Oncology built its systems for treatment. The decades after treatment need an operating model of their own.
By Bushra Rana, CEO, Team Net Medical
Cancer care in the United States has reached a milestone. The American Cancer Society’s 2026 annual report shows that the five-year relative survival rate for all cancers combined has reached 70 percent, and about 2.1 million Americans are expected to receive a new cancer diagnosis this year. The most recent ACS survivorship estimate counts 18.6 million Americans living with a history of cancer, a number projected to pass 22 million by 2035. Nearly half of those survivors were diagnosed five or more years ago. Survivorship is now the longest phase of the cancer journey, and it is the phase with the least structured care.
Clinicians understand what is at stake. Late effects of radiation and systemic therapy, fear of recurrence, financial strain and the work of returning to normal life can last for decades. The field broadly agrees that these needs belong inside the cancer care continuum. Practice has lagged behind that agreement for operational reasons. Oncology workflows, staffing models and financial incentives were designed around active treatment. Survivorship has been added to that structure without being built into it.
For leaders of radiation and medical oncology programs, this is a management problem with a management solution.
A system built for throughput
In a typical week, an oncology practice takes in new consults, fast-progressing cases and treatment decisions that can’t wait. Institutions allocate resources based on throughput and time to treatment initiation. Those metrics are sound, and they measure what the system was designed to deliver.
Survivorship care competes for the same clinic hours, the same physicians and the same scheduling templates. When a schedule is already full of complex workups and high-acuity patients, the follow-up for a patient who finished treatment three years ago is the easiest visit to push. No single decision to put off that visit looks harmful. Across a whole patient population, those delays add up to a pattern of lost surveillance.
The economics push survivorship aside
The financial model adds to the scheduling pressure. Survivorship visits, especially psychosocial and supportive ones, carry low relative value units. They generate no technical charges, and they do not lead to simulation, IMRT planning or infusion. A department measured on linac utilization or chair throughput will reasonably put its capacity elsewhere.
Reimbursement has started to change. Medicare now pays for Principal Illness Navigation under codes G0023 and G0024, which carry into 2026 unchanged. These codes cover assessment, care coordination and health education for patients with a serious illness, and a cancer diagnosis qualifies. Few practices use them. In a recent Association of Community Cancer Centers survey, only 7 percent of responding practices had put the codes in place. Respondents cited patient coinsurance, staffing limits, unclear roles and trouble capturing time in the electronic health record.
That finding is telling. A payment pathway exists, and most programs have no workflow in place to use it. For most programs, the barrier is execution.
Where the risk sits
Leaders should assess the survivorship gap as they would any enterprise risk. Ranked by severity, the risk falls into four areas.
1. Clinical risk. Missed surveillance for cardiac, pulmonary and endocrine late effects, second cancers and recurrence has the most serious consequences for patients and the greatest liability for institutions.
2. Accreditation risk. Commission on Cancer Standard 4.8 requires accredited programs to offer a survivorship program for patients treated with curative intent. A program that exists on paper but runs inconsistently is exposed at survey.
3. Financial risk. Survivors who leave the system for follow-up take their future imaging, screening and recurrence care with them. Unused navigation codes may represent services the program already delivers without billing.
4. Reputational and referral risk. Patients, families and referring physicians judge a cancer program by the full experience. Survivors become its most visible long-term advocates or critics.
An operating model for survivorship
The programs making progress run survivorship as a service line with its own design. The most recent national benchmark from the Commission on Cancer, a survey of 384 accredited programs, found that most already deliver core services such as screening for new cancers and referrals for late effects. The same survey found that programs most wanted two resources. The first was advanced practice clinicians with survivorship expertise. The second was information technology that uses the EHR to support survivorship care. Those two needs point directly to the model.
Define the handoff. Set a clear clinical trigger for moving a patient from active treatment to survivorship. Pair it with a documented summary of the treatment received and a surveillance schedule.
Staff to the work. Assign survivorship visits to nurse practitioners and physician assistants under physician oversight. This protects physician time for new and complex patients and gives survivors a consistent point of contact.
Build it into the EHR. Automate surveillance reminders by diagnosis and treatment type. Add structured templates that capture navigation time so it can be documented and billed.
Capture the reimbursement that exists. Train navigators, social workers and nurses on Principal Illness Navigation requirements. Assign clear ownership for documentation and coding review.
Measure it. Track survivorship visit completion, surveillance adherence, navigation revenue and survivor retention. Report these measures to leadership alongside treatment volume.
A 12-month path for leadership
First 90 days. Audit the current survivorship population, visit completion rates and Standard 4.8 documentation. Identify the patients who are overdue for surveillance.
Months 4 to 6. Define the transition trigger and assign advanced practice staffing. Launch the EHR templates and navigation billing in one disease site.
Months 7 to 12. Expand to all disease sites and report a survivorship dashboard to executive leadership each quarter. Set targets for the following year.
The question for leaders
Oncology has become very good at carrying patients through treatment. The next test of a strong program is how well it cares for the millions of people who live for decades afterward. That depends on structure, staffing and incentives, and leadership controls all three. Survivorship will get the priority that leaders build into the system.
Sources
American Cancer Society, Annual Cancer Statistics Report 2026
American Cancer Society, Cancer Treatment and Survivorship Facts & Figures
American College of Surgeons Bulletin, Study Establishes Benchmark for Cancer Survivorship Services
Journal of Oncology Navigation & Survivorship, Navigation Refresh: Updates to Principal Illness Navigation Billing, May 2026
Bushra Rana is the CEO of Team Net Medical and has run healthcare companies for more than twenty years.
