For decades, oncology programs have measured success by volume, speed and five-year survival rates. Ten cancer leaders told Becker’s these benchmarks are increasingly disconnected from what matters most: timely, equitable access to evidence-based treatment and outcomes that reflect both survival and quality of life.
The contributors to this article will be speaking at Becker’s Oncology Executive Summit in Chicago. Learn how to join them here.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is one oncology metric health systems still celebrate that you believe is becoming less meaningful? What should replace it?
Maysa Abu-Khalaf, MD. Enterprise Director of the Women’s Cancer Center of Excellence and Chair of the Data and Safety Monitoring Committee at the Sidney Kimmel Comprehensive Cancer Center at Jefferson Health (Philadelphia): Oncology metrics for health systems usually focus on four primary pillars: clinical quality, operational efficiency, patient experience and financial performance. A key operational efficiency metric includes physician productivity which is measured by work relative value units per full-time equivalent. This includes the number of new or established patient visits per FTE and does not address the quality of care or account for the clinician’s time and effort outside of clinic hours. Compensation models which rely heavily on traditional volume-based metrics can neglect the time-intensive, non-clinical work necessary for high-quality care. This is especially relevant for the field of oncology, where multidisciplinary cancer care requires communication and coordination between care team members from various disciplines and extensive review of pathology and imaging outside of clinical hours.
An alternative model that is being considered is a value-based care model in oncology that shifts payment from volume-driven fee-for-service to models rewarding quality, patient outcomes, cost efficiency, reduced acute care visits and patient satisfaction rather than just the number of services. By keeping patients at the center of care, value-based care models promote a more personalized holistic cancer care, leading to increased patient satisfaction and engagement. Additionally, shifting away from traditional volume-based metrics models to a patient centered value-based care can improve provider well-being and reduce physician burnout.
A key barrier to the implementation of value-based care is the need for an investment in robust data infrastructure and analytics capabilities to collect, manage and analyze data capturing patient outcomes and tracking electronic patient reported outcomes. This type of investment and the level of administrative burden may not be feasible for smaller and rural practices. It may be an opportune time to leverage advanced artificial intelligence analytic tools that interface with electronic health records in collecting and analyzing this data.
Sachin Apte, MD. Chief Clinical Officer and Physician-in-Chief at Huntsman Cancer Institute (Salt Lake City): Although KPIs don’t necessarily define the totality of a cancer program’s success and impact, they can help organizations prioritize and focus on what’s most important. Access is clearly a critical metric for oncology patients. Cancer programs frequently use new patient access metrics such as third next available visit, fraction of patients seen within seven days or average time until next appointment. While these metrics can serve as indicators of access performance, such limited process measurements don’t account for the many potential downstream constraints that impact patients such as imaging, tissue diagnosis, treatment planning, etc. Rather than focusing on one-dimensional and potentially misleading access metrics, cancer programs should measure and analyze time from referral to guideline concordant treatment initiation. Taken together, this metric will capture all the other critical processes required prior to initiating high-quality treatment. Such a measure would help organizations understand performance for both efficiency and effectiveness. Patients want and need access to timely evidence-based care, so that’s what we should measure.
Dhruv Bansal, MD. Director of Immunotherapy and Thoracic Oncology at Endeavor Health (Evanston, Ill.): Currently, clinical trial activation counts and raw accrual numbers are commonly celebrated in oncology, but these metrics are becoming less meaningful on their own. They fail to reflect efficiency, equity and patient impact, and can obscure issues such as long activation timelines or narrow eligibility criteria that exclude real-world populations. Instead, a composite metric should be adopted that focuses on time-to-first patient-in, screen-failure rate, enrollment diversity and the relevance of trials to the population being treated. Assessing how quickly and equitably patients access trials — and whether the trials align with institutional disease prevalence — provides a more accurate measure of value for both patients and sponsors. The focus should shift from “how many trials opened?” to “how effectively do trials reach the patients who need them?”
Richard Barakat, MD. Physician-in-Chief and Executive Director at Northwell Health Cancer Institute (New Hyde Park, N.Y.): The five-year overall cancer survival rate is becoming a less meaningful standalone benchmark in oncology. The American Cancer Society recently reported an increase in five-year survival from 50% in the 1970s to the current level of 75%. This is largely due to advancements in screening and early detection efforts. While crucial for early intervention, these efforts can introduce lead-time bias and lead to the detection of indolent cancers that might never have progressed clinically or impacted a patient’s lifespan.
Furthermore, the metric does not differentiate between deaths from cancer and deaths with cancer, particularly problematic given the competing risks prevalent in an aging patient demographic. It also overlooks patient quality of life and treatment burden.
A more robust alternative is the cancer-specific mortality rate, which quantifies deaths directly attributable to the disease, thereby offering a clearer and more accurate measure of disease impact. For a truly holistic assessment, this should be complemented by patient-centered outcomes, for example, quality-adjusted life years. By shifting focus from simplistic survival percentages to more sophisticated metrics like cancer-specific mortality rate and incorporating patient-centered outcomes, health systems can gain a much more accurate and meaningful understanding of their impact on cancer patients and public health.
Frantz Berthaud. Senior Vice President of Oncology Services at University Medical Center of El Paso (Texas): Ironically, one metric we should explore relinquishing is the five-year survival rate. With the recent ACS data showing 1 in 7 people surviving beyond the five years, perhaps we need to consider other metrics that speak to current status. We’ve long celebrated this as a core performance metric, and while it is still useful, cancer is becoming more and more a chronic, long-term condition for many patients. Five-year survival tells us if a patient is alive at year five, but not whether they’re thriving, struggling, experiencing disabilities, financially devastated or burdened by long-term toxicities. We should probably look at risk-adjusted cancer-specific mortality with an emphasis on quality of life; we have to adopt the same “precision” as the medicine.
Natasha Carrera. Associate Director of Service Line Management at Fred Hutchinson Cancer Center (Seattle): Health systems still celebrate rising five-year survival rates, but this metric is increasingly misleading. It is distorted by earlier detection and overdiagnosis, often improving even when mortality does not meaningfully decline. A more honest measure of progress is stage-adjusted cancer-specific mortality, paired with patient-reported quality of survival — metrics that reflect whether patients are actually living longer and living well. (Editor’s note: These views are Ms. Carrera’s own.)
Arturo Loaiza-Bonilla, MD. System Chief of Hematology and Oncology at St. Luke’s University Health Network (Bethlehem, Pa.): One metric health systems still celebrate too much is raw volume — new patient visits, infusions delivered or procedures performed. Volume does not equate to value. What should replace it are outcome-adjusted, data-driven metrics: time to appropriate therapy, pathway concordance, avoidable acute care utilization and patient-reported outcomes over time. Modern analytics make it possible to measure what actually matters in real-world practice. In oncology, success should be defined by precision, timeliness, and durable outcomes, not throughput.
Ruben Mesa, MD. President of the Cancer National Service Line and Senior Vice President at Advocate Health (Charlotte, N.C.) and Executive Director of Atrium Health Wake Forest Baptist Comprehensive Cancer Center (Winston-Salem, N.C.): Defeating cancer is a team sport. I am so fortunate to work with an exceptionally talented team of cancer leaders across specialties and in the six states we serve, so I posed this question to our team as we have been contemplating these very topics.
One current metric commonly used for assessing the strength of demand in radiation oncology has been daily patients under treatment. However, tracking new patient treatments is a better measure that more effectively captures the evolution of the field. This is especially true with the increasing use of hypofractionation in standard treatments, as well as the growing utilization of SBRT, SRS, brachytherapy, radioligand therapy, gamma knife and proton beam therapy. The “uncounted” (or undercounted) items are currently drivers of revenue and increased labor needs, particularly in the nursing and provider space.
Additionally, the team feels we need to move to more patient impactful metrics that are not being well utilized. Continued emphasis on treatment volume as a primary oncology metric reflects quantity rather than quality and does not reliably capture value or impact on outcomes, especially as precision, multimodal and organ-preserving therapies mean that fewer treatments can often be better care.
Instead, we should focus on patient- centered, outcome-driven measures — such as time from “suspicion” of cancer to definitive intervention, rates of complication-free and functional recovery, equity-adjusted outcomes, patient-reported quality of life and metrics capturing financial toxicity, including visits, miles traveled, or days off work for patients and caregivers. We are evolving our efforts to pivot to metrics that truly measure value for both the patient and the health system.
Urshila Shah, PharmD. Chief Pharmacy Officer at Westchester Medical Center Health Network (Valhalla, N.Y): Time‑to‑treatment start is becoming less meaningful on its own. A more relevant measure is time‑to‑optimal treatment, which ensures biomarker results; financial authorization, supportive care, and medication readiness are aligned before therapy begins. Programs with integrated oncology and pharmacy leadership can coordinate these steps more reliably, shifting the focus from speed alone to appropriateness, safety, and equity.
Walter Stadler, MD. Chief Clinical Officer at City of Hope Chicago: Patient satisfaction scores are becoming increasingly difficult to interpret since most patients like their physician and most systems manage the process much the same way as other businesses manage online reviews. As such, most scores are “exceptional” with a smattering of poor scores that may or may not reflect important care aspects. The patient voice remains critical, but perhaps these ratings should come through patient support organizations.
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