What Survival Outcomes Reveal: New Evidence on Outcomes in Community Oncology

J Clin Pathways. 2026;12(4-5):e006.

For years, conversations about the value of community oncology have largely centered on reimbursement, site-of-service differentials, spending, and market dynamics. Far less attention has been paid to a more fundamental question: What outcomes are patients actually achieving?

That question matters because community oncology is where the majority of patients with cancer receive treatment in the US. Across urban, suburban, and rural communities, independent oncology practices care for patients through some of the most challenging periods of their lives. These practices provide not only systemic therapy, but also medically integrated pharmacy services, care navigation, symptom management, supportive services, financial counseling, survivorship support, and ongoing care coordination that extends well beyond a single treatment decision.

Despite the central role community oncology plays in cancer care delivery, relatively limited published literature has focused specifically on evaluating quality and outcomes within physician-owned, independent community oncology practices as a distinct care setting. As policymakers, payers, employers, and patients increasingly seek value in cancer care, understanding patient outcomes in these settings has become more important than ever.

Recently, the Community Oncology Alliance (COA), in collaboration with Flatiron Health, released findings from one of the first large-scale real-world analyses evaluating survival outcomes among patients treated in independent community oncology practices participating in the Flatiron Health Research Network.¹ The analysis examined nearly 98 000 patients with metastatic breast cancer and metastatic non–small cell lung cancer and compared outcomes against national benchmark data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, one of the nation’s most widely used sources of population-based cancer survival data.²

The findings were encouraging. Among treated patients with metastatic breast cancer, median overall survival was 48 months compared with 40 months in the national benchmark population. Among treated patients with metastatic non–small cell lung cancer, median overall survival was 15 months compared with 13 months. Survival rates at 1, 3, and 5 years were also consistently higher among patients treated within participating community oncology practices.

For patients with metastatic cancer, these differences are meaningful. Oncology advances are frequently measured in months, making additional survival time clinically significant for patients and families. While observational analyses cannot establish causation, they provide valuable insight into real-world care delivery and demonstrate that meaningful benchmarking of outcomes in independent community oncology is both feasible and informative.

For those of us who work with community oncology practices every day, the findings are not surprising. Independent community oncology has spent decades building care models centered around patient access, continuity, and long-term relationships. Unlike many areas of medicine, cancer care is rarely episodic. Patients may interact with their oncology team dozens of times over months or years. Treatment decisions evolve. Toxicities emerge. Biomarker results guide therapy selection. Disease progresses. New treatment options become available.

“Quality” in oncology is not defined by a single visit or procedure. It is delivered through thousands of interactions throughout a patient’s journey. That longitudinal relationship may be one of community oncology’s greatest strengths.

Patients often receive care close to home, reducing travel burdens while allowing them to remain connected to family and caregivers. They frequently have access to nurse navigators, social workers, financial counselors, nutrition services, and other supportive resources integrated into the practice. Clinical teams develop familiarity with individual patients and are often able to intervene quickly when symptoms worsen or treatment-related complications arise. Emerging evidence suggests that timely symptom management, coordinated care, and minimizing unnecessary delays in treatment may influence patient outcomes and quality of life.^3,4

While more research is needed to better understand which aspects of community oncology contribute most directly to improved outcomes, these are not simply conveniences. They are fundamental components of high-quality cancer care and deserve greater attention as quality frameworks continue to evolve.

The findings also contribute to a broader conversation about value in cancer care. Previous research has consistently demonstrated that community oncology practices often deliver care at lower cost than hospital outpatient departments while maintaining comprehensive oncology services. Historically, that conversation has focused primarily on economics. These findings add another dimension by suggesting that lower cost does not have to come at the expense of quality. High-value cancer care requires both.

Importantly, this work should be viewed as the beginning of a larger effort rather than the final word. One analysis cannot answer every question, nor should it. Future work should continue evaluating outcomes across additional disease states while expanding our understanding of patient experience, care continuity, biomarker implementation, guideline-concordant care, treatment timeliness, and coordination across the cancer care continuum. The appropriate response to emerging evidence is not to stop measuring, but to measure more, which COA is seeking to do with subsequent research projects.

For too long, many discussions about community oncology have been driven by assumptions. Some assume quality could only be found within large institutions. Others view community oncology primarily through the lens of cost. Neither perspective fully captures the reality of modern cancer care delivery.

Independent community oncology practices are sophisticated care delivery organizations that manage increasingly complex cancer populations, implement precision medicine, coordinate multidisciplinary care, and support patients throughout a prolonged and often difficult journey.

As the oncology community continues to pursue higher quality, greater value, and more patient-centered care, our discussions should increasingly be guided by evidence rather than assumptions. Most importantly, they should remain focused on what matters most: the outcomes patients achieve, the experience they have while receiving care, and ensuring that every patient has access to high-quality cancer care close to home.

1. Community Oncology Alliance, Flatiron Health. COA quality of care study: real-world survival outcomes in independent community oncology practices. April 29, 2026. Accessed June 29, 2026. https://communityoncology.org/Publications/Studies-And-Reports/Quality-Of-Care
2. National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program. 2026. Accessed June 29, 2026. https://seer.cancer.gov/
3. Hanna TP, King WD, Thibodeau S, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087. doi:10.1136/bmj.m4087
4. Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/jama.2017.7156