Mayo Clinic takes cancer care beyond walls and into patients’ homes.
It was a funny thought for Erika Manternach: She loved having five-minute-long injections in her stomach.
It wasn’t the needle itself that brought Erika joy, but where the injection was occurring. Erika received treatment in 2024 in her Jacksonville, Florida, home as part of Mayo Clinic’s Cancer Care Beyond Walls program. Launched in April 2023, the program offers patients in the Jacksonville area access to care in their homes instead of the chemotherapy unit at Mayo Clinic in Florida.
“Most people would think a long injection isn’t very fun, but before, my treatment was taking a full day when you added in driving and everything else,” Erika says. “Now it’s five minutes. When it’s over, everything gets cleaned up and my nurse leaves. It’s wonderful.”
Families with Cancer Care Beyond Walls no longer must surrender entire days to in-person chemotherapy. Instead, treatment becomes integrated into their daily lives.
Erika was one of 55 Florida patients who had received infusions in their home through March 2025, a number that has continued to grow.
“Bringing cancer care straight to the patient’s home is a big step toward helping make cancer care more accessible,” says Morgan Posze, R.N., a nurse with the program. “It’s empowering for the patients and the families to not have to go through the stress that comes with having to change your whole life to be able to come to the clinic.”
Cancer frequently functions like a chronic condition, explains Roxana Dronca, M.D., who heads the program. When patients are in chemotherapy, there are regular hospital visits — and with those visits, lots of waiting. Studies have shown that after receiving a cancer diagnosis, patients can spend up to 15 hours a week traveling to receive treatment and sitting in waiting rooms.
“This program was born from Mayo Clinic’s primary value — the needs of the patient come first,” Dr. Dronca says. “It was hard to meet all our patients’ needs during the COVID-19 pandemic, especially patients with cancer. Mayo Clinic made care more accessible and flexible during the pandemic, but after the pandemic the needs of patients with cancer were still there.”
Kim Pineda has been a regular at Mayo Clinic in Florida since being diagnosed with breast cancer in 2016.
She’s endured radiation, as well as challenging courses of chemotherapy — “the kind where I thought I might die, and not from the cancer.”
She went to a supportive stage for nearly a year. Then her cancer returned — this time it was in lymph nodes all along the left side of her body. That required another surgery, and from that point forward, since 2018, she’s been going to Mayo Clinic in Florida for treatment every three weeks.
That’s thousands of hours spent driving, walking from a parking spot through the clinic, and sitting and waiting. For Kim and her husband, Charlie, chemotherapy sessions kept them away for long stretches from the diner they own.
“The biggest challenge with cancer is time,” Kim says. “When you’re getting treated, your meds don’t get ordered until you’re sitting in the chair. For an hour-and-a-half infusion, you’re looking at four hours in the clinic. Even for a five-minute shot, the quickest I was ever in and out was 45 minutes.”
In 2024, in the middle of another long treatment day, Kim asked if there was any way to speed things up.
Her doctor told her there was something she might consider: Cancer Care Beyond Walls. Kim was an ideal candidate because she wasn’t experiencing any issues with her chemotherapy.
The care she received in her Jacksonville home was the same as in the clinic but took up a fraction of the time. Getting chemotherapy and working at the diner became a lot easier.
“I absolutely love it,” Kim says. “I have my little space in the closet where I store all my stuff. That’s my doctor’s office. I pull it out for them in the morning before they come.”
In addition to providing chemotherapy, Cancer Care Beyond Walls has integrated clinical trials for some patients, including Erika.
Erika had previously experienced a bad reaction to immunotherapy. Her Mayo Clinic Comprehensive Cancer Center care team switched her to subcutaneous injections, rather than in a vein, believing the longer absorption period would be easier on her system.
Cancer Care Beyond Walls patients have access to Mayo Clinic care at all times.
This provided an avenue for me to take less time off work and spend more time with my family and doing the things I enjoy.
— ERIKA MANTERNACH
For example, when patients wake up in the middle of the night with a fever — which for those with cancer is a potential crisis that requires a trip to the hospital — a provider is only a push of a button away.
That button is on a tablet that Mayo Clinic provides to every Cancer Care Beyond Walls patient. When the button is pushed, a nurse in the Mayo Clinic in Florida control room appears on screen.
“We’ve worked so hard on this program’s safety and quality standards so that when we were ready to deliver it to our patients, it was a Mayo Clinic level of care,” Dr. Dronca says. “I believe that’s why our patients reacted positively to us, because they did not feel like it’s care that is detached from Mayo Clinic’s standard of excellence.”
The origins of the Cancer Care Beyond Walls began with a heartbreaking loss.
In 2020, Dr. Dronca’s 6-year-old daughter Maya was diagnosed with an inoperable and incurable brain tumor known as a diffuse intrinsic pontine glioma (DIPG). DIPGs are an extremely rare and aggressive form of brain cancer that primarily affects children and carries a median survival time of nine months.
Maya bravely fought her cancer for 14 months. She passed away in 2021.
“It was so difficult to put her in the car and transport her when she was so sick,” Dr. Dronca recalled. “The drive was a ton more painful than any drug. For any procedure that she went to, I would have given anything to have the flexibility and the availability of those services in my home.”
After losing her daughter, Dr. Dronca was overwhelmed with grief. She wasn’t sure she could return to her roles as the chair of the Division of Hematology and Oncology and the site director of the Mayo Clinic Comprehensive Cancer Center in Florida. She feared she would see the face of the daughter she lost in every patient.
She ultimately came back, possessing the compassion of someone who fully understood the pain families go through while fighting cancer. Treating patients with cancer was, and remains, Dr. Dronca’s life mission.
Dr. Dronca resolved that patients should be able to receive convenient, safe care in their homes whenever possible, sparing them the painful drives her family endured when Maya was sick.
“If I had access to the medications to give Maya and the labs to check her health status, I would have done this for her in my home,” Dr. Dronca says. “I kept thinking about it. If I wanted it, wouldn’t other people want it? Other mothers and caregivers and patients must feel like me.”
Jeremy Jones, M.D., is a consultant in the Division of Hematology and Oncology and the medical director of Cancer Care Beyond Walls for Mayo Clinic Platform. He has been involved with the program from the beginning. He says that it didn’t take long to appreciate just how big a difference receiving chemotherapy at home made for patients.
“I knew we were on to something when my first patient was finishing up their six months in the program,” Dr. Jones says. “When I said, ‘OK, we’re going to come back to the clinic now,’ they were like, ‘Absolutely not!’ It’s the first time I’ve ever had a patient express enthusiasm for continuing their current chemo regimen — because it was in their home.”
Erika works as a quality assurance analyst for a trucking logistics company from her home. The Cancer Care Beyond Walls program afforded her a level of flexibility that was impossible to have with traditional care in the clinic. “The infusions are the same at home and in the clinic, but the buildup to actually receiving the treatment takes a long time,” Erika says. “They’re doing your blood work, waiting for the results of your blood work, meeting with the oncologist to clear you. “Then they place the order for the meds. Then you wait for the meds. Then they come in and they prep you.” Now, a typical treatment day for Erika might look like this:
A Cancer Care Beyond Walls nurse calls to discuss how Erika is feeling. This usually lasts just a few minutes.
A visiting nurse comes to Erika’s house to draw blood and measure vitals. This usually lasts about 30 minutes.
In a video call with her Cancer Care Beyond Walls oncology team, they go over the results of her blood work and get the go-ahead for treatment. This usually lasts a few minutes.
The refrigerated chemotherapy medications are delivered to her house by a courier.
The visiting nurse arrives. While the medications are unpacked so they rise to room temperature, the nurse and Erika videoconference with the Cancer Care Beyond Walls team.
Erika receives her treatment. Afterward, there is a second videoconference with the Cancer Care Beyond Walls team. Following that, the nurse cleans up and leaves. The courier returns to the house to remove all medical-related waste.
When Dr. Jones learned of Dr. Dronca’s vision for Cancer Care Beyond Walls, he says he shared her excitement for the idea. He also knew that it would not be easy to build.
“There were a lot of sleepless nights as we were developing Cancer Care Beyond Walls,” Dr. Jones says. “Tons of work went into what we have now — months of planning and thinking about every potential outcome, every potential event that could happen so that we could plan for it.”
Designing and running such an ambitious program required partnerships across the enterprise. None was more important than Mayo Clinic Platform.
“The partnership of Platform really accelerated our efforts,” Dr. Dronca says. “To set up a program like this, between us talking about it and doing the proof of concept was a few months. If you look at how healthcare moves anywhere, it would have taken two or three years to set up. But we had Platform’s support, their innovative thinking and their speed.”
To help bring the ideas to life, Platform needed a cancer care clinical operations expert. They found it in Rosanna Fahy.
At that time, Rosanna was with Memorial Sloan Kettering, where over the course of 31 years she had played a leading role in building and expanding their brick-and-mortar cancer care facilities.
For Rosanna, the opportunity to build the digital side of Cancer Care Beyond Walls — and to work with Platform leaders like John Halamka, M.D., M.S., Dwight and Dian Diercks President of Mayo Clinic Platform, and Maneesh Goyal, Platform chief operating officer — was as daunting as it was exciting. After a thorough interview process, she was offered the position of Platform’s associate vice president for Cancer Care Beyond Walls.
“Cancer is a complex disease,” Rosanna says. “For patients who are in the chemotherapy unit today, it probably takes seven or eight people in different roles who each have to do their piece in a connected way so that patients get safe, high-quality, dependable treatment.
“Now we do it so often that it looks pretty easy. But when you’re sitting in the chemotherapy chair, you’re not realizing how many things had to happen before that moment.”
Some of the key pieces were already available, Rosanna says. Mayo Clinic’s efforts to provide more remote care during the COVID-19 pandemic and the infrastructure of Advanced Care at Home were both valuable.
Since 2020, Advanced Care at Home has provided acute-level, inpatient-quality care to patients whose conditions included infections, congestive heart failure, bone marrow transplants, kidney transplants and other postsurgical needs.
Cancer Care Beyond Walls uses the same tablets and collection of technologies as Advanced Care at Home, making it possible to connect patients to a 24/7 command center.
During business hours on weekdays, when a Cancer Care Beyond Walls patient wants to speak with someone, they can push a button on their tablet and be connected to one of Mayo Clinic’s three dedicated Cancer Care Beyond Walls nurses.
On weekends, patients are connected with an Advanced Care at Home nurse. An oncology provider is on call at all times.
“My interactions with the patients are always either going to be video calls or phone calls,” says Morgan Posze, a nurse in the program. “It’s my job to create a space where the patient feels comfortable sharing their concerns and asking questions.
“I try to focus on listening to not only their medical needs but also their emotional experiences. We’re here to address anything and everything that they need.”
In addition to the foundation provided by Advanced Care at Home, Morgan represents an example of another key resource Cancer Care Beyond Walls already had in place: an exceptional clinical care staff that was committed to better meeting patients’ needs. Morgan, who had been with Mayo Clinic for almost a decade, jumped at the chance to be a part of Cancer Care Beyond Walls.
Her role is to be patients’ central point of contact with Mayo Clinic. Nurses connect patients with their entire care team, working closely with providers and schedulers to help coordinate everything from appointments to tests to medications — making sure everything lines up for each patient and their specific needs.
“The command center has a lot of the equipment that we need to make this virtual care possible,” Morgan says. “It’s really nice for us because the whole Cancer Care Beyond Walls team sits together, so it’s easy to collaborate to come up with plans and make changes. We all sit in one group where we can work together to make sure the patient is getting the best care.”
In 2024, Cancer Care Beyond Walls’ impact was also felt by those Florida patients who needed to come into the Cancer Center for care.
“We are able to reach more patients because we can treat patients at phases of lower acuity in their home,” Dr. Dronca says. “This allows us to see the patients with complex conditions in the chemotherapy unit and the hospital when we need to see them.”
As Cancer Care Beyond Walls grows, one of the many beneficiaries will be patients who live in remote and underserved communities — an important step toward addressing health disparities. Benefactor support is accelerating the program’s growth by enhancing digital tools, developing community partnerships, and recruiting patient navigators and clinical staff to expand the program.
“Mayo Clinic has invested in building a digital product that would enable Cancer Care Beyond Walls’ care delivery model to be expanded, not only at Mayo Clinic but also to our Mayo Clinic Care Network partners,” Rosanna says. “Platform is building digital solutions that help our own practice, and we could ultimately take these same solutions and make them commercially available.”
Mayo Clinic is working to make at-home cancer care widely available. These efforts received a significant boost in 2024 with a generous philanthropic commitment from Stephen M. and Barbara J. Slaggie. In addition to other locations, the Slaggies are helping expand Cancer Care Beyond Walls to Mayo Clinic partners.
“We were excited when we learned about Mayo Clinic’s vision for making world-class cancer care available in more patients’ homes,” says Stephen Slaggie, who is a cancer survivor himself. “Not having to regularly upend your life every time you receive treatment makes it less overwhelming when you are facing cancer.”
For Erika Manternach, 2024 was also the year that Mayo Clinic doctors discovered she had a lymph node that was almost entirely encased with metastatic melanoma. She had initially been diagnosed with cancer in 2021 but had been put on a surveillance program of PET scans, MRIs and skin checks because the cancer seemed stable.
Tons of work went into what we have now — months of planning and thinking about every potential outcome, every potential event that could happen so that we could plan for it.
— JEREMY JONES, M.D.
After Erika underwent lymphadenectomy surgery to remove several cancer-containing lymph nodes and others at high risk, she was recommended to participate in Cancer Care Beyond Walls. Erika’s first two chemotherapy sessions were at Mayo Clinic in Florida before she began the first of 12 at-home sessions, per the structure of the program. To reduce the risk of infusion reactions in the home, all patients must have at least two cycles in the clinic prior to switching to at-home care.
“I can’t speak highly enough about this program,” Erika says. “This provided an avenue for me to take less time off work and spend more time with my family and doing the things I enjoy. It was the perfect fit.”
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