Survival Benefit With Community Oncology Care Observed in COA Analysis

Early data from a new real-world evidence analysis conducted through a partnership between the Community Oncology Alliance (COA) and Flatiron Health indicate that patients with cancer treated in community oncology settings experienced prolonged survival across 2 tumor types, exceeding that of national benchmarks.¹

According to the analysis, which analyzed data from nearly 98,000 patients with metastatic breast cancer and metastatic non–small cell lung cancer (NSCLC) treated in community oncology settings, those treated in community settings saw a clear overall survival (OS) benefit compared with national benchmarks.

While the magnitude of benefit varied by tumor type, it remained directionally consistent. Patients with metastatic NSCLC who were treated at community oncology practices saw a 2-month improvement in survival relative to national benchmarks (median OS, 15 vs 13 months), while survival for patients with metastatic breast cancer receiving treatment in community settings exceeded the national benchmark by 8 months (median OS, 48 vs 40 months). Furthermore, survival rates at 1, 3, and 5 years were consistently higher among patients treated in community oncology settings relative to national benchmarks across both disease types.

The findings, presented at the 2026 Community Oncology Conference in Orlando, Florida, offer what researchers describe as the first comprehensive, real-world assessment of care quality in community oncology settings, adding to a growing body of evidence evaluating site-of-care differences and their potential implications for clinical decision-making, access, and health system costs.

“Where people receive cancer treatment matters. Community oncologists deliver care associated with longer survival, which means more time spent with family and friends,” said Debra Patt, MD, PhD, MBA, president of COA and executive vice president of policy and strategy at Texas Oncology, in a news release.² “Amidst an uncertain business and regulatory environment, community oncology must remain a viable option for patients who depend on it every day, in communities across the country.”

Study Methodology

The analysis examined electronic health record data from nearly 98,000 patients diagnosed with stage IV de novo metastatic breast cancer or metastatic NSCLC between January 2013 and December 2022 receiving care in over 220 community oncology practices within the Flatiron Health Research Network in the United States. These data were derived from the Flatiron Health Research Database (FHRD).

Outcomes were benchmarked against population-based estimates from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, which included a matched cohort of patients diagnosed with metastatic breast cancer or NSCLC within the same time period. Investigators used standardization techniques to ensure comparability between the 2 cohorts, including age, sex, race/ethnicity, and cancer subtype. Separate analyses were conducted for the overall cohorts as well as for the subset of patients in each cohort who received active treatment.

Assessing Site of Care Differences: Clinical Implications

These data offer a meaningful counterpoint to longstanding assumptions that academic or hospital-based settings inherently confer superior outcomes. The finding of a consistent OS advantage across both tumor types and across 1-, 3-, and 5-year landmark time points suggests that the benefit is not attributable to a single point in the treatment trajectory, but may reflect broader patterns of care quality and delivery in the community setting, including continuity of care, patient-provider relationships, and proximity to treatment.

Because the majority of patients in the United States with cancer receive treatment in community oncology settings, these findings carry particular relevance for policy discussions around site-of-care consolidation, reimbursement, and access. Ongoing pressures on independent community practices, including regulatory uncertainty and payer policy shifts, have raised concerns about whether patients may be displaced toward higher-cost, hospital-based settings without a corresponding clinical benefit.

Given the inherent limitations of retrospective databases such as SEER, causal inferences cannot be drawn from these data, and the possibility of residual confounding cannot be excluded. These early data represent the first phase of a multiyear collaboration between COA and Flatiron Health, and further data may expand upon the robustness of these observed patterns. According to COA, potential future analyses may be focused on additional disease states, average times to diagnosis and treatment, and community oncology’s patient-centered approach to care.

REFERENCES

1. Quality of Care. Community Oncology Alliance. April 28, 2026. Accessed April 28, 2026. https://tinyurl.com/azv79ybz

2. Community Oncology Alliance partner with Flatiron on study of cancer patients experience longer survival in community oncology settings. News release. Community Oncology Alliance. April 28, 2026. Accessed April 28, 2026. https://tinyurl.com/mw3pxmj6