2026 Advanced Therapies Report Details the Shift to Community-Based Care

The rapid evolution of advanced therapies like cell and gene therapies is reshaping the oncology landscape and challenging long-standing site-of-care models. Once limited to large academic centers due to safety concerns and logistical complexity, these therapies are now increasingly within reach for community oncology practices. Insights from the 2026 Advanced Therapies Report by Cardinal Health highlight a growing shift toward decentralizing care, with improved clinical confidence, operational infrastructure, and payer understanding helping to make this transition more feasible than ever before.

However, with only a fraction of eligible patients currently receiving these treatments, expanding access remains a pressing priority. In an interview with Targeted Oncology, Fran Gregory, PharmD, MBA, vice president of Emerging Therapies at Cardinal Health, outlines the key forces that have enabled this shift, as well as the core capabilities community practices must build to begin to safely and sustainably deliver advanced therapies.

Targeted Oncology: With strong momentum to move advanced therapies into community settings, what has fundamentally changed in the last few years to make this shift more realistic now vs a decade ago?

Fran Gregory, PharmD, MBA: I think the key thing is the safety and the clinical competency of what we've learned over the last 9 years with these treatments, and even before that in clinical trials, is really looking at the treatment and the safety profile. The adverse events [AEs] that occur after one of these advanced therapies are administered can be a little bit scary. I remember in 2017 evaluating some of these AEs and being a little unsure about the patient outcomes at that time, but over the years, we're so confident. Now we know exactly when cytokine release syndrome is going to happen; we know exactly when neurological toxicity might happen. We're very confident in the timelines at which those AEs occur, and we've made a lot of progress in monitoring devices that these patients can use at home. So, I think that is a really big shift that we've seen… Even the manufacturers, when they're launching these new treatments, are very focused on that range of time where the patient might experience these AEs, where we want to have a heightened, elevated awareness and monitoring of these patients to ensure that we're handling any safety events appropriately and as quickly as possible. So just the learning and the confidence and the clinical profiles of the drug, I think, is the big thing. And that's all due to real-world evidence collection and demonstrating the durability and safety of these profiles over time.

Secondly, I think the infrastructure and technology have matured quite a bit. Again, back in those early days, just the process of getting the treatments to the patients was an undertaking—the cryostorage of the treatments, the temperature control, the courier processes; some of those distribution components were challenging. I always kind of say we've mastered that. Now we're on to some of the more sophisticated challenges. EMR [electronic medical record] data, durability tracking, real-world data, outcomes tracking, and even looking at some of those…health economic outcomes are what we're more able to evaluate today. We've come a long way as far as what we're worried about with these treatments and that it was pretty simple back then; now it's more complex, and we're looking at much more impactful data points that we're able to evaluate the patient benefits from these treatments, as well as the overall health care and cost of care benefits from some of those durable treatments.

Finally, if we look at the economic and payer dynamics, these treatments are certainly much more well understood, and I wouldn't say easily covered by payers, but certainly payers now understand what these treatments are, and they understand the value of these treatments; they understand the health economic impact of these treatments. So, I think as an industry, we've come a long way as far as the clinical teams within the governing bodies that pay for these treatments…hav[ing] a much better understanding of the clinical benefit and the financial impact that these treatments bring to the table.

So, just a few pieces, but at the end of the day, I think patient access is what we all know we need to focus on. We've seen the outcomes. We've seen the durability. We've seen how these treatments change patients’ lives. I think at the end of the day, everyone in this industry that's familiar with these treatments knows that a patient who is a good candidate for this treatment should have the opportunity to receive the best treatment for their cancer type. One of the statistics that's always staggering to me is that only about 20% of patients who have a qualified indication for a CAR [chimeric antigen receptor] T-cell therapy actually receives that treatment. By expanding to community providers, and all of the other [points] I mentioned around some of the [challenges] that we've overcome as an industry, will help lead to improved patient access, and that's really what all of us want at the end of the day.

In the report, nearly half (48%) of community providers said it takes 1 to 2 years to prepare to administer advanced therapies.¹ What are the first 3 capabilities a practice must build to prepare?

I think the first thing is having a multidisciplinary clinical governance structure in place. We always do really, really well if we have a physician champion at the practice who really wants to get to the point of administering advanced therapies to their patients. So, I think that the first thing is having a champion and aligning that multidisciplinary team, developing your SOPs [standard operating procedures] for administration, and obviously managing those AEs and escalations of those AEs.

I think the second thing would be evaluation of an operational infrastructure. …I always say, with these treatments and cancer treatments, [for] any patient [with cancer], there's no room for error. You want to make sure that when there's an escalation, a patient's having an AE, operational steps are in place 100% of the time to get that patient the help that they need or the treatment that they need immediately. So, making sure that your after-hours triage and escalation pathways are in place; your formal hospital partnerships, those are critical. Formal hospital partnerships for those patients that might need escalated care in an expedited way that those are all set up and the patient knows what to do, the physicians at the hospital and the community provider know what to do in those situations… And then your care coordination and staffing rolls into your financials, so investing in a trained clinical staff to ensure that they know how to handle the patients. Another statistic here: 74% of survey respondents said they are investing in trained clinical staff to stand up an advanced therapy program. So clearly, not all of this exists today. It is an investment for some of these providers, and 66% of respondents said they were already invested or beginning to invest in this.

Finally, understanding the unique financials regarding reimbursement for these treatments, and the fact that there are different channels that you can leverage for those financial challenges in the short term and the near term. Specialty pharmacy is really coming into play in this space because of that. Some of these community providers may not necessarily be ready for that financial piece, but they have the clinical and the operational pieces in place, so specialty pharmacy can truly step in and help with that billing and reimbursement component, some of the clinical management and long-term follow up, and just shepherd that patient through the process and back to the clinician at the time that the patient needs follow-up care. So [there’s a] number of different ways that the providers can prepare and begin to think about advanced therapies.

I think one of the most resonating statements in the report that I absolutely can relate to—because we see this every day with the practices we work with—is that every practice is different, and there's not a one-size-fits-all approach at all. I think the comment was, learning from other practices is critical, and it truly can help accelerate the work that you're doing within your practice. So, don't reinvent the wheel if someone else has already figured it out; talk to your peers, talk to your colleagues, and learn from those that have already been through it and figured it out. I think that's really important. Everyone has gaps in their processes, or gaps in their day-to-day activities that maybe don't exactly match up with what is needed for an advanced therapy. But again, every practice is different and just identifying those gaps and finding solutions to those and then moving to the next one is what we try to focus on.

REFERENCES

1. 2026 Advanced Therapies Report. Cardinal Health. 2026. Accessed April 24, 2026. https://tinyurl.com/35rjhnpd

2. Cardinal Health report highlights growing momentum to expand advanced therapies into community care settings. News release. Cardinal Health. April 14, 2026. Accessed April 24, 2026. https://tinyurl.com/3rmfuc6p