Community oncology practices are successfully bringing advanced cancer therapies closer to patients' homes, with CAR-T cell treatments and bispecific antibodies now being delivered in local settings rather than requiring extended stays at distant academic centers. This development represents a significant shift in cancer care delivery, according to Nini Wu, MD, MBA, chief medical and development officer at Navista, a Cardinal Health company.
"When new therapies first come out, depending on how complex the delivery is—and I'll give it as an example: CAR T therapies or bispecific therapies—they are typically given through a research clinical trial or in a center where there's a high level of support," Wu explained during the 2025 Community Oncology Conference. "We're bringing that closer to home, so these therapies that originally required patients and their families to travel for and stay far away from home for not only days but maybe a month or 2 months, and that's a huge challenge."
Expanding Treatment Capabilities in Community Settings
The transition of complex therapies to community practices reflects increasing clinical capabilities and experience among local providers. Wu highlighted that patients can now receive these advanced treatments "in their community or within a shorter transportation time frame from their community," eliminating the significant burden of extended travel and accommodation costs for families.
Beyond cellular therapies, community practices are also expanding their precision medicine capabilities. "We're also seeing increasing capabilities in the delivery of precision medicine, so increased testing availability, understanding of the testing, education around it, so that patients can receive the right therapy at the right time through access to the testing," Wu noted.
Workforce Crisis Threatens Community Oncology Infrastructure
Despite these therapeutic advances, community oncology faces a critical workforce shortage that threatens its ability to deliver care. The COVID-19 pandemic significantly depleted healthcare personnel across multiple roles, affecting not just oncologists but also nurses, triage staff, and front- and back-office personnel.
"They are critical. It is a team that treats patients; it is not just one person," Wu emphasized, highlighting that rebuilding the infrastructure requires restoring the entire clinical team rather than focusing solely on physician recruitment.
Strategic Solutions for Workforce Development
Wu outlined several long-term strategies to address these workforce challenges. A key component involves expanding training exposure during oncology fellowships, as many fellows are trained exclusively in academic centers with limited visibility into community settings where most patients receive care.
The proposed solutions include integrating community-based rotations and partnerships between academic and community sites, allowing trainees to experience firsthand the rewards and challenges of community oncology. Wu also advocates for incentivizing rural and underserved placements through Medicare-supported residency or fellowship positions in oncology, similar to existing primary care incentives.
Empowering Advanced Practice Providers
A critical element of the workforce strategy involves better integration of advanced practice providers (APPs), who often enter oncology without specialized training. Wu suggests implementing dedicated onboarding programs and oncology-specific APP fellowships or certification programs to help integrate these providers more effectively into community teams.
Financial and Operational Challenges
Community oncology practices, particularly smaller operations with 2-3 clinicians, face significant financial pressures in implementing new technologies and therapies. "Being able to deliver the multiple levels of care, invest in the technology, and carry the cost of the therapies and their delivery are areas where those reimbursement challenges, to a degree, each year thinking about how it is going to be taken care of is a burden that sits on the practices," Wu explained.
These reimbursement challenges create ongoing uncertainty for practices that must balance the costs of advanced therapy delivery with sustainable operations. Wu noted that organizations like Navista and the Community Oncology Alliance are focused on supporting community practices through these financial pressures.
Ensuring Sustainable Cancer Care Access
Wu emphasized that community oncology will continue to be "a mainstay of the delivery of care" as the field advances, making support for these practices essential. The combination of expanding therapeutic capabilities and addressing workforce shortages represents a comprehensive approach to ensuring that cancer care remains accessible to the growing number of patients diagnosed each year.
As cancer care becomes increasingly complex, this team-based, forward-looking approach is essential to meet the demands of a changing patient population while maintaining the community-based care model that serves the majority of cancer patients in the United States.
