OBJECTIVES: At the Quebec Health Technology Assessment Agency (AETMIS) in Canada we assessed whether home chemotherapy for cancer was effective, safe, and satisfactory to patients, and examined the cost, organizational, and ethical implications, in order to make policy recommendations. METHODS: We carried out a systematic review of the scientific literature using the PubMed (MEDLINE 1980-present) and CancerLit (1975-present) bibliographic databases. We supplemented this review with 16 semi-structured interviews with service providers, including oncology nurses, physicians, and home care coordinators, in 2 provinces with different organizational structures for cancer care (Quebec and Ontario). RESULTS: Clinical effectiveness of home cancer chemotherapy appears similar to that in non-home settings. Home treatment can be delivered safely if patients are carefully selected and trained. Patient eligibility criteria relate to learning capability, suitability of the home environment, and geographic accessibility. Improvements in patient quality of life at home have not been well documented in the literature. Patient preference and satisfaction with home therapy is supported, although mostly among self-selected groups. Cost studies show that home chemotherapy is less expensive than inpatient treatment from a hospital perspective. When home treatment is used as a substitute for outpatient therapy, the result tends to be a cost shifting from hospitals to home care organizations. Effects on costs to patients/families require more study. Interviews with service providers showed variable delivery, with greater patient load capacity and uniformity of services where hospital oncology departments or regionalized centres of expertise have organized, collaborative links with community home care services and sufficient resources. CONCLUSIONS: Home chemotherapy requires a well-integrated multidisciplinary team of health professionals in partnership with selected patients and their informal caregivers. Our study shows the need for regionalized approaches within centralized standard setting and funding, increased resources and support for program evaluation, and a comprehensive cancer care model.