Integrating Oncology Advanced Practice Nursing Into Hospital Day-Care and Hospital at Home-Based Pathways: A Retrospective Study (PACI Study)

OBJECTIVES: Growing complexity in oncology care necessitates innovative organizational models in outpatient and home-based settings. While oncology advanced practice nurses (APNs) are integrated into the French healthcare system, evidence on their routine implementation remains limited. This study evaluated an oncology APN-led care pathway across Day Hospital (DH) and Hospital-at-Home (HaH) settings, describing patient profiles, treatment characteristics, and organizational determinants of HaH utilization. METHODS: We conducted a retrospective study of patients managed by an oncology APN between November 2019 and May 2025 across DH and HaH settings. Sociodemographic, cancer-related, treatment-related, and care delivery data were extracted from electronic medical records and APN activity logs. DH and HaH patients were compared for profiles, follow-up characteristics, and organizational constraints. RESULTS: Overall, 209 patients were included: 64% women, median age 64 years (range 21-93). The most frequent cancers were breast (41.6%), lung (29.8%), and glioma (6.7%). About 116 patients were managed in DH and 93 in HaH; HaH patients lived significantly closer to the hospital. Treatments were mainly immunotherapies (53.5%) and anti-HER2 therapies (36.3%), administered every 21 days. Adoption of the APN-led pathway increased progressively over time, with the APN managing 107 patients simultaneously in 2024. Main barriers to HaH access were organizational constraints related to provider availability and eligibility criteria. CONCLUSIONS: This study provides real-world evidence on the organizational functioning of an oncology APN-led care pathway across hospital and home-based settings. The findings highlight adoption dynamics, organizational determinants of HaH access, and the central coordinating role of the APN.