BACKGROUND: The widespread adoption of immune checkpoint inhibitors has significantly improved outcomes across multiple solid tumors but has also increased pressure on hospital-based oncology services, particularly oncology day hospitals. Subcutaneous (SC) formulations of immunotherapy offer a clinically validated alternative to intravenous (IV) administration and may facilitate more efficient, patient-centered models of cancer care delivery. However, the organizational, economic, and governance implications of this transition remain insufficiently explored. METHODS: We conducted a mixed-methods analysis integrating four components: (1) a structured narrative review of clinical evidence regarding SC immune checkpoint inhibitors, including pharmacokinetics, efficacy, safety, and patient-reported outcomes; (2) an economic evaluation including cost-effectiveness and return-on-investment analyses; (3) benchmarking of national and international decentralized oncology care models; and (4) cross-sectional surveys of healthcare professionals (n = 84) and patients receiving immunotherapy (n = 76). Based on these findings, a hub-and-spoke care delivery framework supported by digital health tools was developed. RESULTS: Across tumor types, SC immunotherapy demonstrated pharmacokinetic bioequivalence to IV formulations, with comparable efficacy and safety profiles. Treatment time was reduced by approximately 85-90%, resulting in improved patient-reported experience and reduced cumulative treatment burden. Adoption of SC immunotherapy was associated with up to 40% reduction in oncology day hospital occupancy and an estimated net annual saving of approximately €1,410 per patient. Both patients and healthcare professionals supported decentralized administration for selected clinically stable patients; however, acceptance was strongly dependent on preservation of oncologist-led care, strict patient selection, digital monitoring, and clearly defined escalation pathways. CONCLUSIONS: SC immunotherapy is a clinically effective and safe alternative to IV administration whose principal value lies in enabling selective decentralization of oncology care rather than simple logistical convenience. When implemented within a structured hub-and-spoke model that preserves medical oncology leadership, SC immunotherapy may improve patient experience, optimize healthcare resources, and strengthen long-term health system sustainability without compromising safety or continuity of care.
Muñoz-Couselo et al. (Mon,) studied this question.