it scales, two payment problems must be addressed: pharmacy-benefit copays that penalize patients for leaving the clinic, and the administration revenue clinics lose when they do. The authors point to reimbursement for home monitoring and care coordination as one route to the latter. 

Source: Malling CD, et al. (2026 Aug 21) JAMA Netw Open. A Telemedicine-Supported Home-Injection Model for Patients With Breast Cancer