For patients undergoing intensive treatments such as bone marrow transplantation, recovery can mean weeks away from children, daily routines and the people who matter most.

For caregivers, it can mean repeated hospital visits and the strain of holding daily life together.

The home-first shift

Through NUHS@Home, selected patients recovering from complex conditions can receive hospital-level care in their own homes while remaining under specialist supervision. Its Value-Driven Outcomes framework tracks quality, safety, utilisation and patient experience, helping teams understand whether patients can recover safely and effectively outside the hospital.

The results challenged the assumption that higher-acuity recovery must always begin in hospital. Across the cancer pathway, NUHS@Home has saved 2,981 hospital days and reduced average admission duration by 14 per cent, demonstrating how hospital-level care can be delivered safely in a different setting while maintaining quality and safety.

Patients recovering from autologous stem cell transplantation have traditionally remained in hospital because the post-transplant period carries serious risks, including infections, low blood counts, gastrointestinal toxicities and febrile neutropenia, which can become life-threatening if not recognised and treated promptly.

The need for close monitoring has not changed. What has changed is the starting point: can recovery safely begin at home, with hospital expertise wrapped around the patient?

Dr Edwin Thong, Associate Consultant, Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), put it this way: “Specialised care like cancer care, can increasingly be delivered beyond hospital walls, helping patients recover closer to the people who matter most and return to familiar routines.”

Advances in telemedicine, remote monitoring and structured clinical protocols now allow selected patients to receive specialist oversight while recovering at home.

For suitable patients, NUHS@Home provides daily clinical reviews, teleconsultations, remote monitoring, medication support, home visits when needed and direct escalation back to hospital if concerns arise.

Patients remain under the joint care of the NUHS@Home and transplant teams. The clinical standards stay the same, but the setting changes: home first, hospital when needed.

Who is suitable for home-based recovery?

Moving specialised cancer care into the home is contingent on careful patient selection. The transplant team and NUHS@Home clinicians jointly assess clinical stability, suitability of home environment, ability to participate in monitoring, caregiver support, risk of complications and ability to comply with the care plan.

Patients who need closer inpatient monitoring continue to receive conventional hospital care.

NUHS@Home is not a move away from hospital, but a way to place suitable patients in the right setting for recovery.

Close care, centred at home

A home-first model does not mean less oversight. It depends on close coordination, structured monitoring, regular communication and clear escalation pathways.

Dr Hazel Teng, Consultant, Division of Advanced Internal Medicine, Alexandra Hospital (AH), described the value this way: “When care can be delivered safely at home, while maintaining quality and achieving good outcomes, we create value for patients, families and the healthcare system.”

Patients receive monitoring equipment and clear guidance before transfer. Vitals and symptoms are reviewed regularly, and clinical decisions remain collaborative across teams. Home becomes the centre of recovery, with hospital expertise close at hand.

What this changes for families

For patients, the impact extends beyond clinical outcomes. A patient who underwent a bone marrow transplant shared that recovering at home enabled her to stay close to her children and helped her focus on recovery. Another patient chose NUHS@Home after bariatric surgery to recover in the company of her family, while avoiding prolonged hospitalisation.

Measuring whether home-first care works

NUHS@Home is part of NUHS’s broader Value-Driven Outcomes journey, measuring value across a home-first model: hospital-level support delivered beyond hospital walls.

A dedicated VDO dashboard tracks quality, safety and utilisation outcomes, helping teams monitor performance and guide improvements as the programme grows.

As Dr Teng explained, outcomes measurement shows whether home-based hospital-level care remains safe, effective and sustainable.

Home first, not home only

The key lesson from NUHS@Home is not that every patient should be treated at home, or that hospital care becomes less important.

It is that home should be considered first when it can meet patients’ needs safely, while hospital care remains available when closer monitoring, treatment or escalation is required.

So, can specialist cancer care be home-first?

For selected patients, the answer is yes.

The NUHS@Home cancer pathway shows that recovery does not always need to begin away from family and familiar surroundings. With careful patient selection, specialist oversight, remote monitoring and clear escalation pathways, home can be the first setting for recovery while clinical quality is maintained.

Because when cancer has already taken so much from patients and caregivers, recovery should not have to take them away from home as well.

In consultation with Dr Hazel Teng, Consultant, Division of Advanced Internal Medicine, AH, and Dr Edwin Thong, Associate Consultant, Department of Haematology-Oncology, NCIS.