Home Phlebotomy as Enabling Infrastructure for Cancer Care at Home and Decentralized Clinical Trials

Importance: Review about care at home often treats acute hospital-at-home, tele-oncology, home laboratory collection, and decentralized clinical trials as variants of the same model, despite major differences in clinical intensity, payment pathways, and operational risk. Objective: To evaluate whether home phlebotomy should be treated as enabling infrastructure for cancer care at home and decentralized clinical trials, with focused assessment of the Cancer Center (a large NCI-designated comprehensive cancer center in the United States) implementation, the National Cancer Institute (NCI) MATCHES program and MSK, and publicly available evidence regarding myOnsite Healthcare. Evidence Review: This narrative review was conducted on March 5, 2026, using PubMed, PubMed Central, and official or institutional sources from CMS, MedPAC, NCI, FDA, and a large NCI-designated comprehensive cancer center in the United States. Public myOnsite materials were reviewed separately and classified as company-reported evidence. Twenty-four sources were included: 12 peer-reviewed articles, 6 official policy or regulatory sources, 2 institutional sources, and 4 company-reported sources. Findings: National acute hospital-at-home evidence suggests clinical promise but operational and financial fragility. CMS reported lower overall mortality but mixed readmission effects, slightly longer length of stay, and lower 30-day postdischarge spending for more than half of the most common diagnosis-related groups studied.2 MedPAC documented limited uptake and substantial delivery friction.3 In contrast, the MSK home phlebotomy study reported 345 patients, 1,464 home visits, and 5,104 specimens, with 1 clotted specimen, 0 hemolyzed specimens, and 147 of 149 surveyed patients (99%) stating they would use the service again or recommend it.1 The MATCHES/TRACE initiative at MSK embeds home laboratories, remote monitoring, and treatment-at-home elements into tele-oncology research.9-14 Conclusions and Relevance: Home phlebotomy appears more operationally tractable than full inpatient substitution and may represent a high-value enabling layer for oncology care at home and decentralized trials. The strongest near-term opportunity is not generic home visits but protocolized, institution-integrated, specimen-safe execution.